Incontinencia anal postparto y control evolutivo hasta los doce meses

Objectives

To determine the prevalence of anal incontinence (AI) of faeces and gases, as well as the factors associated with the pregnancy, delivery and postpartum.

Design

Twelve-month follow-up study with visits at 2, 6 and 12 months.

Settings

Vic General Hospital as a basic general hospital in the Osona region (Central Catalonia, Spain).

Subject of the study

Women who had a live birth at full-term between the 1^st of January 2001 and the 31^st of March 2002.

Methodology

During admission for childbirth, data were collected on the mother (age, parity, body mass index, symptoms of incontinence during pregnancy), the type of delivery (vaginal, caesarean) and the foetus (weight, cranial circumference). Two months after parturition, the mothers were examined by a gynaecologist to detect and establish the clinical diagnosis of anal incontinence by means of a specific protocol. The women were asked whether they had symptoms of involuntary release of faeces or gases: women with symptoms of AI underwent a pelvic examination before being referred to a specialist in coloproctology for an assessment. Women with symptoms of AI at 2 months postpartum were recalled at 6 months for a new clinical assessment by the gynaecologist, and after 12 months all those who had shown persistence of symptoms at 6 months were contacted by phone. The prevalence of anal incontinence at 2 months postpartum was calculated and also the association of symptoms with maternal, foetal and delivery factors.

Results

A total of 531 women were visited at 2 months postpartum. Of these, 11 were diagnosed with anal incontinence. At 12 months post partum, 4 (36.4%) of these 11 women continued to have symptoms of incontinence. The prevalence of anal incontinence at 2 months after delivery was 2.1% (95% CI: 1.0-3.7) and was associated with primiparity (Odds ratio OR] = 7.21, P = 0.029) and forceps use (OR = 5.54, P = 0.021).

Conclusions

The prevalence of AI symptoms at 12 months after parturition was low but in a half of the patients the symptoms were prevalent for more than 6 months. Primiparity and forceps use are associated with the AI symptoms at 2 months postpartum.