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Comparative Study
. 2008 Mar;115(4):421-34.
doi: 10.1111/j.1471-0528.2007.01553.x.

Does the mode of delivery predispose women to anal incontinence in the first year postpartum? A comparative systematic review

S J Pretlove  1 , P J Thompson, P M Toozs-Hobson, S Radley, K S Khan
Affiliations
Comparative Study

Does the mode of delivery predispose women to anal incontinence in the first year postpartum? A comparative systematic review

S J Pretlove et al. BJOG. 2008 Mar.

Erratum in

  • BJOG. 2010 Sep;117(10):1307-8

Abstract

Objectives: To assess if mode of delivery is associated with increased symptoms of anal incontinence following childbirth.

Design: Systematic review of all relevant studies in English.

Data sources: Medline, Embase, Cochrane Library, bibliographies of retrieved primary articles and consultation with experts.

Study selection and data extraction: Data were extracted on study characteristics, quality and results. Exposure to risk factors was compared between women with and without anal incontinence. Categorical data in 2 x 2 contingency tables were used to generate odds ratios.

Results: Eighteen studies met the inclusion criteria with 12,237 participants. Women having any type of vaginal delivery compared with a caesarean section have an increased risk of developing symptoms of solid, liquid or flatus anal incontinence. The risk varies with the mode of delivery ranging from a doubled risk with a forceps delivery (OR 2.01, 95% CI 1.47-2.74, P < 0.0001) to a third increased risk for a spontaneous vaginal delivery (OR 1.32, 95% CI 1.04-1.68, P = 0.02). Instrumental deliveries also resulted in more symptoms of anal incontinence when compared with spontaneous vaginal delivery (OR 1.47, 95% CI 1.22-1.78). This was statistically significant for forceps deliveries alone (OR 1.5, 95% CI 1.19-1.89, P = 0.0006) but not for ventouse deliveries (OR 1.31, 95% CI 0.97-1.77, P = 0.08). When symptoms of solid and liquid anal incontinence alone were assessed, these trends persisted but were no longer statistically significant.

Conclusion: Symptoms of anal incontinence in the first year postpartum are associated with mode of delivery.

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