Postpartum anal incontinence in a resource-constrained setting: Prevalence and obstetric risk factors

Abstract

Background. Postpartum anal incontinence (AI) is a common and debilitating condition, but data from resource-constrained settings are scarce.

Objective. To show that AI is common in a resource-constrained setting and that obstetric factors contribute to its development.

Methods. This prospective questionnaire-based study performed in the Durban metropolitan area of South Africa involved black Africans and Indians. Patients were recruited antenatally and followed up for 6 months after delivery. Data collected antenatally and 6 weeks and 6 months after delivery included demographics, obstetric factors and symptoms of AI. The association between these variables and AI were explored using bivariate and multivariate analysis.

Results. The median age of the 1 248 participants was 24 years (range 13 - 45 years). The majority were black Africans (n=1 004, 80.4%), 86 (6.7%) underwent induction of labour, 95 (7.6%) required augmentation, 186 (14.9%) had epidural analgesia, 418 had mediolateral episiotomies (33.5%), and 51 (4.1%) had third- or fourth-degree tears. The antenatal prevalence of AI was 57.9% (n=722). Six weeks after delivery, 23.1% more women had symptoms of AI compared with the antenatal prevalence. At 6 months, only 0.7% of women reported symptoms. Being black African was significantly associated with AI (odds ratio (OR) 1.7, 95% confidence interval (CI) 1.2 - 2.7) and having had epidural analgesia was significantly associated with faecal incontinence (OR 1.7, 95% CI 1.1 - 2.9) at 6 weeks after delivery. At 6 months most women reported no symptoms of AI.

Conclusion. Postpartum AI is common in our resource-constrained setting and appears to be transient, with most cases resolving by 6 months.