Anal incontinence after anal sphincter disruption: a 30-year retrospective cohort study

To compare the prevalence of anal incontinence remote from delivery (approximately 30 years postpartum) in 29 women whose index delivery was complicated by anal sphincter disruption versus a matched control group of 89 women who had an episiotomy without extension to the anal sphincter and versus a group of 33 women who delivered via cesarean.

In this retrospective cohort study, a structured questionnaire was sent to women in the above categories who delivered at a university hospital between 1961 and 1965 and for whom we could obtain current addresses. Outcome measures included frequent fecal and flatus incontinence and bothersome fecal and flatus incontinence.

The three groups did not differ significantly in age, weight, age at delivery, parity, weight of largest baby, postmenopausal status, estrogen replacement usage, most medical conditions, or rectocoele, rectovaginal fistula, or incontinence surgeries. Frequent flatus incontinence was reported by nine (31.0%), 38 (42.7%), and 12 (36.4%) women in the anal sphincter disruption, episiotomy, and cesarean groups, respectively (not significant). The number of women with bothersome flatus incontinence was higher in the anal sphincter disruption group: 17 (58.6%) versus 27 (30.3%) in the episiotomy only group and versus five (15.2%) in the cesarean group (P = .001). Frequent fecal incontinence was reported by two (6.9%), 16 (18.0%), and 0 women (P = .008 between cesarean and episiotomy only groups), whereas bothersome fecal incontinence was reported by eight (27.6%), 23 (25.8%), and five (15.2%) women (not significant) in the anal sphincter disruption, episiotomy only, and cesarean groups, respectively.

Regardless of the type of delivery, anal incontinence occurs in a surprisingly large number of middle-aged women.