Anal incontinence during postpartum period: a community based cross sectional study

Abstract

INTRODUCTION: Anal incontinence is regarded as the "unvoiced symptom". It has a negative impact on the quality of life of the sufferer. The commonest cause in women in the reproductive age group is child birth and it is important to determine the burden of anal incontinence and identify possible risk factors in order to improve the quality of intra partum and postpartum care. OBJECTIVE: To determine the frequency and severity of anal incontinence among post partum mothers in Vavuniya district and to identify factors associated with it. METHODS: A community based cross sectional study was conducted. Sample included all mothers (hospital and home deliveries) who had completed postpartum period between 1st August and 30th September 2007. They were identified from the "expected date of delivery" registers maintained by Public Health Midwives (PHMs). Data were collected by trained PHMs at the respondents' houses using an interviewer administered questionnaire. RESULTS: The mean age of the 540 postpartum mothers interviewed was 28 (range: 16 - 44) years. Majority 78 % (n=423) were Sri Lankan Tamils, 13 %(n=68) Sinhalese and remaining 9%(n=49) Moors. Thirty nine percent (n=209) of them were primi parous. Eighty one percent (n=435) had a normal vaginal delivery and 79% (n=344) of them had an episiotomy. Eighty nine mothers complained of anal incontinence giving a prevalence of 16.5% (95% Cl: 13.4 - 19.6). Among them 94.4% (n=84) considered it as a minor problem and only 39.3% (n=35) had consulted a health worker for the symptom. Risk factors for anal incontinence according to descending order of risk included, having an episiotomy (OR= 5.06; 95%CI: 2.60-9.86), vaginal delivery (OR=4.58; 95% Ci: 1.63-12.84), primi parity (OR= 3.45; 95% Cl: 2.25 -5.21), family income above Rs5000/- per month (OR-1.92; 95% Cl: 1.21 - 3.04) and duration of labour (OR= 1.81; 95% Cl : 1.15-2.87) CONCLUSION: Anal incontinence is not an uncommon symptom in postpartum mothers and majority of affected individuals avoid seeking medical attention. Factors associated with increased risk of anal sphincter damage should be considered during delivery and an attempt should be taken to reduce it.