[Fecal incontinence: prevalence and role of rupture of the anal sphincter during delivery; literature analysis]

Abstract

Objective: To obtain insight regarding the prevalence of faecal incontinence according to age and sex and the influence of an anal sphincter rupture during vaginal delivery on its development.

Method: Literature search in Medline (1966-May 1998), Huisarts en Wetenschap (1972-1997) and Nederlands Tijdschrift voor Geneeskunde (1986-1997).

Results: The prevalence of faecal incontinence was 0.75-2.2% of the adult population, increasing to 2.8-9% at the age of 65 years and older. Among people aged 85 years and older and those living in homes for the aged, the prevalence was much higher (up to 16.7%). There was no clear difference between the sexes, but dependable research on sex differences at a younger age did not exist. There was a significantly higher risk of developing faecal incontinence after an intrapartum anal sphincter rupture, compared to women without an anal sphincter rupture. This difference persisted until 30 years postpartum, but disappeared afterwards. A possible explanation is a persistent anal sphincter defect, despite surgical repair immediately postpartum. Decreased innervation of the sphincter may also play a role.

Conclusion: Faecal incontinence is a frequent problem, especially in the elderly. There is no clear sex difference in prevalence. In younger women, there is a higher risk of developing faecal incontinence after an anal sphincter rupture during a vaginal delivery. This is probably due to a persistent sphincter defect in combination with decreased innervation of the sphincter.