Prevalence of post-obstetric faecal incontinence in sri lankan women: a prospective observational study

Abstract

OBJECTIVES: To measure the prevalence and degree of post-obstetric faecal incontinence, to identify obstetric risk factors and to assess the impact of it on the quality of life. DESIGN: Prospective observational study. SETTING: Professorial obstetric unit, Teaching Hospital, Ragama. POPULATION: Seven hundred women who delivered during a period of two months in 2003 in the above unit. METHODS: Obstetric data were collected from case notes. Basic socio demographic data and the contact details were obtained by using a questionnaire administered by an interviewer within 24 hours of delivery. Information regarding symptoms related to faecal incontinence and its effect on quality of life was obtained by a self administered postal questionnaire at six weeks postpartum. MAIN OUTCOME MEASURES: frank faecal incontinence, fae.cal soiling and urgency. RESULTS: Four hundred and eleven questionnaires were returned, 58.7% response rate. Twenty-four women (5.8%) developed faecal incontinence after the index birth. Twenty-one (90%) of them had faecal urgency alone. Two of them had frank faecal incontinence, faecal soiling and urgency, one had frank faecal incontinence in addition to faecal urgency. Mode of delivery was the only risk factor found to be independently associated with faecal incontinence. Instrumental delivery was associated with increased risk of symptoms (OR 3.7, 95% CI 1.3-11.1) while caesarean section was marginally associated with reduced risk (OR 0.3, 95% CI 0.07-1.4) compared with normal vaginal delivery. No evidence of association was found between faecal incontinence and following factors- maternal age, maternal pre-pregnancy, body mass index, onset of labour, duration of 2" stage, episiotomy, perineal lacerations and fetal birth weight. All women with faecal incontinence except those who had occational urgency reported that this bowel problem affected their social, psychological, occupational, domestic, physical and sexual lives. CONCLUSIONS: Postpartum faecal incontinence is more common than previously realized, even though majority of them had only urgency. Women undergoing instrumental delivery had almost 4 times risk of developing faecal incontinence while caesarean section appeared to offer some protection. Faecal incontinence had considerable effect on the quality of life. Therefore identification and treatment is a priority.