n South African Journal of Obstetrics and Gynaecology - Postpartum anal incontinence in a resource-constrained setting : prevalence and obstetric risk factors : research

Volume 20, Issue 1
  • ISSN : 0038-2329
  • E-ISSN: 2078-5135



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

To show that AI is common in a resource-constrained setting and that obstetric factors contribute to its development.
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.
The median age of the 1 248 participants was 24 years (range 13 - 45 years). The majority were black Africans (=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% (=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.
Postpartum AI is common in our resource-constrained setting and appears to be transient, with most cases resolving by 6 months.

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