Fecal and urinary incontinence after delivery: risk factors and prevention

Service de gynecologie-obstetrique, hopital de la Croix-Rousse, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon 04, France. olivier.dupuis@chu-lyon.fr

Objectives:

This study was undertaken to review the available data on urinary and fecal incontinence and their association with maternal as well as fetal per partum characteristics. METHOD: A Pubmed (Medline search performed between 1999 and 2003 using "urinary incontinence and delivery" and "fecal incontinence and delivery" identified 501 relevant papers. Most of them are retrospective analyses whereas few are randomized controlled trials (RCT).

Results:

Two studies performed with computer-stored databases analyzed the risk factors of incontinence among 2,886,126 deliveries. Primiparity, birthweight over 4000 g and all types of assisted vaginal deliveries significantly increased the risk of anal sphincter damage. Results concerning the effect of episiotomy are conflicting. Controlled randomized trials have shown that pelvic floor muscle training during pregnancy as well as planned cesarean section significantly and moderately decrease the risk of urinary incontinence. The only RCT available has shown that planned cesarean section did not reduce significantly incontinence of flatus. Finally the only trial that compare surgical techniques used to repair the anal sphincter did not show any significant difference.

Conclusion:

Risk factors for anal sphincter damage during delivery are well known. RCT focusing on how to prevent and how to cure fecal as well as urinary incontinence are urgently needed.