Objective: Fecal incontinence is an embarrassing and disabling condition of which the epidemiology is poorly understood. Our goal is to estimate the incidence of fecal incontinence after childbirth.
Methods: A population-based survey was mailed to all women who delivered a liveborn infant in the state of Oregon between April 2002 and September 2002. The survey estimated the incidence of fecal incontinence. Surveys were to be completed within 3-6 months postpartum. Women were considered to have fecal incontinence based upon the National Institute of Child Health and Human Development definition of fecal incontinence: recurring episodes of involuntary loss of stool or flatus.
Results: Surveys were mailed to 21,824 eligible postpartum women. A total of 8,774 women responded (40%) to the survey, 2,569 (29%) of whom reported experiencing fecal incontinence since delivery. Almost half (46%) of all women with postpartum fecal incontinence reported incontinence of stool, and 38% reported exclusively incontinence of flatus. Approximately 46% reported onset of incontinence after delivery of their first child. Higher body mass index, longer pushing, forceps-assisted delivery, third- or fourth-degree laceration, and smoking were associated with severe fecal incontinence.
Conclusion: In this population-based study, more than one in four women reported fecal incontinence within 6 months of childbirth, with almost half reporting onset of symptoms after delivery of their first child. Four in 10 women reported loss of flatus or stool during intercourse. Given the burden of this condition, both in number and social impact coupled with the hesitancy of women to want to initiate this conversation, providers should ask women about symptoms of fecal incontinence during postpartum examinations. Additionally, these data suggest that there may be a benefit to extending postpartum follow-up visits beyond the typical 6-8 weeks to provide surveillance for potential incontinence.
Level of evidence: II.