Fecal incontinence during the first 12 months postpartum: complex causal pathways and implications for clinical practice.

OBJECTIVES: To investigate whether postpartum fecal incontinence is less common in women who had a cesarean delivery and more common in women who had an operative vaginal birth compared with women who had a spontaneous vaginal birth for their first newborn, and whether postpartum fecal incontinence is more common in women who report intimate-partner violence.

METHODS: This was a multicenter, prospective, nulliparous pregnancy cohort (n=1,507) using standardized measures to assess frequency and severity of fecal incontinence in pregnancy and at 3, 6, 9, and 12 months postpartum.

RESULTS: Approximately 17% reported fecal incontinence at some point in the first 12 months postpartum, with 12.8% reporting fecal incontinence beyond the first 3 months postpartum. Fecal incontinence at 4 to 12 months postpartum was significantly more common among women who had experienced emotional violence, physical violence, or both in the first 12 months postpartum (18.8% compared with 11.5%, adjusted odds ratio [OR] 1.62, 95% confidence interval [CI] 1.05-2.50). Compared with spontaneous vaginal birth, cesarean delivery (13.1% compared with 11.3%, adjusted OR 0.99, 95% CI 0.65-1.53), and operative vaginal birth (15.0% compared with 11.3%, adjusted OR 1.33, 95% CI 0.86-2.07) did not significantly alter the likelihood of fecal incontinence beyond the first 3 months postpartum.

CONCLUSION: Understanding causal pathways for postpartum fecal incontinence requires attention to the interplay of pregnancy and birth events and upstream factors such as intimate-partner violence. This has implications for how clinicians present evidence and discuss risks associated with vaginal birth and cesarean delivery. In this nulliparous cohort, method of birth was not a major determinant of fecal incontinence status beyond 3 months postpartum.

LEVEL OF EVIDENCE: II.