Risk Factors for Fecal and Urinary Incontinence After Childbirth: The Childbirth and Pelvic Symptoms Study
Wednesday, 11 July 2007 - Anal sphincter tear at the time of vaginal delivery is a major cause of fecal incontinence (FI) in young women. Prior studies have demonstrated that the occurrence of a sphincter tear approximately doubles the risk of FI 6 months after delivery. Whereas sphincter tear is a strong risk factor for FI, only a minority of women who sustain sphincter tears report FI, possibly because of successful repair or other protective factors. Conversely, those who deliver vaginally without a tear, and even those who deliver by caesarean section prior to labour, are not completely protected from the development of new FI symptoms. Incident FI in such cases is presumably because of either occult lacerations or anatomic and/or physiologic changes that occur during pregnancy and delivery. Thus, sphincter tear is not inevitably coupled with FI and it is important to understand other variables that may increase the risk of FI associated with vaginal delivery. The Childbirth and Pelvic Symptoms (CAPS) study was performed by the Pelvic Floor Disorders Network (PFDN). Previously it was reported that in a cohort of primiparous women participating in the CAPS study, FI symptoms were significantly more common after vaginal delivery with anal sphincter tear than after vaginal delivery without sphincter tear or after cesarean delivery prior to labor (17%, 8%, and 8%, respectively). However, urinary incontinence (UI) symptoms were not significantly different across the three groups, affecting 22–34% of women 6 months postpartum. The objective of this secondary analysis of data from the CAPS study was to determine which women were at highest risk for FI and UI 6 months postpartum, and whether any maternal or obstetrical characteristics modify the effect of sphincter tear. Through this research Briganti et al. (2007) identified characteristics of women for whom interventions to prevent or ameliorate symptoms might be indicated.
Of the 921 women who participated in the CAPS study, 759 (82%) completed interviews at 6 months: 335 in the sphincter tear group, 319 in the vaginal control group, and 105 in the cesarean control group. The analysis is based on data from the 759 women who completed the 6-month interview. FI was assessed using the FISI and UI using the Medical, Epidemiological, and Social Aspects of Aging Questionnaire. FI risk factor analyses were conducted within each group, because of higher prevalence in the tear group. UI analyses were conducted with the groups combined. It was found that in women with sphincter tears, FI at 6 months was associated with white race (OR 6.1, 95% CI1.3–29.4), antenatal UI (OR 2.2, CI 1.1–4.3), 4th versus 3rd degree tear (OR 2.0, CI 1.0–4.0), older age at delivery (OR 1.6 per 5 yr, CI 1.2–2.1), and higher body mass index (BMI) (OR 1.3 per 5 kg/m2, CI 1.0–1.7). No factors were associated with FI in the vaginal or cesarean control groups. Across all groups, risk factors for postpartum UI were antenatal UI (OR 3.5, CI 2.4–5.2), less education (OR 2.0, CI 1.4–2.8), and higher BMI (OR 1.2 per 5 kg/m2, CI 1.1–1.4); cesarean delivery was protective (OR 0.5, CI 0.3–0.9).
As conclusion, postpartum FI and UI are associated with few modifiable risk factors. However, the presence of antenatal UI and high BMI may help clinicians target at-risk women for early intervention.
Burgio, K. L., Borello-France, D., Richter, H. E., Fitzgerald, M. P., Whitehead, W., Handa, V. L., Nygaard, I., Fine, P., Zyczynski, H., Visco, A. G., Brown, M. B., & Weber, A. M. (2007). Risk Factors for Fecal and Urinary Incontinence After Childbirth: The Childbirth and Pelvic Symptoms Study. The American Journal of Gastroenterology, doi: 10.1111/j.1572-0241.2007.01364.x.