Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study

Johannessen, Hege Hølmo; Wibe, Arne; Stordahl, Arvid; Sandvik, Leiv; Backe, Bjørn; Mørkved, Siv

doi:10.1111/1471-0528.12438

Cited by 53 publications

(71 citation statements)

References 30 publications

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“…27,29 Thus the findings in this study may suggest that the complexity of maintaining continence and the embarrassment/ stigma of being unable to control one's bowels may result in AI affecting several QoL domains, and 'Depression' in particular. Based on previous reports that AI during preg- nancy is one of the main predictors of postpartum AI 5,17 , early intervention and information may possibly aid in reducing and preventing postpartum AI.…”

Section: Discussionmentioning

confidence: 99%

“…17 The main reason for choosing primiparous women as our study population was that we wanted a homogeneous study population with no previous deliveries. A pilot study was conducted from May to August 2009, and a cross-sectional study was undertaken between September 2009 and December 2010.…”

Section: Methodsmentioning

confidence: 99%

“…[10][11][12][13][14][15] Previous findings indicate that nearly 30-50% of pregnant women experience AI in late pregnancy; however, the prevalence of AI is markedly reduced 6-12 months after delivery. 10,13,16,17 Due to the complexity of maintaining continence, it is suggested that the individual perception and experience of AI may contribute more to the impact on QoL than the objective severity of AI. Hence obtaining measures of conditionspecific Health Related QoL as well as the severity of a patient's incontinence problems is recommended.…”

Section: Introductionmentioning

confidence: 99%

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Anal incontinence and Quality of Life in late pregnancy: a cross‐sectional study

Johannessen

Mørkved

Stordahl

et al. 2014

BJOG

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Objective To evaluate the association between different types of anal incontinence (AI) and Quality of Life (QoL) in late pregnancy.Design Cross-sectional study.Setting Two maternity units in Norway 2009-2010.Population Primiparae aged 18 or over.Methods Participants answered questions about AI during the last 4 weeks of pregnancy on the St. Mark's score and impact of QoL in the Fecal Incontinence QoL score. Socioeconomic data were obtained from hospital records.Main outcome measures Self-reported AI and impact on QoL.Results 1571 primiparae responded; 573 (37%) had experienced AI during the last 4 weeks of pregnancy. One third of the incontinent women reported reduced QoL in the domain 'Coping'. 'Women experiencing urgency alone reported markedly better QoL compared to any other AI symptoms. AI appeared to have the strongest impact on the domains 'Coping' and 'Embarrassment'. Depression was only associated with experiencing the combination of all three symptoms [odds ratio (OR) 13; 95%confidence interval (CI) 3.2-51]. Experiencing flatus alone weekly or more was associated with the highest impact on 'Embarrassment' (OR 20; 95%CI 6.4-61) compared with all other symptoms or combination of AI symptoms, except the combination of all three AI symptoms.Conclusions Between 3 and 10% of the primiparae in this material experienced AI to such a extent that it affected QoL. The greatest impact was seen in the QoL domain 'Coping'. These findings highlight the importance of an increased awareness of AI in late pregnancy among health professionals and the need to implement routine discussions about AI with expectant and new mothers.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anal incontinence and Quality of Life in late pregnancy: a cross‐sectional study

Johannessen

Mørkved

Stordahl

et al. 2014

BJOG

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“…The study population consisted of parous Norwegian-speaking women over the age of 18 who reported AI on inclusion (fecal incontinence monthly or more often or St. Mark's score ≥3 points). 10 The study included women with and without obstetrical anal sphincter injury (OASI) and primary sphincter repair. Exclusion criteria were inadequate Norwegian language skills, neurological conditions such as multiple sclerosis and polio, women already receiving PFME treatment before inclusion due to severe postpartum AI or pelvic floor dysfunction, PFM pain/dysfunction, secondary sphincter repair, and being unable to attend treatment and follow up at the nearest available anorectal out-patient clinic or community pelvic floor physiotherapist.…”

Section: Methodsmentioning

confidence: 99%

“…AI was defined as reporting incontinence of stool monthly or more, incontinence of flatus weekly or more, or combinations of two or more incontinence symptoms including fecal urgency on the St. Mark's score. 10,13 Based on the previously documented correlation between the St. Mark's score and patients' subjective improvement following PFME for AI symptoms, a reduction of 2 points or more on the St. Mark's score was considered clinically relevant in this sample of young, healthy women. 11 At Øst-fold Hospital Trust, two-dimensional (2D) and threedimensional EAUS was performed in a side-lying position using a B-K Medical â EAUS machine type 2050 with a 360°probe (B-K Medical Aps, Denmark).…”

Section: Clinical Assessmentsmentioning

confidence: 99%

Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial

Johannessen

Wibe

Stordahl

et al. 2016

BJOG

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Objective To evaluate the effect of pelvic floor muscle exercises (PFME) for postpartum anal incontinence (AI).Design A parallel two-armed randomised controlled trial stratified on obstetrical anal sphincter injury with primary sphincter repair and hospital affinity.Setting Ano-rectal specialist out-patient clinics at two hospitals in Norway.Population One hundred and nine postpartum women with AI at baseline. MethodsThe intervention group received 6 months of individual physiotherapy-led PFME and the control group written information on PFME. Changes in St. Mark's scores and predictors of post-intervention AI were assessed by independent samples t-tests and multiple linear regression analyses, respectively. The study was not blind.Main outcome measures The primary outcome measure was change in AI symptoms on the St. Mark's score from baseline to post-intervention. Secondary outcome measures were manometry measures of anal sphincter length and strength, endoanal ultrasound (EAUS) defect score and voluntary pelvic floor muscle contraction.Results There was a significant difference in the reduction of St. Mark's scores from baseline to post-intervention in favour of the PFME group (À2.1 versus À0.8 points, P = 0.040). No differences in secondary outcome measures were found between groups. Baseline St. Mark's, PFME group affinity and EAUS defect score predicted post-intervention St. Mark's score in the imputed intention-to-treat analyses. The analysis on unimputed data showed that women performing weekly PFME improved their AI scores more than women in the control group did.Conclusions Our results indicate that individually adapted PFME reduces postpartum AI symptoms.

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Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women

Woodley

Boyle

Cody

et al. 2017

Cochrane Database of Systematic Reviews

212

144

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Targeting continent antenatal women early in pregnancy and offering a structured PFMT programme may prevent the onset of urinary incontinence in late pregnancy and postpartum. However, the cost-effectiveness of this is unknown. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on urinary incontinence, although the reasons for this are unclear. It is uncertain whether a population-based approach for delivering postnatal PFMT is effective in reducing urinary incontinence. Uncertainty surrounds the effects of PFMT as a treatment for urinary incontinence in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women.It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches and in certain groups of women. Hypothetically, for instance, women with a high body mass index are at risk factor for urinary incontinence. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups and how much PFMT women in both groups do, to increase understanding of what works and for whom.Few data exist on faecal incontinence or costs and it is important that both are included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence.

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Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study

Cited by 53 publications

References 30 publications

Anal incontinence and Quality of Life in late pregnancy: a cross‐sectional study

Anal incontinence and Quality of Life in late pregnancy: a cross‐sectional study

Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomised controlled trial

Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women

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