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Does Cesarean Delivery Prevent Anal Incontinence?

Lal, Mira MD, MRCOG; Mann, Christopher H. MRCOG, MD; Callender, Roger FRCOG; Radley, Simon FRCS, MD

Original Research

OBJECTIVE: To compare the incidence and severity of anal incontinence in primiparas after cesarean delivery versus spontaneous vaginal delivery.

METHODS: A total of 184 primiparas who delivered by cesarean (104 emergency, 80 elective) and 100 who delivered vaginally were interviewed 10 ± 2 months postpartum. A comprehensive bowel function questionnaire was completed. Bowel-specific questions included bowel habits, laxative use, urgency, flatus, urge and passive incontinence, soiling, and pad use, before and during pregnancy and postpartum. Obstetric details were confirmed from obstetric records.

RESULTS: Anal incontinence was first present in nine (5%) mothers after cesarean delivery and eight (8%) after vaginal delivery (relative risk 0.611, 95% confidence interval 0.25, 1.53). Severe symptoms necessitating pad use affected two (3%) mothers after elective cesarean and one (1%) after vaginal delivery. Two (3%) mothers after elective cesarean, one (1%) after emergency cesarean, and two (2%) after vaginal delivery had at least two symptoms. Anal incontinence followed prelabor emergency cesarean in two mothers. Of the 22 mothers who sustained a second-degree tear, five (23%) had new anal incontinence compared with only one (3%) of 40 mothers with an intact perineum (Fisher exact test value = 9.697, P = .014).

CONCLUSION: Because severe anal incontinence followed elective and prelabor emergency cesarean, it seems that pregnancy itself can lead to pelvic floor disorders. A high incidence of anal incontinence is associated with a second-degree tear. Measures to detect and reduce postpartum anal incontinence should target all pregnant women and mothers, even after prelabor cesarean delivery.

Previously healthy primiparas can have severe anal incontinence after elective or prelabor cesarean delivery.

Department of Obstetrics and Gynecology, Wordsley Hospital, Dudley Group of Hospitals, National Health Service Trust, Stourbridge, West Midlands; Department of Obstetrics and Gynecology, Queen Elizabeth Hospital, Birmingham; and Department of Surgery, University of Birmingham, Birmingham, United Kingdom.

Address reprint requests to: Mira Lal, MD, MRCOG, Department of Obstetrics and Gynecology, Wordsley Hospital, Stream Road, Stourbridge, West Midlands, DY8 5QX, United Kingdom; E-mail: mira@miralal.freeserve.co.uk.

Department work should be attributed to Department of Obstetrics and Gynecology, Wordsley Hospital, Dudley Group of Hospitals, National Health Service Trust, Stourbridge, and Department of Surgery, University of Birmingham.

Received June 13, 2002. Received in revised form July 24, 2002. Accepted August 1, 2002.

© 2003 The American College of Obstetricians and Gynecologists