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. 2020 Apr;127(5):619-627.
doi: 10.1111/1471-0528.16075. Epub 2020 Jan 19.

Postpartum psychological distress associated with anal incontinence in the EDEN mother-child cohort

X Fritel  1 , B Gachon  1 , M J Saurel-Cubizolles  2 ; EDEN Mother-Child Cohort Study Group
Collaborators, Affiliations
Free article

Postpartum psychological distress associated with anal incontinence in the EDEN mother-child cohort

X Fritel et al. BJOG. 2020 Apr.
Free article

Abstract

Objective: To estimate the prevalence of flatus-only and faecal incontinence, to describe their risk factors and to analyse the association between anal incontinence and psychological distress over the first year postpartum.

Design: Cohort study from pregnancy to 12 months postpartum.

Setting: Two university hospital maternity wards in France.

Population: A total of 2002 pregnant women were recruited between 2003 and 2006. Data on anal incontinence were available for the 1632 women who comprise the sample for analysis.

Methods: Women were enrolled during pregnancy. A postal questionnaire was sent at 4 and 12 months postpartum.

Main outcome measures: Anal (flatus-only and faecal) incontinence was assessed at 4 months postpartum. Mental health was assessed at 4 and 12 months postpartum by the Edinburgh Postpartum Depression Scale (EPDS) and use of antidepressant drugs as well as by self-rated mental health.

Results: At 4 months postpartum, the prevalence for flatus-only incontinence was 14.4% and for faecal incontinence 1.7%; multivariate analysis, restricted to women reporting no anal incontinence before the index pregnancy, showed that continuing breastfeeding at 4 months was related to a higher risk of de novo postpartum anal incontinence (OR = 2.23). Women who reported anal incontinence at 4 months were more frequently depressed (EPDS ≥10 or antidepressant use) at 12 months postpartum: 36.0% of those with faecal incontinence were depressed, 23.3% of those with flatus-only incontinence and only 14.8% of the continent women.

Conclusion: Postnatal faecal incontinence was rare but associated with poorer maternal mental health. Postnatal screening should be encouraged, and psychological support offered.

Tweetable abstract: Postnatal faecal incontinence was associated with depression; postnatal screening should be encouraged and psychological support offered.

Keywords: Anal incontinence; cohort study; depression; postpartum.

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