Anal incontinence & sphincter injury: vaginal childbirth a factor.

HOLLYWOOD, FLA. -- Anatomic anal sphincter injury from vaginal childbirth is significantly associated with anal incontinence and stage IV pelvic organ prolapse, according to a study presented at the annual meeting of the American Urogynecologic Association.

"What is new about this study is that no one has evaluated the etiology of anal incontinence in women with prolapse and/or urinary incontinence," said Dr. Catherine M. Nichols of Virginia Commonwealth University, Richmond.

Historically, neuropathic injury was implicated as the likely cause of anal incontinence. "But what we found was that there is evidence of anatomic anal sphincter injury in the majority of women with anal incontinence who have other pelvic floor disorders," she said.

In addition, "a major factor in the development of anal incontinence in this population is anatomic anal injury occurring during vaginal childbirth many years previous," Dr. Nichols noted.

She and her colleagues assessed 51 women over age 35 years with stage II or greater pelvic organic prolapse (7 women), urinary incontinence (15 women), or both (29 women). Incontinence types included stress, urge, and mixed.

The mean age was 58 years and the mean BMI was 30.5. All participants had at least one prior vaginal delivery.

Exclusion criteria included irritable bowel syndrome, irritable bowel disease, or a presenting complaint of anal incontinence.