Abstract

INTRODUCTION: Uncertainties remain as to whether cesarean section is protective for short and long term development of anal incontinence. Our aim was to explore whether women who had only delivered vaginally were at greater risk of anal incontinence compared to nulliparous women and women who had undergone caesarean sections only. MATERIAL AND METHODS: Background information, medical history and data on anal incontinence (defined as fecal or flatus incontinence weekly or more) reported by women participating in a large population-based health survey in Norway (HUNT 3) during the period October 2006-June 2008, was collected and linked to data from the Medical Birth Registry of Norway. Anal incontinence prevalence was calculated and multivariable logistic regression analyses were applied. RESULTS: Mean age amongst the 12.567 women was 49.9 years. Age and educational level were similar in women with caesarean sections only and those with vaginal delivery and obstetric anal sphincter injuries (OASIS). Nulliparas and women with vaginal delivery and no OASIS were older and had higher educational achievements. One in four women with OASIS reported anal incontinence compared to one in six amongst the other women(p<.001). Age, educational level, diarrhea, constipation, birthweight and OASIS increased the risk of anal incontinence in all women. Parity was associated with anal incontinence in parous women only. No differences were found for fecal urgency. CONCLUSIONS: Women with vaginal deliveries complicated by OASIS were at increased risk of anal incontinence. However, no increased risk of anal incontinence was found in nulliparous women or women with cesarean sections only or vaginal deliveries not complicated by OASIS.