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

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.