Prevalence of postpartum anal incontinence: a cross sectional study in Northern Sri Lanka

Abstract

OBJECTIVES: To estimate the prevalence of postpartum anal incontinence (AI) and to highlight associated factors that account for variation in the prevalence in Vavuniya district in Northern Sri Lanka. 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. Participants were identified from the "expected date of delivery" registers maintained by public health midwives. Data were collected by trained public health midwives at the respondents' houses using an interviewer administered questionnaire. RESULTS: The mean age of the 540 postpartum mothers interviewed was 28 years (range: 16 - 44). Majority 78% (n=423) were Sri Lankan Tamils, 13% (n=68) Sinhalese and remaining 9% (n=49) Moors. Thirty nine percent (n=209) were primi parous, 81% (n=435) had a normal vaginal delivery and 79% (n=344) had an episiotomy. Out of 540 mothers, 16.5% (95% CI: 13.4 - 19.6) reported anal incontinence. Among them only 39.3% (n=35) had consulted a health worker for the symptom. In the bivariate analysis the following factors were significantly associated with anal incontinence: parity, history of an episiotomy, duration of labour >12hrs, mode of delivery (vaginal), family income and maternal age (teenage). But the multiple logistic regression analysis revealed only the episiotomy status as an independent risk factor (adjusted odd ratio: 3.4 (95% CI: 1.28 - 8.9). CONCLUSIONS: Anal incontinence is not an uncommon symptom in postpartum mothers and majority of affected individuals avoided seeking medical attention. Factors associated with increased risk of anal sphincter damage should be considered during delivery and an attempt should be made to reduce it