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Postpartum anal incontinence

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Postpartum anal incontinence is a complex disorder that develops mainly in young women and negatively affects their social and professional activity. The aim of this review is to summarize the available literature and current concepts on the etiology, pathogenesis, diagnosis and treatment of postpartum anal incontinence. The prevalence of postpartum anal incontinence varies from 13 to 39 %. The risk factors include vaginal delivery, the use of instrumental methods, age, body mass index > 30, delivery-associated perineal tears, incontinence during pregnancy and smoking. The role of episiotomy in anal incontinence is not clear, some authors note a high risk of median episiotomy compared with mid-lateral one. Diagnosis of anal incontinence is mainly based on clinical examination and history data. The most informative imaging modality is endoanal ultrasound. Treatment of anal incontinence should begin with diet correction and medications for stool control. The efficacy of various treatment programs directed to strengthening the pelvic floor and anal sphincter muscles is controversial and needs further study. Surgical treatment is indicated if the conservative therapy is unsuccessful; the most common methods are sphincteroplasty and electroneuromodulation of the sacral plexus branches. Primary prevention measures for postpartum anal incontinence should focus on eliminating or reducing the risk factors. Special training programs for obstetricians can significantly reduce the number of perineal tears and their severity, as well as reduce the need in obstetric forceps. Secondary prevention steps include the correct choice of the first and subsequent deliveries in women with an increased risk.

About the Authors

A. L. Petrushin
Karpogory Central Regional Hospital
Russian Federation

Alexander L. Petrushin - PhD, Head of Surgery, AR Karpogory CDH.

47 Lenina St, Karpogory, Arkhangelsk Region 164600.

Теl.: +7(921)0767329.

A. V. Pryalukhina
Karpogory Central Regional Hospital
Russian Federation

Anastasiya V. Pryalukhina - Obstetrician-gynecologist, AR Karpogory CDH.

47 Lenina St, Karpogory, Arkhangelsk Region 164600.

Теl.: +7(911)5954550.


1. Abramowitz L. Complications analedurant la grossesse et le post-partum. POSTU. 2014;1-10. Available at:

2. Meyer I., Richter H.E. Impact of fecal incontinence and its treatment on quality of life in women. Women Health (Lond.). 2015;11(2):225-38. DOI: 10.2217/WHE.14.66.

3. Costilla V.C., Foxx-Orenstein A.E., Mayer A.P., Crowell M.D. Office-based management of fecal incontinence. Gastroenterol Hepatol. 2013;9(7):423-33. Available at:

4. Dunivan G.C., Heymen S., Palsson O.S. et al. Fecal incontinence in primary care: prevalence, diagnosis, and health care utilization. Am J Obstet Gynecol. 2010;202(5):493. DOI: 10.1016/j.ajog.2010.01.018.

5. Johannessen H.H., Wibe A., Stordahl A. et al. Prevalence and predictors of anal incontinence during pregnancy and 1 year after delivery: a prospective cohort study. BJOG. 2014;121:269-80. DOI: 10.1111/1471-0528.12438.

6. Johannessen H.H., Wibe A., Stordahl A. et al. Do pelvic floor muscle exercises reduce postpartum anal incontinence? A randomized controlled trial. BJOG. 2017;124:686-94. DOI: 10.1111/1471-0528.14145.

7. Swift S.E. The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol. 2000;183:277-85. DOI: 10.1067/mob.2000.107583.

8. Villot A., Deffieux X., Demoulin G. et al. Priseen charge de l'incontenenceanale du post-partum: revue de litterature. Prog Urol. 2015;25(17):1191-203. DOI: 10.1016/j.purol.2015.06.002.

9. Aliev E.A. Causes and prevention of anal sphincter malfunction. [Prichiny i profilaktika nedostatochnosti sfinktera zadnego prohoda]. Vestnik Nacional'nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2011;6(1):48-54. (In Russ.). Available at:

10. Borello-France D., Burgio K.L., Richter H.E. et al. Fecal and urinary incontinence in primiparous women. Obstet Gynecol. 2006;108:863-72. DOI: 10.1097/01.AOG.0000232504.32589.3b.

11. Espuna-Pons M., Solans-Domenech M., Sanchez E., GRESP. Double incontinence in a cohort of nulliparous pregnant women. Neurourol Urodyn. 2012;31(8):1236-41. DOI: 10.1002/nau.22249.

12. Rommen K., Schei B., Rydning A.H. et al. Prevalence of anal incontinence among Norwegian women: a cross-sectional study. BMJ. 2012;2:e001257. DOI: 10.1136/bmjopen-2012-001257.

13. Brown H.W., Wexner S.D., Segall M.M. et al. Accidental bowel leakage in the mature women’s health study: prevalence and predictors. Int J Clin Pract. 2012;66:1101-8. DOI: 10.1111/ijcp.12018.

14. Hall W., McCracken K., Osterweil P., Guise J-M. Frequency and predictors for postpartum fecal incontinence. Am J Obstet Gynecol. 2003;188:1205-7. DOI: 10.1067/mob.2003.333.

15. Sultan A.H., Kamm M.A., Hudson C.N. Pudendal nerve damage during labour: prospective study before and after childbirth. Int J Obstet Gynaecol. 1994;101(1):22-8. DOI: 10.1111/j.1471-0528.1994.tb13005.x.

16. Guise J.M., Morris C., Osterweil P. et al. Incidence of fecal incontinence after childbirth. Obstet Gynecol. 2007;109:281-8. DOI: 10.1097/01.AOG.0000254164.67182.78.

17. Parant O., Simon-Toulza C., Cristini C. et al. Faecal incontinence after first instrumental vaginal delivery using Thierry’s spatulas. Int Urogynecol J. 2010;21:1195-203. DOI: 10.1007/s00192-010-1176-3.

18. Yang X., Zhang H.X., Yu H.Y. et al. The prevalence of fecal incontinence and urinary incontinence in primiparous postpartum Chinese women. Eur J Obstet Gynecol Reprod Biol. 2010;152:214-7. DOI: 10.1016/j.ejogrb.2010.05.031.

19. Chan S.S.C., Cheung R.Y.K., Yiu K.W. et al. Prevalence of urinary and fecal incontinence in Chinese women during and after their first pregnancy. Int Urogynecol J. 2013;24:1473-9. DOI: 10.1007/s00192-012-2004-8.

20. Nordenstam J., Altman D., Brismar S., Zetterstrom J. Natural progression of anal incontinence after childbirth. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1029-35. DOI: 10.1007/s00192-009-0901-2.

21. MacArthur C., Glazener C., Lancashire R. et al. Faecal incontinence and mode of first and subsequent delivery: a six-year longitudinal study. BJOG. 2005;112:1075-82. DOI: 10.1111/j.1471-0528.2005.00721.x.

22. Abramowitz L., Sobhani I., Ganansia R. et al. Are sphincter defects the cause of anal incontinence after vaginal delivery? Results of a prospective study. Dis Colon Rectum. 2000;43:590-8. DOI: 10.1007/BF02235567.

23. Pretlove S.J., Thompson P.J., Toozs-Hobson P.M. et al. Does the mode of delivery predispose women to anal incontinence in the first year postpartum? A comparative systematic review. BJOG. 2008;115:421-34. DOI: 10.1111/j.1471-0528.2007.01553.x.

24. Pollack J., Nordenstam J., Brismar S. et al. Anal incontinence after vaginal delivery: a five-year prospective cohort study. Obstet Gynecol. 2004;104:1397-402. DOI: 10.1097/01.AOG.0000147597.45349.e8.

25. La Cross A., Groff M., Smaldone A. Obstetric anal sphincter injury and anal incontinence following vaginal birth: a systematic review and meta-analysis. J Midwifery Womens Health. 2015;60:37-47. DOI: 10.1111/jmwh.12283.

26. Fitzpatrick M., Behan M., O’Connell P.R., O’Herlihy C. Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery. BJOG. 2003;110:424-9. DOI: 10.1046/j.1471-0528.2003.02173.x.

27. Johannessen H.H., Wibe A., Stordahl A. et al. Anal incontinence among first time mothers - What happens in pregnancy and the first year after delivery? Acta Obstet Gynecol Scand. 2015;94:1005-13. DOI: 10.1111/aogs.12689.

28. Signorello L.B., Harlow B.L., Chekos A.K., Repke J.T. Midline episiotomy and anal incontinence: retrospective cohort study. BMJ. 2000;320:86-90. DOI: 10.1136/bmj.320.7227.86.

29. Van Bavel J., Hukkelhoven C.W.P.M., de Vries C. et al. The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: a ten-year analysis of national registry. Int Urogynecol J. 2018:29:407. DOI: 10.1007/s00192-017-3422-4.

30. Snooks S.J., Swash M., Mathers S.E., Henry M.M. Effect of vaginal delivery on the pelvic floor: a 5-year follow-up. Br J Surg. 1990;77:1358-60. DOI: 10.1002/bjs.1800771213.

31. Fynes M., Donnelly V., Behan M. et al. Effect of vaginal delivery on anorectal physiology and faecal continence: a prospective study. Lancet. 1999;354:983-6. DOI: 10.1016/S0140-6736(98)11205-9.

32. Ryhammer A.M., Laurberg S., Hermann A.P. Long-term effect of vaginal deliveries on anorectal function in normalperimenopausal women. Dis Colon Rectum. 1996;39:852-9. DOI: 10.1007/BF02053982.

33. Andrews V., Sultan A.H., Thakar R., Jones P.W. Occult anal sphincter injuries-myth or reality? BJOG. 2006;113:195-200. DOI: 10.1111/j.1471-0528.2006.00799.x.

34. Musaev Kh.N., Mamedov M.M., Akhundova N.N. Long-term results of surgical treatment of postpartum perineal tears. [Otdalennye rezul'taty hirurgicheskogo lecheniya poslerodovyh razryvov promezhnosti]. Vestnikhirurgii Kazahstana. 2010;(1):72. (In Russ.). Available at:

35. Johnson J.K., Lindow S.W., Duthie G.S. The prevalence of occult obstetric anal sphincter injury following childbirth-literature review. J Matern Fetal Neonatal Med. 2007;20:547-54. DOI: 10.1080/14767050701412917.

36. Laine K., Gissler M., Pirhonen J. Changing incidence of anal sphincter tears in four nordic countries through the last decades. Eur J Obst Gynecol. 2009;146(1):71-5. DOI: 10.1016/j.ejogrb.2009.04.033.

37. Markland A.D., Goode P.S., Burgio K.L. et al. Incidence and risk factors for fecal incontinence in black and white older adults: a population-based study. J Am Geriatr Soc. 2010;58:1341-6. DOI: 10.1111/j.1532-5415.2010.02908.x.

38. Sultan A.H., Kamm M.A., Hudson C.N. et al. Anal-sphincter disruption during vaginal delivery. N Eng J Med. 1993;329:1905-11. DOI: 10.1056/NEJM199312233292601.

39. Pinta T.M., Kylanpaa M., Salmi T.K. et al. Primary sphincter repair: are the results of the operation good enough? Dis Colon Rect. 2004;47(1):18-23. DOI: 10.1007/s10350-003-0006-9.

40. Sultanova S.G.. Structure, diagnosis, prevention and treatment of postoperative complications of perineal labor ruptures, complicated by anal incontinence. [Struktura, diagnostika, profilaktika i lechenie posleoperacionnyh oslozhnenij rodovyh razryvov promezhnosti, oslozhnennyh anal'noj inkontinenciej]. Kazanskijmedicinskijzhurnal. 2015;96(5):779-83. (In Russ.). Available at:

41. Kuismanen, K., Nieminen, K., Karjalainen, K. et al. Outcomes of primary anal sphincter repair after obstetric injury and evaluation of novel three-choice assessment. Tech Coloproctol. 2018;22:209. DOI: 10.1007/s10151-018-1770-9.

42. Paquette I.M., Varma M.G., Kaiser A.M. et al. The American Society of Colon and Rectal Surgeons' clinical practice guideline for the treatment of fecal incontinence. Dis Colon Rectum. 2015;58:623-36. DOI: 10.1097/DCR.0000000000000397.

43. Vitton V., Soudan D., Siproughis L. et al. Treatment of faecal incontinence: recommendations from French National Society of Coloproctology. Colorectal Dis. 2013;16:159-66. DOI: 10.1111/codi.12410.

44. Pinsk I., Brown J., Phang P.T. Assessment of sonographic quality of anal sphincter muscles in patients with faecal incontinence. Colorectal Dis. 2009;11:933-40. DOI: 10.1111/j.1463-1318.2008.01730.x.

45. Bharucha A.E., Zinsmeister A.R., Schleck C.D, Melton L.J. Bowel disturbances are the most important risk factors for late onset fecal incontinence: a population-based case-control study in women. Gastroenterol. 2010;139:1559-66. DOI: 10.1053/j.gastro.2010.07.056.

46. Hansen J.L., Bliss D.Z., Peden-McAlpine C. Diet strategies used by women to manage fecal incontinence. J Wound Ostomy Continence Nurs. 2006;33(1):52-61.

47. Omar M.I., Alexander C.E. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;6:CD002116. Available at:

48. Cheetham M.J., Kamm M.A., Phillips R.K.S. Topical phenylephrine increases anal canal resting pressure in patients with faecal incontinence. Gut. 2001;48:356-9. DOI: 10.1136/gut.48.3.356.

49. Damon H., Siproudihis L., Faucheron J.L. et al. Perineal retraining improves conservative treatment for faecal incontinence: A multicenter randomized study. Dig Liver Dis. 2013;46(3):237-42. DOI: 10.1016/j.dld.2013.11.002.

50. Glazener C.M., Herbison G.P., Wilson P.D. et al. Conservative management of persistent postnatal urinary and faecalincontinence: randomized controlled trial. BMJ. 2001;323:593-6. DOI: 10.1136/bmj.323.7313.593.

51. Wilson P.D., Herbison G.P. A randomized controlled trial of pelvic floor muscle exercises to treat postnatal urinary incontinence. Int Urogynecol JPelvic Floor Dysfunct. 1998;9:257-64. DOI: 10.1007/BF01901501.

52. Peirce C., Murphy C., Fitzpatrick M. et al. Randomized controlled trial comparing early home biofeedback physiotherapy with pelvic floor exercises for the treatment of third-degree tears (EBAPT Trial). BJOG. 2013;120:1240-7. DOI: 10.1111/1471-0528.12194.

53. Norton C., Cody J.D. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Cochrane Database Syst Rev. 2012;7:CD002111. Available at:

54. Deutekom M., Dobben A.C. Plugs for containing faecal incontinence. Cochrane Database Syst Rev. 2012;4:CD005086. Available at:

55. Bond C., Youngson G., MacPherson I. et al. Anal plugs for the management of fecal incontinence in children and adults: a randomized control trial. J Clin Gastroenterol. 2007;41(1):45-53. DOI: 10.1097/MCG.0b013e31802dcba5.

56. Meurette G., Duchalais E., Lehur P.A. Surgical approaches to fecal incontinence in the adult. J Visc Surg. 2014;151:29-39. DOI: 10.1016/j.jviscsurg.2013.12.011.

57. Lehur P.A., Meurette G. Chirurgie de l’incontinenceanale de l’adulte. In: EMC - Techniques chirurgicales - Appareil digestif. Paris: Elsevier Masson SAS, 2008. 1-16.

58. Brown S.R., Wadhawan H., Nelson R.L. Surgery for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;7:CD001757. Available at:

59. Ibragimli Sh.F., Israfilbeyli S.G., Akhundov I.T., Gasanova M.G. Determination of radical surgery timing for long-term III-degree perineal ruptures. [Opredelenie srokov radikal'noj operacii pri staryh razryvah promezhnosti III stepeni]. Harkivs'ka hirurgichna shkola. 2011;(5):110-2. (In Russ.). Available at:

60. Glasgow S.C., Lowry A.C. Long-term outcomes of anal sphincter repair for fecal incontinence: a systematic review. Dis Colon Rectum. 2012;55:482-90. DOI: 10.1097/DCR.0b013e3182468c22.

61. Gutierrez A.B., Madoff R.D., Lowry A.C. et al. Long-term results of anterior sphincteroplasty. Dis Colon Rectum. 2004;47:727-32. DOI: 10.1007/s10350-003-0114-6.

62. Thornton M.J., Kennedy M.L., Lubowski D.Z., King D.W. Long-term follow-up of dynamic graciloplasty for faecal incontinence. Colorectal Dis. 2004;6:470-6. DOI: 10.1111/j.1463-1318.2004.00714.x.

63. Kaiser A.M., Orangio G.R., Zutshi M. et al. Current status: new technologies for the treatment of patients with fecal incontinence. Surg Endosc. 2014;28:2277-301. DOI: 10.1007/s00464-014-3464-3.

64. Ratto C., Litta F., Parello A. et al. Sacral nerve stimulation in faecal incontinence associated with an anal sphincter lesion: a systematic review. Colorectal Dis. 2012;14:e297-304. DOI: 10.1111/j.1463-1318.2012.03003.x.

65. Maeda Y., Laurberg S., Norton C. Perianal injectable bulking agents as treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;2:CD007959. DOI: 10.1002/14651858.CD007959.pub3.

66. Wong M.T., Meurette G., Wyart V. et al. The artificial bowel sphincter: a single institution experience over a decade. Ann Surg. 2011;254:951-6. DOI: 10.1097/SLA.0b013e31823ac2bc.

67. Wexner S.D., Jin H.Y., Weiss E.G. et al. Factors associated with failure of the artificial bowel sphincter: a study of over 50 cases from Cleveland Clinic Florida. Dis ColRect. 2009;52:1550-7. DOI: 10.1007/DCR.0b013e3181af62f8.

68. Laine K., Rotvold W., Staff A.C. Are obstetric anal sphincter ruptures preventable? Large and consistent rupture rate variations between the Nordic countries and between delivery units in Norway. Acta Obstet GynecolScand. 2012;92:94-100. DOI: 10.1111/aogs.12024.

69. Stafne S.N., Salvesen K.A., Romundstad P.R. et al. Does regular exercise including pelvic floor muscle training prevent urinary and anal incontinence during pregnancy? A randomized controlled trial. BJOG. 2012;119:1270-80. DOI: 10.1111/j.1471-0528.2012.03426.x.

70. Mc Kenna D.S., Ester J.B., Fischer J.R. Elective cesarean delivery for women with a previous anal sphincter rupture. Am J Obstet Gynecol. 2003;189:1251-6. DOI: 10.1067/S0002-9378(03)00621-5.


For citations:

Petrushin A.L., Pryalukhina A.V. Postpartum anal incontinence. Obstetrics, Gynecology and Reproduction. 2019;13(1):50-62. (In Russ.)

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