Anal incontinence after vaginal delivery or cesarean section

Abstract

Women with vaginal deliveries complicated by OASIS are at increased risk of anal incontinence. However, no increased risk of anal incontinence was found in nulliparous women or women who had cesarean sections only or vaginal deliveries not complicated by OASIS.

Economic evaluation of elective cesarean versus vaginal delivery on cost of future pelvic floor disorders in the United States

“…We sought to identify the presence of SUI or POP as measured by validated questionnaires and/or pelvic exam. Anal incontinence was excluded from the model, as rates of this condition are very low after both modes of delivery, and have not been found to be significantly lower after cesarean delivery 20–22 . Cohort studies that provided prevalence to allow for attributable risk calculations for specific mode of delivery were summarized and the results were averaged.…”

Evolution and risk factors of anal incontinence during the first 6 years after first delivery: a prospective cohort study

“…Previous studies indicate that, compared with vaginal delivery, caesarean section does not preserve postpartum anal continence. 8,24 Estimates show that to avoid one case of AI, 18 caesarean sections need to be performed. 12 However, women with vaginal deliveries complicated by OASIS have increased risk of AI compared with women with caesarean section or vaginal delivery without OASIS.…”

“…12 However, women with vaginal deliveries complicated by OASIS have increased risk of AI compared with women with caesarean section or vaginal delivery without OASIS. 8,12 Moreover, women with tears involving the internal anal sphincter muscle or anal mucosa (fourth degree tears) have a higher risk of AI and FI than do women with tears involving only the external anal sphincter muscle. 6,25 The role of instrumental delivery in development of postpartum AI is unclear.…”

“…3,4 Vaginal deliveries complicated by abnormal presentation of the fetus, obstetric anal sphincter injuries (OASIS) and/or instrumental delivery, and forceps deliveries in particular, are obstetric factors found to increase the risk of short-and long-term postpartum AI. [5][6][7][8][9][10] However, there is conflicting evidence on how different modes of delivery affect the development of postpartum incontinence and whether elective caesarean delivery may reduce the risk of subsequent incontinence. 8,9,11,12 Moreover, a recent systematic review concluded that there is limited evidence on longterm quality of life among women who experience postpartum AI or undergo subsequent deliveries after sustaining OASIS.…”

“…[5][6][7][8][9][10] However, there is conflicting evidence on how different modes of delivery affect the development of postpartum incontinence and whether elective caesarean delivery may reduce the risk of subsequent incontinence. 8,9,11,12 Moreover, a recent systematic review concluded that there is limited evidence on longterm quality of life among women who experience postpartum AI or undergo subsequent deliveries after sustaining OASIS. 13 Non-obstetric factors associated with an increased risk of long-term AI include adverse general health 14,15 and active bowel disease involving diarrhoea or constipation.…”