Mode of Delivery and Fecal Incontinence at Midlife: A Study of 2,640 Women in the Gazel Cohort

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Abstract

OBJECTIVE:

To estimate obstetric risk factors of fecal incontinence among middle-aged women.

METHODS:

We conducted a mail survey of the Gazel cohort of volunteers for epidemiologic research. In 2000, a questionnaire on anal incontinence was mailed to 3,114 women who were then between the ages of 50 and 61 years; 2,640 (85%) women returned the completed questionnaire. Fecal incontinence was defined by involuntary loss of stool. Logistic regression was used to estimate the effect of obstetric and general risk factors.

RESULTS:

Prevalence of fecal incontinence in the past 12 months was 9.5% (250). Significant risk factors for fecal incontinence were completion of high school (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1–2.0), self-reported depression (OR 2.1, 95% CI 1.6–2.7), overweight or obesity measured by body mass index (BMI) (OR 1.5 for BMI of 25–30, 95% CI 1.1–2.0; OR 1.6 for BMI more than 30, 95% CI 1.1–2.5), surgery for urinary incontinence (OR 3.5, 95% CI 2.0–6.1), and anal surgery (OR 1.7, 95% CI 1.1–2.9). No obstetric variable (parity, mode of delivery, birth weight, episiotomy, or third-degree perineal tear) was significant. Prevalence of fecal incontinence was similar for nulliparous, primiparous, secundiparous, and multiparous women (11.3%, 9.0%, 9.0%, and 10.4%, respectively), and among parous women, it was similar for women with spontaneous vaginal, instrumental (at least one), or only cesarean deliveries (9.3%, 10.0%, and 6.6%, respectively).

CONCLUSION:

In our population of women in their 50s, fecal incontinence was not associated with either parity or mode of delivery.

LEVEL OF EVIDENCE:

III

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