Major perineal vaginal delivery trauma tied to fecal incontinence: 6 weeks after childbirth.(Gynecology)

HOLLYWOOD, FLA. -- Major perineal trauma from vaginal delivery increases the risk for fecal incontinence 6 weeks after childbirth, according to a follow-up study in women at low risk for the disorder.

It is estimated that up to 15% of women experience fecal incontinence and up to 40% experience urinary incontinence after vaginal delivery. Both forms of incontinence were assessed in a multiethnic cohort of women participating in the ongoing Function After Childbirth Trial (FACT).

Interim results on 213 women were presented at the annual meeting of the American Urogynecologic Society.

A total of 28% of the participants experienced major perineal trauma, defined as a second-, third-, or fourth-degree laceration and/or deep vaginal tear. Site (anterior or posterior) and severity of perineal trauma was noted. The location and severity was not associated with subsequent urinary incontinence or sexual dysfunction.

"Remarkably, only two women underwent episiotomy, so most women had spontaneous trauma," said Dr. Rebecca Rogers, director of the Women's Health Urogynecology Center at the University of New Mexico, Albuquerque.

All women were attended by a nurse midwifery service. The cohort was young (mean age 25 years), and the mean birth weight was 3,392 g (about 7.5 pounds). The study group was 50% Hispanic, 40% white, and 10% Native American. Follow-up rates were 67% at 6 weeks and 63% at 3 months.

All women completed a modified McGill Pain Questionnaire at discharge. Participants who had major trauma, defined as a second-degree laceration or greater, were no more likely than women without to report perineal pain. At 3 months, only 8% of women report ed perineal pain.