ANAL INCONTINENCE AFTER ANAL-SPHINCTER DISRUPTION - A 30-YEAR RETROSPECTIVE COHORT STUDY

Objective: To compare the prevalence of anal incontinence remote from delivery (approximately 30 years postpartum) in 29 women whose index d elivery was complicated by anal sphincter disruption versus a matched control group of 89 women who had an episiotomy without extension to t he anal sphincter and versus a group of 33 women who delivered via ces arean. Methods: In this retrospective cohort study, a structured quest ionnaire was sent to women in the above categories who delivered at a university hospital between 1961 and 1965 and for whom we could obtain current addresses. Outcome measures included frequent fecal and natus incontinence and bothersome fecal and natus incontinence. Results: Th e three groups did not differ significantly in age, weight, age at del ivery, parity, weight of largest baby, postmenopausal status, estrogen replacement usage, most medical conditions, or rectocoele, rectovagin al fistula, or incontinence surgeries. Frequent flatus incontinence wa s reported by nine (31.0%), 38 (42.7%), and 12 (36.4%) women in the an al sphincter disruption, episiotomy, and cesarean groups, respectively (not significant). The number of women with bothersome flatus inconti nence was higher in the anal sphincter disruption group: 17 (58.6%) ve rsus 27 (30.3%) in the episiotomy only group and versus five (15.2%) i n the cesarean group (P =.001). Frequent fecal incontinence was report ed by two (6.9%), 16 (18.0%), and 0 women (P =.008 between cesarean an d episiotomy only groups), whereas bothersome fecal incontinence was r eported by eight (27.6%), 23 (25.8%), and five (15.2%) women (not sign ificant) in the anal sphincter disruption, episiotomy only, and cesare an groups, respectively. Conclusion: Regardless of the type of deliver y, anal incontinence occurs in a surprisingly large number of middle-a ged women. (C) 1997 by The American College of Obstetricians and Gynec ologists.