International Journal of Colorectal Disease

, Volume 34, Issue 1, pp 177–180 | Cite as

Obstetric risk factors for early-onset anal incontinence

  • Kristina Drusany Starič
  • Gregor NorčičEmail author
Short Communication



The aim of the study was to identify primiparous pregnant women with a higher risk for early anal incontinence (AI) after labour.


In the retrospective case control study, 133 primiparous women were questioned using the Wexner scoring system, and possible obstetric anal sphincter injuries (OASIS) were assessed using endoanal ultrasonography (EUS) 6–12 weeks after the labour. Obstetric characteristics (possible risk factors) for AI were collected from the maternal medical records. The univariate and multiple regression of maternal, neonatal and labour risk factors were calculated. Cut-off values were set to divide women into groups with higher and lower risk for AI.


The data of 30 primiparous women with and 103 without AI were analysed. Univariate logistic regression of obstetrics characteristics showed that stimulation of labour (RO [95% CI] 3.31 [1.07, 10.28]) and neonatal head circumference (RO [95% CI] 1.36 [1.03, 1.78]) are both associated with AI. With a neonatal head circumference of 34 cm or more (cut-off value), probability for AI was 33%, while below that value, it was just 2%. The incidence of AI was not significantly different between women with surgically repaired OASIS and women without anal sphincter injury.


The findings can assist in the identification of pregnant women at higher risk of AI. The women at higher risk of AI should be given special attention during the labour and specific rehabilitation after the labour.


Faecal incontinence OASIS Labour Neonatal head circumference Oxytocin Risk factors Cut-off values 



The authors are thankful to Ms. Jennifer Kelly for proof-reading the paper.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Statement on human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Eason E, Labrecque M, Marcoux S, Mondor M (2002) Anal incontinence after childbirth. CMAJ 166(3):326–330PubMedPubMedCentralGoogle Scholar
  2. 2.
    Glazener CMA, Abdalla M, Stroud P, Naji S, Templeton A, Russell IT (1995) Postnatal maternal morbidity: extent, causes, prevention and treatment. Br J Obstet Gynaecol 102:282–287CrossRefPubMedGoogle Scholar
  3. 3.
    Halle TK, Salvesen KÅ, Volløyhaug I (2016) Obstetric anal sphincter injury and incontinence 15-23 years after vaginal delivery. Acta Obstet Gynecol Scand 95(8):941–947CrossRefGoogle Scholar
  4. 4.
    Parks AG, Swash M, Urich H (1977) Sphincter denervation in anorectal incontinence and rectal prolapse. Gut 18:656–666CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Gregory WT, Lou JS, Simmons K, Clark AL (2008) Quantitative anal sphincter electromyography in primiparous women with anal incontinence. Am J Obstet Gynecol 198(5):550.e1–550.e6CrossRefGoogle Scholar
  6. 6.
    Dudding TC, Vaizey CJ, Kamm MA (2008) Obstetric anal sphincter injury: incidence, risk factors, and management. Ann Surg 247(2):224–237CrossRefGoogle Scholar
  7. 7.
    Fernando RJ, Sultan AH, Kettle C, Thakar R (2013) Methods of repair for obstetric anal sphincter injury. Cochrane Database Syst Rev (12)Google Scholar
  8. 8.
    Oberwalder M, Dinnewitzer A, Baig MK et al (2004) The association between late-onset anal incontinence and obstetric anal sphincter defects. Arch Surg 139(4):429–432CrossRefPubMedGoogle Scholar
  9. 9.
    Vandervoort AA (2002) Aging of the human neuromuscular system. Muscle Nerve 25:17–25CrossRefPubMedGoogle Scholar
  10. 10.
    Mathé M, Valancogne G, Atallah A, Sciard C, Doret M, Gaucherand P, Beaufils E (2016) Early pelvic floor muscle training after obstetrical anal sphincter injuries for the reduction of anal incontinence. Eur J Obstet Gynecol Reprod Biol 199:201–206CrossRefPubMedGoogle Scholar
  11. 11.
    Fayyad UM, Irani KB (1993) Multi-interval discretization of continuous-valued attributes for classification learning. Chambéry, France: 13th International Joint Conference on Artificial Intelligence, pp 1022–1027Google Scholar
  12. 12.
    Drusany Starič K, Bukovec P, Jakopič K, Zdravevski E, Trajkovik V, Lukanović A (2017) Can we predict obstetric anal sphincter injury? Eur J Obstet Gynecol Reprod Biol 210:196–200CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Gynaecology and ObstetricsUniversity Medical Centre LjubljanaLjubljanaSlovenia
  2. 2.Department of Abdominal SurgeryUniversity Medical Centre LjubljanaLjubljanaSlovenia

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