A systematic review of etiological factors for postpartum fecal incontinence

E.M. Bols, E.J. Hendriks, B.C. Berghmans, C.G.M.I. Baeten, J.G. Nijhuis, R.A. de Bie

Research output: Contribution to journalArticleAcademicpeer-review

40 Citations (Scopus)

Abstract

Abstract Background. Conflicting results are reported about the contribution of maternal, obstetric and fetal characteristics to postpartum fecal incontinence (FI), which is hampering prevention and management of FI. Objective. To perform a systematic review identifying delivery-related etiological factors for postpartum FI. Search strategy. Literature searches of PubMed, EMBASE, CINAHL, DocOnline and reference lists from 1980 up to 2009 were conducted. Selection criteria. Prospective cohort studies evaluating maternal, obstetric or fetal risk factors for postpartum FI, with a follow-up period of at least three months, were assessed. We reviewed full reports in English, German or Dutch, with anal incontinence (AI), FI, flatus incontinence, soiling, urgency and FI severity scores as reported outcomes. Data collection and analysis. Data on study characteristics, methodological quality and outcome were extracted from 31 studies according to a standardized protocol. Clinical and methodological sources of heterogeneity permitted only a qualitative analysis. Main results. A third- or fourth-degree sphincter rupture was the only etiological factor strongly (AI) or moderately (flatus incontinence) associated with postpartum FI. No association with other postulated risk factors was found, for example, birth weight or instrumental delivery. The potential co-existence of different risk factors impedes the interpretation of the influence of a single delivery-related risk factor. Conclusions. This systematic review, including only longitudinal studies and recognizing the importance of separating results for different outcomes, identifies that a third- or fourth-degree sphincter rupture is the only factor that is strongly (AI) or moderately (flatus incontinence) associated with postpartum FI.
Original languageEnglish
Pages (from-to)302-314
Number of pages13
JournalActa Obstetricia et Gynecologica Scandinavica
Volume89
Issue number3
DOIs
Publication statusPublished - Mar 2010

Keywords

  • Delivery
  • etiology
  • fecal incontinence
  • postpartum
  • systematic review
  • ANAL-SPHINCTER INJURY
  • OBSTETRIC RISK-FACTORS
  • VAGINAL DELIVERY
  • URINARY-INCONTINENCE
  • PELVIC FLOOR
  • PRIMIPAROUS WOMEN
  • FORCEPS DELIVERY
  • CESAREAN-SECTION
  • TEARS
  • 1ST

Cite this

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title = "A systematic review of etiological factors for postpartum fecal incontinence",
abstract = "Abstract Background. Conflicting results are reported about the contribution of maternal, obstetric and fetal characteristics to postpartum fecal incontinence (FI), which is hampering prevention and management of FI. Objective. To perform a systematic review identifying delivery-related etiological factors for postpartum FI. Search strategy. Literature searches of PubMed, EMBASE, CINAHL, DocOnline and reference lists from 1980 up to 2009 were conducted. Selection criteria. Prospective cohort studies evaluating maternal, obstetric or fetal risk factors for postpartum FI, with a follow-up period of at least three months, were assessed. We reviewed full reports in English, German or Dutch, with anal incontinence (AI), FI, flatus incontinence, soiling, urgency and FI severity scores as reported outcomes. Data collection and analysis. Data on study characteristics, methodological quality and outcome were extracted from 31 studies according to a standardized protocol. Clinical and methodological sources of heterogeneity permitted only a qualitative analysis. Main results. A third- or fourth-degree sphincter rupture was the only etiological factor strongly (AI) or moderately (flatus incontinence) associated with postpartum FI. No association with other postulated risk factors was found, for example, birth weight or instrumental delivery. The potential co-existence of different risk factors impedes the interpretation of the influence of a single delivery-related risk factor. Conclusions. This systematic review, including only longitudinal studies and recognizing the importance of separating results for different outcomes, identifies that a third- or fourth-degree sphincter rupture is the only factor that is strongly (AI) or moderately (flatus incontinence) associated with postpartum FI.",
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author = "E.M. Bols and E.J. Hendriks and B.C. Berghmans and C.G.M.I. Baeten and J.G. Nijhuis and {de Bie}, R.A.",
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language = "English",
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pages = "302--314",
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A systematic review of etiological factors for postpartum fecal incontinence. / Bols, E.M.; Hendriks, E.J.; Berghmans, B.C.; Baeten, C.G.M.I.; Nijhuis, J.G.; de Bie, R.A.

In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 89, No. 3, 03.2010, p. 302-314.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

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AU - Bols, E.M.

AU - Hendriks, E.J.

AU - Berghmans, B.C.

AU - Baeten, C.G.M.I.

AU - Nijhuis, J.G.

AU - de Bie, R.A.

PY - 2010/3

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N2 - Abstract Background. Conflicting results are reported about the contribution of maternal, obstetric and fetal characteristics to postpartum fecal incontinence (FI), which is hampering prevention and management of FI. Objective. To perform a systematic review identifying delivery-related etiological factors for postpartum FI. Search strategy. Literature searches of PubMed, EMBASE, CINAHL, DocOnline and reference lists from 1980 up to 2009 were conducted. Selection criteria. Prospective cohort studies evaluating maternal, obstetric or fetal risk factors for postpartum FI, with a follow-up period of at least three months, were assessed. We reviewed full reports in English, German or Dutch, with anal incontinence (AI), FI, flatus incontinence, soiling, urgency and FI severity scores as reported outcomes. Data collection and analysis. Data on study characteristics, methodological quality and outcome were extracted from 31 studies according to a standardized protocol. Clinical and methodological sources of heterogeneity permitted only a qualitative analysis. Main results. A third- or fourth-degree sphincter rupture was the only etiological factor strongly (AI) or moderately (flatus incontinence) associated with postpartum FI. No association with other postulated risk factors was found, for example, birth weight or instrumental delivery. The potential co-existence of different risk factors impedes the interpretation of the influence of a single delivery-related risk factor. Conclusions. This systematic review, including only longitudinal studies and recognizing the importance of separating results for different outcomes, identifies that a third- or fourth-degree sphincter rupture is the only factor that is strongly (AI) or moderately (flatus incontinence) associated with postpartum FI.

AB - Abstract Background. Conflicting results are reported about the contribution of maternal, obstetric and fetal characteristics to postpartum fecal incontinence (FI), which is hampering prevention and management of FI. Objective. To perform a systematic review identifying delivery-related etiological factors for postpartum FI. Search strategy. Literature searches of PubMed, EMBASE, CINAHL, DocOnline and reference lists from 1980 up to 2009 were conducted. Selection criteria. Prospective cohort studies evaluating maternal, obstetric or fetal risk factors for postpartum FI, with a follow-up period of at least three months, were assessed. We reviewed full reports in English, German or Dutch, with anal incontinence (AI), FI, flatus incontinence, soiling, urgency and FI severity scores as reported outcomes. Data collection and analysis. Data on study characteristics, methodological quality and outcome were extracted from 31 studies according to a standardized protocol. Clinical and methodological sources of heterogeneity permitted only a qualitative analysis. Main results. A third- or fourth-degree sphincter rupture was the only etiological factor strongly (AI) or moderately (flatus incontinence) associated with postpartum FI. No association with other postulated risk factors was found, for example, birth weight or instrumental delivery. The potential co-existence of different risk factors impedes the interpretation of the influence of a single delivery-related risk factor. Conclusions. This systematic review, including only longitudinal studies and recognizing the importance of separating results for different outcomes, identifies that a third- or fourth-degree sphincter rupture is the only factor that is strongly (AI) or moderately (flatus incontinence) associated with postpartum FI.

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KW - etiology

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KW - systematic review

KW - ANAL-SPHINCTER INJURY

KW - OBSTETRIC RISK-FACTORS

KW - VAGINAL DELIVERY

KW - URINARY-INCONTINENCE

KW - PELVIC FLOOR

KW - PRIMIPAROUS WOMEN

KW - FORCEPS DELIVERY

KW - CESAREAN-SECTION

KW - TEARS

KW - 1ST

U2 - 10.3109/00016340903576004

DO - 10.3109/00016340903576004

M3 - Article

VL - 89

SP - 302

EP - 314

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

IS - 3

ER -