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Clin Colon Rectal Surg 2014; 27(03): 110-112
DOI: 10.1055/s-0034-1383903
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Obstetrics and Fecal Incontinence

Kathleen Chin
1   Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, UT Southwestern School of Medicine, Dallas, Texas
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Publication History

Publication Date:
24 September 2014 (online)

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Abstract

Anal incontinence (AI) can be a debilitating condition for women following vaginal delivery. Operative vaginal delivery and anal sphincter laceration are important risk factors for the development of postpartum AI. Obtaining a comprehensive delivery history, along with a thorough physical examination of the perineum, vagina and rectum may aid the clinician in the diagnosis of an anal sphincter defect. Sonographic imaging can also assist in identifying sphincter defects. The treatment of AI may include a combination of dietary modification, medications that promote constipation, pelvic floor physical therapy, biofeedback, anal sphincteroplasty, and/or sacral neuromodulation.

Keywords

postpartum anal incontinence - anal sphincter defect - obstetric injury
 

  • References

  • 1 Macmillan AK, Merrie AE, Marshall RJ, Parry BR. The prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature. Dis Colon Rectum 2004; 47 (8) 1341-1349
    CrossrefPubMedGoogle Scholar
  • 2 Boreham MK, Richter HE, Kenton KS , et al. Anal incontinence in women presenting for gynecologic care: prevalence, risk factors, and impact upon quality of life. Am J Obstet Gynecol 2005; 192 (5) 1637-1642
    CrossrefPubMedGoogle Scholar
  • 3 Xu X, Menees SB, Zochowski MK, Fenner DE. Economic cost of fecal incontinence. Dis Colon Rectum 2012; 55 (5) 586-598
    CrossrefPubMedGoogle Scholar
  • 4 Borello-France D, Burgio KL, Richter HE , et al; Pelvic Floor Disorders Network. Fecal and urinary incontinence in primiparous women. Obstet Gynecol 2006; 108 (4) 863-872
    CrossrefPubMedGoogle Scholar
  • 5 Badiou W, Bousquet PJ, Prat-Pradal D, Monroziès X, Mares P, de Tayrac R. Short vs long second stage of labour: is there a difference in terms of postpartum anal incontinence?. Eur J Obstet Gynecol Reprod Biol 2010; 152 (2) 168-171
    CrossrefPubMedGoogle Scholar
  • 6 Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med 1993; 329 (26) 1905-1911
    CrossrefPubMedGoogle Scholar
  • 7 Laine K, Skjeldestad FE, Sanda B, Horne H, Spydslaug A, Staff AC. Prevalence and risk factors for anal incontinence after obstetric anal sphincter rupture. Acta Obstet Gynecol Scand 2011; 90 (4) 319-324
    CrossrefPubMedGoogle Scholar
  • 8 Huebner M, Gramlich NK, Rothmund R, Nappi L, Abele H, Becker S. Fecal incontinence after obstetric anal sphincter injuries. Int J Gynaecol Obstet 2013; 121 (1) 74-77
    CrossrefPubMedGoogle Scholar
  • 9 Andrews V, Sultan AH, Thakar R, Jones PW. Occult anal sphincter injuries—myth or reality?. BJOG 2006; 113 (2) 195-200
    CrossrefPubMedGoogle Scholar
  • 10 Abdool Z, Sultan AH, Thakar R. Ultrasound imaging of the anal sphincter complex: a review. Br J Radiol 2012; 85 (1015) 865-875
    CrossrefPubMedGoogle Scholar
  • 11 Deen KI, Kumar D, Williams JG, Olliff J, Keighley MR. Anal sphincter defects. Correlation between endoanal ultrasound and surgery. Ann Surg 1993; 218 (2) 201-205
    CrossrefPubMedGoogle Scholar
  • 12 Oom DM, West RL, Schouten WR, Steensma AB. Detection of anal sphincter defects in female patients with fecal incontinence: a comparison of 3-dimensional transperineal ultrasound and 2-dimensional endoanal ultrasound. Dis Colon Rectum 2012; 55 (6) 646-652
    CrossrefPubMedGoogle Scholar
  • 13 Dobben AC, Terra MP, Slors JF , et al. External anal sphincter defects in patients with fecal incontinence: comparison of endoanal MR imaging and endoanal US. Radiology 2007; 242 (2) 463-471
    CrossrefPubMedGoogle Scholar
  • 14 Roos AM, Abdool Z, Sultan AH, Thakar R. The diagnostic accuracy of endovaginal and transperineal ultrasound for detecting anal sphincter defects: The PREDICT study. Clin Radiol 2011; 66 (7) 597-604
    CrossrefPubMedGoogle Scholar
  • 15 Mahony RT, Malone PA, Nalty J, Behan M, O'connell PR, O'herlihy C. Randomized clinical trial of intra-anal electromyographic biofeedback physiotherapy with intra-anal electromyographic biofeedback augmented with electrical stimulation of the anal sphincter in the early treatment of postpartum fecal incontinence. Am J Obstet Gynecol 2004; 191 (3) 885-890
    CrossrefPubMedGoogle Scholar
  • 16 Boyle R, Hay-Smith EJ, Cody JD, Mørkved S. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2012; 10: CD007471
    PubMedGoogle Scholar
  • 17 Farrell SA, Flowerdew G, Gilmour D , et al. Overlapping compared with end-to-end repair of complete third-degree or fourth-degree obstetric tears: three-year follow-up of a randomized controlled trial. Obstet Gynecol 2012; 120 (4) 803-808
    CrossrefPubMedGoogle Scholar
  • 18 Garcia V, Rogers RG, Kim SS, Hall RJ, Kammerer-Doak DN. Primary repair of obstetric anal sphincter laceration: a randomized trial of two surgical techniques. Am J Obstet Gynecol 2005; 192 (5) 1697-1701
    CrossrefPubMedGoogle Scholar
  • 19 Zutshi M, Tracey TH, Bast J, Halverson A, Na J. Ten-year outcome after anal sphincter repair for fecal incontinence. Dis Colon Rectum 2009; 52 (6) 1089-1094
    CrossrefPubMedGoogle Scholar
  • 20 Devroede G, Giese C, Wexner SD , et al; SNS Study Group. Quality of life is markedly improved in patients with fecal incontinence after sacral nerve stimulation. Female Pelvic Med Reconstr Surg 2012; 18 (2) 103-112
    CrossrefPubMedGoogle Scholar
  • 21 Mellgren A, Wexner SD, Coller JA , et al; SNS Study Group. Long-term efficacy and safety of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 2011; 54 (9) 1065-1075
    CrossrefPubMedGoogle Scholar
  • 22 Johnson J, Clifton RG, Roberts JM , et al; Eunice Kennedy Shriver National Institute of Child Health; Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Pregnancy outcomes with weight gain above or below the 2009 Institute of Medicine guidelines. Obstet Gynecol 2013; 121 (5) 969-975
    CrossrefPubMedGoogle Scholar
  • 23 Eogan M, O'Brien C, Daly L, Behan M, O'Connell PR, O'Herlihy C. The dual influences of age and obstetric history on fecal continence in parous women. Int J Gynaecol Obstet 2011; 112 (2) 93-97
    CrossrefPubMedGoogle Scholar
  • 24 Sze EH. Prevalence and severity of anal incontinence in women with and without additional vaginal deliveries after a fourth-degree perineal laceration. Dis Colon Rectum 2005; 48 (1) 66-69
    CrossrefPubMedGoogle Scholar
  • 25 McKenna DS, Ester JB, Fischer JR. Elective cesarean delivery for women with a previous anal sphincter rupture. Am J Obstet Gynecol 2003; 189 (5) 1251-1256
    CrossrefPubMedGoogle Scholar