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Evolution and risk factors of anal incontinence during the first 6 years after first delivery: a prospective cohort study
Author(s) -
Johannessen HH,
Mørkved S,
Stordahl A,
Wibe A,
Falk RS
Publication year - 2020
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.16322
Subject(s) - medicine , pregnancy , obstetrics , vaginal delivery , prospective cohort study , caesarean section , childbirth , postpartum period , poisson regression , population , gynecology , cohort study , cohort , surgery , genetics , environmental health , biology
Objective To explore changes in prevalence of anal incontinence (AI) from late first pregnancy to 6 years postpartum, and to evaluate possible risk factors for changes in AI during the 6‐year period. Design Prospective longitudinal cohort study. Setting Two Norwegian health regions. Population or sample Women with first deliveries between May 2009 and December 2010. Methods Participants reported AI in late pregnancy, 6 months, 1 and 6 years after first delivery using postal or digital questionnaires. AI prevalence was calculated, and mixed effects Poisson regression analyses with robust variance were applied. Main outcome measures AI from late pregnancy to 6 years postpartum. Results Among 1571 participants, 65% had normal vaginal first deliveries, 20% had vaginal deliveries complicated by instrumental intervention and/or obstetric anal sphincter injury (IVD ± OASIS). Nearly 1 in 10 women reported persistent incontinence during the 6 years. The overall AI prevalence was reduced from late pregnancy to 1 year postpartum for all modes of delivery. At 6 years postpartum, women with IVD ± OASIS had a higher AI prevalence (23%; 95% CI 16–30%) compared with women with caesarean section (8%; 95% CI 2–13%) or normal vaginal delivery (12%; 95% CI 9–16%). Moreover, women who were <23 years, ≥34 years, unemployed during first pregnancy, who had active bowel disease (PR: 2.4; 95% CI 2.0–2.7), or bowel evacuation problems during the 6‐year period had higher AI prevalence. Conclusions Mode of first delivery modified AI prevalence during the 6‐year period, whereas age, bowel disease and bowel evacuation problems were associated with higher prevalence of AI from late first pregnancy to 6 years postpartum. Tweetable abstract Complicated vaginal delivery, age and bowel emptying problems increase the risk of long‐term anal incontinence.