Faecal incontinence and mode of first and subsequent delivery: a six-year longitudinal study

Objective To investigate the prevalence of persistent and long term postpartum faecal incontinence and associations with mode of first and subsequent deliveries. Design Longitudinal study. Setting Maternity units in Aberdeen, Birmingham and Dunedin. Population Four thousand two hundred and fourteen women who returned postal questionnaires three months and six years postpartum. Methods Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery history. Main outcome measures Incontinence to bowel motions three months and six years after index birth. For delivery history, the outcome was incontinence only at six years. Results The prevalence of persistent faecal incontinence was 3.6%. Almost 90% of these women reported no symptoms before their first birth. The forceps delivery of a first baby was independently predictive of persistent symptoms (OR 2.06, 95% CI 1.40-3.04). A caesarean section first birth was not significantly associated with persistent symptoms (OR 1.07, 95% CI 0.64-1.81). Delivering exclusively by caesarean section also showed no association with subsequent symptoms (OR 1.04, 95% CI 0.72-1.50) but ever having forceps was significantly predictive (OR 1.48, 95% CI 1.18-1.87). Other factors independently associated with persistent faecal incontinence were older maternal age, increasing number of births and Asian ethnic group. Birthweight and long second stage were not significantly associated. Conclusions The risk of persistent faecal incontinence is significantly higher after a first delivery by forceps. We found no evidence of a lower risk of subsequent faecal incontinence for exclusive caesarean section deliveries.