Association of race with anal incontinence in parous women

To investigate the relationship between race and anal incontinence (AI). Our hypotheses were (a) AI symptoms are similar between white and black women and (b) asymptomatic black and white women are equally likely to develop AI over one year of prospective observation.

Parous women enrolled in a longitudinal cohort study were assessed for AI symptoms annually using Epidemiology of Prolapse and Incontinence Questionnaire. An AI score > 0 indicated any bother from AI; a score > 22.8 indicated clinically significant AI. We compared the odds of AI scores >0 at the visit level between white vs black women with logistic regression models using generalized estimating equations. We also estimated the odds of new AI symptoms at time T + 1(one year later) among women free of AI symptoms at time T comparing white vs black women. In the latter analysis, we considered new AI symptoms to be represented by scores above 11.4. Covariates included in the adjusted models were: mode of delivery, obstetrical anal sphincter injuries, body mass index, age at the first delivery, and parity at enrollment.

Among 1256 participants, 189 (15.0%) were black. AI score = 0 was observed at 74.2% (= 5122/6902) person-visits. The adjusted odds ratio of AI score > 0 was 1.83 (95% CI 1.24, 2.70) for white vs black women. Across 4364 visit pairs with AI score = 0 at time T, 203 (4.7%) had AI score > 11.4 at visit T + 1 and white race significantly increased the odds of developing symptoms at time T + 1 (adjusted OR = 2.26, 95% CI 1.28, 3.98).

In an analysis that controlled for mode of delivery, obstetrical anal sphincter injuries, obesity, age at first delivery, and parity, white race was significantly associated with AI symptoms at any point in time as well as to the development of AI over one year of observation.