Childbirth and Pelvic Symptoms

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The Childbirth and Pelvic Symptoms (CAPS) study was a prospective cohort study performed by the Pelvic Floor Disorders Network to study postpartum fecal and urinary incontinence in primiparous women. The primary goal of the study was to estimate and compare the prevalence and incidence of postpartum urinary and fecal incontinence (UI and FI, respectively) in 3 cohorts of primiparous women: (1) those who had anal sphincter disruption during vaginal delivery; (2) a control group of women without clinically apparent anal sphincter disruption during delivery; and (3) a second control group who underwent a cesarean delivery without labor.  The cohorts were interviewed at 6 weeks and 6 months following delivery to identify symptoms of UI and FI symptoms using the Fecal Incontinence Severity Index and the Medical, Epidemiological, and Social Aspects of Aging Questionnaire, respectively.  A total of 921 women participated in this study; 407 in the Sphincter Tear cohort, 390 in the Vaginal Control cohort, and 124 in the Cesarean Control cohort. Of these, 837 (91%) completed interviews at 6 weeks, 759 (82%) at 6 months, and 728 (79%) provided data at both time points.  The study found that women with clinically recognized anal sphincter tears are more than twice as likely to report postpartum fecal incontinence than women without sphincter tears. Cesarean delivery before labor is not entirely protective against pelvic floor disorders.


D Borello-France, K Burgio, HE Richter, H Zyczynski, MP FitzGerald, W Whitehead, P Fine, I Nygaard, V Handa, A Visco, AM Weber, M Brown for the Pelvic Floor Disorders Network. Fecal and Urinary Incontinence in Primiparous Women: The Childbirth and Pelvic Symptoms (CAPS) Study. Obstetrics and Gynecology 2006; 108: 863-872.

The Pelvic Floor Disorders Network Investigators conducted the Childbirth and Pelvic Symptoms (CAPS) study to learn about the occurrence of fecal and urinary incontinence after childbirth. Women delivering their first child either by vaginal delivery or by cesarean were asked to participate in the study. Study participants were interviewed by telephone regarding symptoms and episodes of fecal and urinary incontinence at 6 weeks and 6 months after childbirth. Over 800 women participated in this study. 407 of these women experienced an anal sphincter tear (a tear in the muscles surrounding the anal opening) during vaginal delivery; 390 had a vaginal delivery but without any tear; and 124 delivered by cesarean without labor.

The study showed that 6 weeks after childbirth, about 27% of women who experienced a tear at childbirth reported fecal incontinence compared to only 11% of women who did not have a tear. Rates of fecal incontinence diminished 6 months after childbirth but were still higher for women who experienced tears (17%) compared to those who did not experience tears (8%). Women who had a tear also reported more severe fecal incontinence and higher rates of incontinence of gas compared to women without tears. Surprisingly, women who delivered by cesarean also had substantial rates of fecal symptoms.

The study also showed that, at 6 months after delivery, rates of urinary incontinence rates were similar across all three groups. Urinary incontinence occurred in about 34% of women who had tears, 31% of women without tears and 23% of women who delivered by cesarean.

Investigators concluded that, given the impact that both fecal and urinary incontinence may have on the lives of young women, research and changes in clinical practice to prevent sphincter tears should remain a high priority.

MP FitzGerald, A Weber, N Howden, GW Cundiff, MB Brown for the Pelvic Floor Disorders Network. Risk factors for anal sphincter tear during vaginal delivery. Obstet Gynecol 2007;109:29-34.

One of the main causes of bowel incontinence in young women is a tear in the anus at the time of vaginal childbirth. The goal of this study was to find out whether there were any factors that affected the likelihood that a woman would have an anal tear at the time of her first delivery. About 900 women who had just delivered their first child participated in this study.

The study found that women who had a forceps delivery and women who had an episiotomy were more likely to have had an anal tear, especially when forceps and episiotomy were used together and the woman also had an epidural during labor. The study couldn’t say whether or not an individual woman should have forceps, episiotomy or an epidural, because other factors such as the wellbeing of the baby were not taken into consideration.

The results of this study might be helpful to health care providers who are helping women plan for their labor and delivery.

S Kwon, AG Visco, MP Fitzgerald, W Ye and W Whitehead for the Pelvic Floor Disorders Network (PFDN). Validity and reliability of the Modified Manchester questionnaire. Diseases of the Colon and Rectum 2004; 10.1007/s10350-004-0899-y.

Fecal incontinence can greatly impact women's lives. The PFDN team wanted to study how bowel control problems affect women's social, emotional and physical health. They also wanted to learn if common treatments work well. To better answer these questions, the team tested ways to measure bowel problems and their impact on women's daily lives. They wanted to make sure that the questions were accurate, and that they matched women's experiences and feelings.

Each woman in the study completed a survey by telephone. Then, each woman completed the same survey on paper. The surveys were repeated a few days later. This process was done to see if the women answered the questions the same way using different formats. The PFDN team found that women answered the questions similarly, whether by telephone or on paper. The team will use these important surveys for future studies.

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