Incidence and Predictors of Anal Incontinence After Obstetric Anal Sphincter Injury in Primiparous Women

Richter HE1, Nager CW, Burgio KL, Whitworth R, Weidner AC, Schaffer J, Zyczynski HM, Norton P, Jelovsek JE, Meikle SF, Spino C, Gantz M, Graziano S, Brubaker L; for the NICHD Pelvic Floor Disorders Network. Female Pelvic Med Reconstr Surg. 2015 Jan 21. [Epub ahead of print]
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1From the *Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL; †Department of Obstetrics and Gynecology, University of California San Diego, San Diego, CA; ‡Deparment of Gerontology, Geriatrics and Pallative Care, Veterans Administration GRECC, Birmingham, AL; §Research Triangle Institute, Research Triangle Park; ∥Department of Obstetrics and Gynecology, Duke University, Durham, NC; ¶Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX; **Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA; ††Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT; ‡‡Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH; §§Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; ∥∥Department of Biostatistics, University of Michigan, Ann Arbor, MI; and ¶¶Department of Obstetrics and Gynecology, Loyola University Chicago, Chicago, IL.


OBJECTIVE: This study aimed to describe the incidence of fecal incontinence (FI) at 6, 12, and 24 weeks postpartum; anal incontinence (AI) and fecal urgency at 24 weeks; and identify predictors of AI in women with obstetric anal sphincter injury (OASI).

METHODS: Primiparous women sustaining OASIs were identified at 8 clinical sites. Third-degree OASIs were characterized using World Health Organization criteria, 3a (<50%) or 3b (>50%) tear through the sphincter. Fecal incontinence was defined as leakage of liquid/solid stool and/or mucus in the past month; AI was defined as leakage of liquid/solid stool and/or mucus and/or gas in the past month and was assessed at 6, 12, and 24 weeks postpartum using the Fecal Incontinence Severity Index. Logistic regression identified variables associated with AI.

RESULTS: Three hundred forty-three women participated: 297 subjects sustained a third-degree OASI, 168 type 3a, 98 type 3b and 31 indeterminant; 45 had a fourth-degree OASI. Overall FI incidence at 6, 12, and 24 weeks was 7% [23/326; 95% confidence interval (CI), 4%-10%], 4% (6/145; 95% CI, 2%-9%), and 9% (13/138; 95% CI, 5%-16%), respectively. At 24 weeks, AI incidence was 24% (95% CI, 17%-32%) and fecal urgency 21% (95% CI, 15%-29%). No significant differences in FI and AI rates were noted by third-degree type or between groups with third and fourth OASI. Flatal incontinence was greater in women sustaining a fourth-degree tear (35% vs 16%, P = 0.04). White race (adjusted odds ratio, 4.64; 95% CI, 1.35-16.02) and shorter duration of second stage (adjusted odds ratio, 1.47 per 30 minute decrease; 95% CI, 1.12-1.92) were associated with AI at 24 weeks.

CONCLUSIONS: Overall 24-week incidence of FI is 9% (95% CI, 5%-16%) and AI is 24% (95% CI, 17%-32%). In women with OASI, white race and shorter second-stage labor were associated with postpartum AI.Clinical Trial Registration: NCT01166399 (http://clinicaltrials.gov).

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