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[Delivery and anal incontinence: definition, classification, prevalence and pathophysiology]
V Kalis1, P Chaloupka, J Turek
1Gynekologicko-porodnická klinika LF UK a FN, Plzen.
Ceska Gynekologie
|October 1, 2003
Summary
Vaginal delivery significantly increases women's risk of anal incontinence (AI), a condition affecting up to 20% post-birth. Causes include sphincter tears and nerve damage, but AI often improves over time.
Area of Science:
- Obstetrics and Gynecology
- Pelvic Floor Disorders
- Women's Health
Context:
- Vaginal delivery poses an eightfold higher risk for women developing anal incontinence (AI) compared to men.
- Postnatal anal incontinence is a prevalent and disabling condition affecting 13-20% of women.
- Understanding the link between childbirth and AI is crucial for improving maternal healthcare.
Purpose:
- To summarize the relationship between vaginal delivery and anal incontinence (AI).
- To review the classification, prevalence, incidence, and causes of AI in women.
- To explore pathogenetic mechanisms, including neurological injury and anal sphincter tears.
Summary:
- Anal incontinence (AI), defined as involuntary leakage of flatus, liquid, or solid stool, is significantly more common in women due to childbirth.
- Key factors contributing to AI include anal sphincter tears (apparent in 2.3% and occult in 35% of primigravidae) and perineal neurological injury, especially after multiple vaginal births.
- While 42% report impaired quality of life, AI shows improvement over time in 36-76% of cases, though long-term outcomes require further study.
Impact:
- Highlights the significant impact of childbirth on women's pelvic floor health and quality of life.
- Emphasizes the need for routine postnatal screening for anal and urinary incontinence.
- Informs clinical practice and future research on preventing and managing anal incontinence after vaginal delivery.