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Anal function: effect of pregnancy and delivery.
C Chaliha1, A H Sultan, J M Bland
1Urogynaecology Unit, St George's Hospital, London, United Kingdom.
American Journal of Obstetrics and Gynecology
|August 24, 2001
Summary
Pregnancy and vaginal delivery can decrease anal pressures and cause sphincter trauma, increasing incontinence risk. However, these physical changes often do not correlate with reported anal symptoms in women.
Area of Science:
- Obstetrics and Gynecology
- Pelvic Floor Disorders
- Gastroenterology
Background:
- Pregnancy and childbirth are significant events impacting pelvic floor function.
- Anal continence, sensation, and sphincter integrity are crucial for quality of life.
- Understanding postpartum changes is essential for effective patient management.
Purpose of the Study:
- To evaluate the impact of pregnancy and delivery on anal continence.
- To assess changes in anorectal sensation and manometry.
- To determine the effect on anal sphincter integrity postpartum.
Main Methods:
- Prospective study of 286 nulliparous women in their third trimester.
- Symptom questionnaires, anorectal sensation, and manometry performed during pregnancy and postpartum.
- Anal endosonography conducted three months postpartum to assess sphincter integrity.
Main Results:
- Fecal urgency increased from 1% pre-pregnancy to 10.5% postpartum; anal incontinence rose from 1.4% to 8.7%.
- Vaginal delivery, especially instrumental, reduced anal pressures (P=.015 for squeeze, P=.002 for resting) but did not affect sensation.
- Sphincter disruption found in 38% of women postpartum; vaginal delivery (P<.0001) and perineal trauma (P<.001) linked to defects.
Conclusions:
- Vaginal delivery is associated with decreased anal pressures and increased sphincter trauma.
- Anal sensation remains unaffected by vaginal delivery.
- Postpartum anal symptoms were not correlated with manometry, sensation, or sphincter integrity findings.