Abstract

Fecal incontinence and associated pelvic floor dysfunction during and one year after the first pregnancy

Acta Obstet Gynecol Scand.?2023 Jun 20.?doi: 10.1111/aogs.14614.?Online ahead of print. 

 

Markus Harry Jansson?1?2?3,?Karin Franzén?2,?Gunilla Tegerstedt?4,?Jan Brynhildsen?1?2,?Ayako Hiyoshi?5,?Kerstin Nilsson?2 

 
     

Author information

1Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. 

2School of Medical Sciences, Faculty of Health and Medicine, Örebro University, Örebro, Sweden. 

3Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden. 

4Unit of Obstetrics and Gynecology, CLINTEC, Karolinska University Hospital at Huddinge, Karolinska Institute, Stockholm, Sweden. 

5Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. 

Abstract

Introduction:?Obstetric anal sphincter injury is an important risk factor for postpartum fecal incontinence but few studies have reported fecal incontinence occurring, even during pregnancy. The first objective of this study was to examine the prevalence of fecal incontinence, obstructed defecation and vaginal bulging early and late in pregnancy and postpartum. The second objective was to assess the association between symptoms in pregnancy, delivery characteristics, and bowel and vaginal bulging symptoms at 1 year postpartum. 

Material and methods:?This prospective cohort study was conducted between October 2014 and October 2017, including 898 nulliparous women enrolled with the maternity healthcare service in Örebro County, Sweden. The women responded to questionnaires regarding pelvic floor dysfunction in early and late pregnancy and at 8 weeks and 1 year postpartum. The data were analyzed using random effect logistic models estimating odds ratios (ORs) and generalized linear models estimating relative risks, with 95% confidence intervals (CIs). 

Results:?At 1 year postpartum, the prevalence of fecal incontinence, obstructed defecation and vaginal bulging was 6% (40/694), 28% (197/699) and 8% (56/695), respectively. Among women with vaginal delivery, the risk of fecal incontinence and vaginal bulging increased significantly both in late pregnancy, with ORs of 3.4 (95% CI 1.5-7.7) and 3.6 (95% CI 1.6-8.1), respectively, and at 1 year postpartum, with ORs of 5.0 (95% CI 2.1-11.5) and 8.3 (95% CI 3.8-18.1), respectively, compared with early pregnancy. Among all women, factors associated with increased prevalence of fecal incontinence 1 year postpartum were fecal incontinence during pregnancy (adjusted relative risk [aRR] 7.4; 95% CI 4.1-13.3), obstructed defecation during pregnancy (aRR 2.0; 95% CI 1.1-3.9) and concurrent obstructed defecation (aRR 2.4; 95% CI 1.3-4.5). 

Conclusions:?This prospective study shows an increased risk of fecal incontinence by late pregnancy, suggesting that the pregnancy itself may be involved in the development of postpartum fecal incontinence. Obstructed defecation during pregnancy and postpartum was found to be associated with increased risk of fecal incontinence postpartum, indicating that postpartum fecal incontinence may be a result of incomplete bowel emptying. 

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