Objective: To investigate the prevalence of and factors associated with fecal incontinence and its precursors amongst high-risk women at 12 months postpartum. Method: A survey of women in the immediate and later postpartum was conducted. Participants were 568 women at higher risk of anal sphincter damage, namely those who had an instrumental delivery and/or delivered a high birth weight baby (≥4000g) in the postpartum wards of three tertiary teaching hospitals in the Hunter Region, NSW, Australia. Women participated in a baseline hospital-based interview and a 12-month follow-up telephone interview. The main outcome measures were frank fecal incontinence (solid and/or liquid stool) and precursor symptoms (flatal incontinence, soiling and/or fecal urgency) at 12-months postpartum. Results: The prevalence of fecal incontinence was 6.9% (2.6% solid stool; 4.9% liquid stool). The prevalence of precursor symptoms was 32.4% (24.4% flatal incontinence; 10.9% soiling; 14.8% fecal urgency). Concurrent urinary incontinence and postpartum constipation were significantly associated with both frank fecal incontinence and precursor symptoms. In addition, joint hypermobility and older maternal age were associated with frank fecal incontinence, while inability to stop the urine flow and multiparity was associated with precursor symptoms. Conclusions: The present findings suggest that older and multiparous women, and women with joint hypermobility, are at increased risk of postpartum anal incontinence symptoms following a high-risk delivery. Concurrent urinary incontinence, constipation and flow stopping inability are also associated with postpartum anal incontinence symptoms following high-risk deliveries.
Obstetrics and Gynecology Vol. 102, Issue 6, p. 1299-1305