Pregnant women commonly experience fecal incontinence

Last Updated: 2015-11-16

By Will Boggs MD

NEW YORK (Reuters Health) - Fecal incontinence is a common cause of reduced quality of life among pregnant women, researchers from Spain report.

Two earlier studies suggested that between 3% and 10% of pregnant women experience fecal incontinence that affected quality of life and led to associated depressive symptoms.

Dr. David Pares and colleagues from the University of Barcelona investigated the incidence and severity of fecal incontinence during the first and third trimesters of pregnancy and evaluated its impact on quality of life in a cross-sectional study of 228 pregnant women, 121 of them nulliparous.

Overall, 40.8% reported some episode of fecal incontinence, including accidents of solid stools (15 women), liquid stools (six women) and flatus (72 women). As a result of these problems, 5.2% of women used a pad on a daily basis.

Quality of life subscales of bodily pain, general health, vitality, role-emotional, and mental health were significantly lower in women with symptoms of fecal incontinence than in women without these symptoms.

The researchers found no significant differences in age, body mass index, history of previous deliveries, or trimester of pregnancy between women with and without fecal incontinence, according to the November Diseases of the Colon & Rectum report.

Fecal incontinence was reported more commonly in the third trimester (42.6%) than in the first trimester (35.6%), but the difference fell short of statistical significance.

"It has been suggested that relaxin, a hormone that is produced in the first trimester by the corpus luteum, causes depolymerization of the intermolecular and intramolecular collagen bonds participating in the genesis of (urinary incontinence)," the researchers explain.

"Thus, stress urinary incontinence is explained by loosening of the collagen within the pubourethral ligaments. We believe that these findings contribute to a greater understanding of the development of fecal incontinence in this group of patients, because our hypothesis is that similar consequences may influence the function of the perineal body and urogenital diaphragm, as well as rectovaginal septum consistency. Therefore, an ongoing study has been designed to investigate this hypothesis," they concluded.

Dr. Hege Holmo Johannessen, Specialist Physiotherapist at Ostfold Hospital Trust, Fredrikstad, Norway, who recently reported on anal incontinence among first-time mothers (http://bit.ly/1N6RURA), told Reuters Health by email, "Anal incontinence is quite common among pregnant women due to the possible impact of hormonal, mechanical, and neuromuscular changes naturally occurring in pregnancy. Based on previous reports, anal incontinence in pregnancy is one of the main predictors of postpartum anal incontinence, and some studies suggest that the pregnancy-related factors such as age, hormonal, mechanical, and neuromuscular changes and incontinence symptoms in pregnancy have a greater impact on postpartum anal incontinence symptoms than delivery-related factors such as obstetric anal sphincter injuries."

"I think that the most important thing that can be done in order to reduce anal incontinence in pregnancy and postpartum is to increase awareness among health professionals advising pregnant women, general practitioners, gynecologists, obstetricians, midwives, and physiotherapists, to name a few, that anal incontinence is quite a common problem among young, healthy pregnant women," she said. "Few will disclose these problems unless asked directly, and these symptoms may be reduced or even cured by referring those who report experiencing anal incontinence symptoms for pelvic floor muscle training before or after delivery."

"Most women experiencing this in pregnancy or in the early postpartum phase will be continent within one year after delivery," Dr. Johannessen said.

Dr. Pares did not respond to a request for comments.

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/1MxlOsF

Dis Colon Rectum 2015.