Incidence and risk factors of postpartum anal incontinence: a prospective study of 503 cases.

BACKGROUND

Background

Anal incontinence is a devastating functional postpartum complication. it can cause deep deterioration in the quality of life.

AIM: To assess the incidence of postpartum anal incontinence (PPAI) and the major risk factors predisposing for it in the short and middle terms.

METHODS

This prospective observational study was conducted in the department of Obstetrics and Gynecology B in the Maternity and Neonatology Center of Tunis between March 1st and july 31st, 2009.

RESULTS

Five hundred and three women were included. PPAI was 4.2% on the fourth day postpartum and 4% between weeks 6 and 8 postpartum. Predisposing factors to 4th day PPAI were forceps delivery (p<0.001), prolonged second stage of labor> 5hours (p=0.047), expulsion phase > 20mn (p<0.001), uterine revision (P=0.001) and first degree perineal lacerations (p<0.001). Between 6 and 8 weeks postpartum, identified risk factors were Shoulder dystocia (p<0.001), anu-vulvar distance < 2cm, perineal scars and transverse abdominal diameter >105mm (p<0.001).

CONCLUSION

Preventive measures must be implemented in patients with PPAI risk factors.