Vijayan C. P1, Sujatha B. S2
ABSTRACT: Introduction: Anal incontinence reported from other countries ranges from 4% to 14% among postpartum women. Among the Indian women's studies are not available. AIM OF STUDY: 1. Estimating the prevalence of anal incontinence among postpartum Indian women. 2. Assessing the influence of known risk factors for the development of sphincter injury and anal incontinence. Study Design: Cross sectional Study. Study Setting: postpartum clinic, Government Medical College Hospital, Kottayam, Kerala, South India – 686008. Sample: Consecutive 350 women attending the post-partum clinic from January 1st 2012 who were willing to take part in the study. They were examined at six weeks after delivery in the clinic. METHOD: Maternal Demographic and obstetric data were collected through interview and verification of medical records. A standardized questionnaire was the tool used to collect data about anal incontinence. Continence grading scales according to Jorge and Wexeners Scoring System was used to assess severity of symptoms and a score 6 (six) and above was taken as loss of continence. Risk factors of anal incontinence were collected from the medical records – [Age of mother, parity, Body Mass Index, medical history, mode of delivery, duration of labor, birth weight of the baby, perineal tear] Women with anal incontinence were examined for anal sphincter tone, anal grip and anal reflex. Analysis: Prevalence was calculated as a percentage and the associations with risk factors were analyzed using chi square test or fishers’ exact test as the case may be. A Type I error of 0.05 or less was taken as significant association. SUMMARY AND CONCLUSIONS: A cross sectional survey among consecutive willing 350 postpartum women who attended the post natal clinic of the Government Medical College Hospital, Kottayam, six weeks after delivery revealed the following facts: 1) The prevalence of anal incontinence in postpartum women, six weeks after delivery was 2.6% as per Wexner Scoring System with a cutoff score of six (6). 2) The majority had mild incontinence and two (2) women had moderate incontinence. 3) The risk factors for anal incontinence, which showed statistically significant relation are older age (above 30years), high BMI, instrumental delivery, 3rd degree perineal tears, prolonged second stage of labor, Cephalo -Pelvic disproportion and large baby size. 4) The prevalence of anal incontinence is less in Indian population, compared to western population and most of Indian women had mild anal incontinence. This shows that the argument in favor of caesarean section to prevent anal incontinence is baseless. This can be used as an argument to promote vaginal delivery.
