Faecal incontinence persisting after childbirth: a 12 year longitudinal study

Abstract

Objectives: To investigate persistent faecal incontinence (FI) 12 years after birth and association with delivery mode history and quality of life.

Design: Twelve-year longitudinal study.

Setting: Maternity units in Aberdeen, Birmingham and Dunedin.

Population: Women who returned questionnaires 3 months and 12 years after index birth.

Methods: Data on all births over 12 months were obtained from units and women were contacted 3 months, 6 years and 12 years post birth.

Main outcome measure: Persistent FI, defined as reported at 12 years and one or more previous contacts. SF12 assessed quality of life.

Results: Of 7879 women recruited at 3 months, 3763 responded at 12 years, 2944 of whom also responded at 6 years: nonresponders were similar in obstetric factors. Prevalence of persistent FI was 6.0% (227/3763); 43% of 12-year responders who reported FI at 3 months also reported it at 12 years. Women with persistent FI had significantly lower SF12 scores. Compared with only spontaneous vaginal deliveries, women who had one or more forceps delivery were more likely to have persistent FI (odds ratio [OR] 2.08, 95% confidence interval [95% CI] 1.53-2.85) but it was no less likely with exclusively caesarean births (OR 0.93, 95% CI 0.54-1.58). More obese women than normal weight women reported persistent FI (OR 1.52, 95% CI 1.06-2.17).

Conclusions: This longitudinal study has demonstrated persistence of FI many years after birth and shown that one forceps birth increased the likelihood, whereas exclusive caesarean birth showed no association. Obesity, which increased symptom likelihood, is a modifiable risk factor.