Anal incontinence among first time mothers - What happens in pregnancy and the first year after delivery?

作者：Johannessen Hege Holmo^*; Wibe Arne; Stordahl Arvid; Sandvik Leiv; Morkved Siv

来源：Acta Obstetricia et Gynecologica Scandinavica, 2015, 94(9): 1005-1013.

DOI：10.1111/aogs.12689

• Anal incontinence
• postpartum
• pregnancy

IntroductionPregnancy- and delivery-related factors affect postpartum anal incontinence. We aimed to explore changes in continence status among primiparas from late pregnancy through the first year postpartum.
Material and methodsIn this prospective cohort study set in two Norwegian hospitals, 862 healthy primiparas completed questionnaires about the main outcome measure anal incontinence, including flatus incontinence and urgency, at three time points; late pregnancy, 6 and 12months postpartum. Socioeconomic and delivery-related data were obtained from hospital records. Logistic regression analyses were applied to determine the association between continence status at 12months postpartum, and continence status in late pregnancy, 6months postpartum, demographic and delivery-related characteristics.
ResultsAmong the 189 (22%) primiparas reporting anal incontinence in late pregnancy, 34 (18%) had persistent anal incontinence 1year later. Forty-eight (43%) of the 113 women incontinent at 6months postpartum experienced persistent anal incontinence at 12months. Eight percent of previously continent women reported new onset anal incontinence at 6 and 12months after delivery. Occipitoposterior presentation was the only delivery-related factor increasing the risk of postpartum anal incontinence [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.0-3.4]. Young age increased the risk of anal incontinence at 1year after delivery, whereas incontinence in late pregnancy increased the risk of anal incontinence persisting through 6 and 12months postpartum.
ConclusionIn most first-time mothers with postpartum anal incontinence, the onset of anal incontinence was before delivery. Except for occipitoposterior presentation, no delivery-related factors increased the risk of postpartum anal incontinence. This may indicate that hormonal, mechanical or neuromuscular changes in pregnancy affect long-term anal incontinence more than vaginal delivery.

• 出版日期2015-9