Obstetric Trauma, Pelvic Floor Injury and Fecal Incontinence: A Population-Based Case–Control Study
- 1 June 2012
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in American Journal Of Gastroenterology
- Vol. 107 (6), 902-911
- https://doi.org/10.1038/ajg.2012.45
Abstract
OBJECTIVES: Current concepts based on referral center data suggest that pelvic floor injury from obstetric trauma is a major risk factor for fecal incontinence (FI) in women. In contrast, a majority of community women only develop FI decades after vaginal delivery, and obstetric events are not independent risk factors for FI. However, obstetric events are imperfect surrogates for anal and pelvic floor injury, which is often clinically occult. Hence, the objectives of this study were to evaluate the relationship between prior obstetric events, pelvic floor injury, and FI among community women. METHODS: In this nested case–control study of 68 women with FI (cases; mean age 57 years) and 68 age-matched controls from a population-based cohort in Olmsted County, MN, pelvic floor anatomy and motion during voluntary contraction and defecation were assessed by magnetic resonance imaging. Obstetric events and bowel habits were recorded. RESULTS: By multivariable analysis, internal sphincter injury (cases—28%, controls—6%; odds ratio (OR): 8.8; 95% confidence interval (CI): 2.3–34) and reduced perineal descent during defecation (cases—2.6±0.2 cm, controls—3.1±0.2 cm; OR: 1.7; 95% CI: 1.2–2.4) increased FI risk, but external sphincter injury (cases—25%, controls—4%;PPP=0.052) with external sphincter atrophy. CONCLUSIONS: State-of-the-art imaging techniques reveal pelvic floor injury or abnormal anorectal motion in a minority of community women with FI. Internal sphincter injury and reduced perineal descent during defecation are independent risk factors for FI. In addition to grades 3–4 episiotomy, smoking may be a potentially preventable, risk factor for pelvic floor injury.Keywords
This publication has 46 references indexed in Scilit:
- Bowel Disturbances Are the Most Important Risk Factors for Late Onset Fecal Incontinence: A Population-Based Case-Control Study in WomenGastroenterology, 2010
- Fecal incontinence in older women: are levator ani defects a factor?American Journal of Obstetrics and Gynecology, 2010
- Onset and Risk Factors for Fecal Incontinence in a US CommunityAmerican Journal of Gastroenterology, 2010
- Fecal Incontinence in US Adults: Epidemiology and Risk FactorsGastroenterology, 2009
- Relation of Bowel Habits to Fecal Incontinence in WomenThe American Journal of Gastroenterology, 2008
- Management of faecal incontinence in adults: summary of NICE guidanceBMJ, 2007
- Internal anal sphincter defect influences continence outcome following obstetric anal sphincter injuryAmerican Journal of Obstetrics and Gynecology, 2007
- Symptoms and Quality of Life in Community Women With Fecal IncontinenceClinical Gastroenterology and Hepatology, 2006
- Fecal incontinence in US women: A population-based studyAmerican Journal of Obstetrics and Gynecology, 2005
- A new questionnaire for constipation and faecal incontinenceAlimentary Pharmacology & Therapeutics, 2004