Anal Incontinence Lingers After Vaginal Birth

More Common With Anal Sphincter Tear, Additional Births, and Increased Age

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Dec. 10, 2004 -- Moms who experience soiling, or stool incontinence, after delivering vaginally can have the problem for years, say Swedish researchers.

Despite having surgery to repair severe vaginal tears that occur during delivery of a baby, many women continue to suffer from this form of incontinence. The researchers say that their study shows that soiling and involuntarily passing of gas persists for a few years and having children in the future worsens the problem.

Women are particularly vulnerable if the vaginal tear, which involves the anal sphincter, occurs while delivering their first child. Having more children and becoming mothers at an older age are also risk factors.

Johan Pollack, MD, and colleagues from the Karolinska Institutet Danderyd Hospital in Stockholm, announced the findings in the December issue of Obstetrics and Gynecology. They studied 242 first-time moms for five years.

All the women gave birth vaginally and 36 had severe vaginal tears involving the anal sphincter during their first delivery.

Sphincter tears are rare. They're usually reported in less than 3% of births, but first-time mothers have a higher risk of the problem, say the researchers. Doctors immediately try to repair the damage with surgery, but the results aren't always perfect.

The researchers defined anal incontinence as involuntarily passing gas or incontinence of solid or loose stools. Even mild involuntary, sporadic cases of passing gas (less than once a week) were classified as anal incontinence.

Flatulence was the most common type of anal incontinence. Stool incontinence (or soiling) was rare, affecting a total of 16 women during the course of the study.

Forty-four percent of women with sphincter tears reported anal incontinence nine months after giving birth. All cases were flatulence, and most happened less than once a week. Five years after delivery more than half of these women continued to have symptoms.

A quarter of all women without sphincter tears also reported anal incontinence at nine months. Most cases were mild flatulence occurring less than once a week. At five years, about a third of these women complained of anal incontinence.


Again, most cases were flatulence. Eleven women with sphincter tears also reported fecal incontinence less than once a week.

Women who had more children were more likely to be affected. Among moms without sphincter tears, the five-year incontinence rate was 34% for those who had more babies, compared with 25% for women with one child.

Age also mattered. A 30-year-old woman has twice the risk of developing anal incontinence as a 20-year-old, the researchers say.

If women were incontinent at nine months after delivery the problem wasn't likely to go away and often worsened, say the researchers. That was particularly true for women with anal sphincter tears. They were almost eight times as likely to have symptoms at five years if they'd had the problem nine months after delivery.

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SOURCES: Pollack, J. Obstetrics and Gynecology, December 2004; vol 104: pp 1397-1402.
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