Faecal incontinence persisting after childbirth: a 12 year longitudinal study

Objectives 

To investigate persistent faecal incontinence (FI) 12years after birth and association with delivery mode history and quality of life. 

Design 

Twelve-year longitudinal study. 

Setting 

Maternity units in Aberdeen, Birmingham and Dunedin. 

Population 

Women who returned questionnaires 3months and 12years after index birth. 

Methods 

Data on all births over 12months were obtained from units and women were contacted 3months, 6years and 12years post birth. 

Main outcome measure 

Persistent FI, defined as reported at 12years and one or more previous contacts. SF12 assessed quality of life. 

Results 

Of 7879 women recruited at 3months, 3763 responded at 12years, 2944 of whom also responded at 6years: nonresponders were similar in obstetric factors. Prevalence of persistent FI was 6.0% (227/3763); 43% of 12-year responders who reported FI at 3months also reported it at 12years. Women with persistent FI had significantly lower SF12 scores. Compared with only spontaneous vaginal deliveries, women who had one or more forceps delivery were more likely to have persistent FI (odds ratio [OR] 2.08, 95% confidence interval [95% CI] 1.53-2.85) but it was no less likely with exclusively caesarean births (OR 0.93, 95% CI 0.54-1.58). More obese women than normal weight women reported persistent FI (OR 1.52, 95% CI 1.06-2.17). 

Conclusions 

This longitudinal study has demonstrated persistence of FI many years after birth and shown that one forceps birth increased the likelihood, whereas exclusive caesarean birth showed no association. Obesity, which increased symptom likelihood, is a modifiable risk factor.