Fecal Incontinence and Associated Pelvic Floor Dysfunction During and One year After the First Pregnancy

Overview

Journal Acta Obstet Gynecol Scand

Publisher Wiley

Specialty Gynecology & Obstetrics

Date 2023 Jun 20

PMID 37338103

Authors

Markus Harry Jansson

Karin Franzen

Gunilla Tegerstedt

Jan Brynhildsen

Ayako Hiyoshi

Kerstin Nilsson

Affiliations

Soon will be listed here.

Abstract

Introduction: Obstetric anal sphincter injury is an important risk factor for postpartum fecal incontinence but few studies have reported fecal incontinence occurring, even during pregnancy. The first objective of this study was to examine the prevalence of fecal incontinence, obstructed defecation and vaginal bulging early and late in pregnancy and postpartum. The second objective was to assess the association between symptoms in pregnancy, delivery characteristics, and bowel and vaginal bulging symptoms at 1 year postpartum.

Material And Methods: This prospective cohort study was conducted between October 2014 and October 2017, including 898 nulliparous women enrolled with the maternity healthcare service in Örebro County, Sweden. The women responded to questionnaires regarding pelvic floor dysfunction in early and late pregnancy and at 8 weeks and 1 year postpartum. The data were analyzed using random effect logistic models estimating odds ratios (ORs) and generalized linear models estimating relative risks, with 95% confidence intervals (CIs).

Results: At 1 year postpartum, the prevalence of fecal incontinence, obstructed defecation and vaginal bulging was 6% (40/694), 28% (197/699) and 8% (56/695), respectively. Among women with vaginal delivery, the risk of fecal incontinence and vaginal bulging increased significantly both in late pregnancy, with ORs of 3.4 (95% CI 1.5-7.7) and 3.6 (95% CI 1.6-8.1), respectively, and at 1 year postpartum, with ORs of 5.0 (95% CI 2.1-11.5) and 8.3 (95% CI 3.8-18.1), respectively, compared with early pregnancy. Among all women, factors associated with increased prevalence of fecal incontinence 1 year postpartum were fecal incontinence during pregnancy (adjusted relative risk [aRR] 7.4; 95% CI 4.1-13.3), obstructed defecation during pregnancy (aRR 2.0; 95% CI 1.1-3.9) and concurrent obstructed defecation (aRR 2.4; 95% CI 1.3-4.5).

Conclusions: This prospective study shows an increased risk of fecal incontinence by late pregnancy, suggesting that the pregnancy itself may be involved in the development of postpartum fecal incontinence. Obstructed defecation during pregnancy and postpartum was found to be associated with increased risk of fecal incontinence postpartum, indicating that postpartum fecal incontinence may be a result of incomplete bowel emptying.

Citing Articles

Bothersome Pelvic Floor Dysfunction and Quality of Life During Pregnancy and Postpartum in Primiparous Women.

Nestor S, Brynhildsen J, Hiyoshi A, Jansson M Int Urogynecol J. 2025; .

PMID: 39833538 DOI: 10.1007/s00192-024-06038-1.

Levator Ani Deficiency and Pelvic Floor Dysfunction 1 Year Postpartum: A Prospective Nested Case-Control Study.

Jansson M, Brismar Wendel S, Rotstein E BJOG. 2024; 132(5):596-605.

PMID: 39623952 PMC: 11879914. DOI: 10.1111/1471-0528.18036.

Pelvic floor symptoms according to the severity of second-degree perineal tears within 12 months post-partum: A longitudinal prospective cohort study.

Macedo M, Rislokken J, Rotstein E, Saltyte Benth J, Ellstrom Engh M, Siafarikas F Acta Obstet Gynecol Scand. 2024; 103(7):1366-1376.

PMID: 38709004 PMC: 11168255. DOI: 10.1111/aogs.14854.

Fecal incontinence and associated pelvic floor dysfunction during and one year after the first pregnancy.

Jansson M, Franzen K, Tegerstedt G, Brynhildsen J, Hiyoshi A, Nilsson K Acta Obstet Gynecol Scand. 2023; 102(8):1034-1044.

PMID: 37338103 PMC: 10378031. DOI: 10.1111/aogs.14614.

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