Faecal incontinence and mode of first and subsequent delivery: a six-year longitudinal study

BJOG. 2005 Aug;112(8):1075-82. doi: 10.1111/j.1471-0528.2005.00721.x.


Objective: To investigate the prevalence of persistent and long term postpartum faecal incontinence and associations with mode of first and subsequent deliveries.

Design: Longitudinal study.

Setting: Maternity units in Aberdeen, Birmingham and Dunedin.

Population: Four thousand two hundred and fourteen women who returned postal questionnaires three months and six years postpartum.

Methods: Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery history.

Main outcome measures: Incontinence to bowel motions three months and six years after index birth. For delivery history, the outcome was incontinence only at six years.

Results: The prevalence of persistent faecal incontinence was 3.6%. Almost 90% of these women reported no symptoms before their first birth. The forceps delivery of a first baby was independently predictive of persistent symptoms (OR 2.06, 95% CI 1.40-3.04). A caesarean section first birth was not significantly associated with persistent symptoms (OR 1.07, 95% CI 0.64-1.81). Delivering exclusively by caesarean section also showed no association with subsequent symptoms (OR 1.04, 95% CI 0.72-1.50) but ever having forceps was significantly predictive (OR 1.48, 95% CI 1.18-1.87). Other factors independently associated with persistent faecal incontinence were older maternal age, increasing number of births and Asian ethnic group. Birthweight and long second stage were not significantly associated.

Conclusions: The risk of persistent faecal incontinence is significantly higher after a first delivery by forceps. We found no evidence of a lower risk of subsequent faecal incontinence for exclusive caesarean section deliveries.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Delivery, Obstetric / statistics & numerical data*
  • Fecal Incontinence / epidemiology
  • Fecal Incontinence / etiology*
  • Female
  • Humans
  • Longitudinal Studies
  • Maternal Age
  • New Zealand / epidemiology
  • Obstetrical Forceps / statistics & numerical data
  • Pregnancy
  • Pregnancy Complications / etiology*
  • Prevalence
  • Risk Factors
  • Time Factors
  • United Kingdom / epidemiology