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Pregnancy and Incontinence: What is it and Why does it Happen?

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Pregnant woman stressed from incontinence

Pregnancy can be a time of wonder and anticipation. And, for many women, it may also be a time that includes unpleasant challenges. Early in the pregnancy, many women begin experiencing the inability to control gas (flatus), and involuntary loss of feces and urine. Although this may be temporary, unfortunately, some instances of urinary, fecal and flatal incontinence that occurs during pregnancy has been found to continue post delivery.

Causes of Incontinence

The stress of pregnancy and the birthing process can lead to injury of the anal sphincter as well as the area of the perineum. Studies have found that nearly 1 in 3 women who experience this injury also experience problems with involuntary loss of both feces and flatus. [1] The degree of the trauma to the perineal area contributes to whether a women is likely to experience urinary, fecal or flatal (gas) incontinence. Women who experience the most severe anal sphincter and perineal tears tend to have the greatest challenge controlling gas and fecal release. [2] [3]

Age and Number of Children are Prime Factors

Women who have had multiple vaginal deliveries have been found to have a higher incidence of anal incontinence. [4] The occurrence of this problem increases with subsequent pregnancies and age. One study found that a third delivery was the proverbial straw, as women were much more likely to experience long-term problems with uncontrollable gas, anal and urinary incontinence following a third pregnancy than after the first two deliveries. [5]

Additional Risk Factors

Researchers have also found that deliveries which require instruments have an increased likelihood of trauma and tearing. More women report problems controlling fecal release following a delivery by forceps. [6] Vacuum extraction also appears to contribute to this problem; one study examining the impacts of vacuum delivery reported a higher incidence of chronic incontinence with women who delivered by this method. [7]

Is Incontinence Avoidable?

In an effort to prevent the trauma and tearing that can result from vaginal delivery, many doctors perform episiotomies. However, a recent study has found that episiotomy provides little protection against these problems. [8] Another study explored the impact of perineal massage performed during pregnancy as a way to alleviate problems after delivery. The results found perineal massage provided little protection for perineal function after the delivery. [9]

Despite the best efforts of doctors to reduce trauma to the anal and perineal areas, further studies have reported that anal incontinence effects many women regardless of how they delivered. [10]

The Long-term Outlook

The problems of fecal, flatal and urinary incontinence can have a significant impact on the quality of life for a woman after delivery. There is some good news, however, for expecting mothers. Some researchers have reported that the majority of incontinence suffered during pregnancy and the postpartum period is a temporary problem. [11]

Many experts believe that the best solution is to speak openly with your health care provider when incontinence is experienced, either prior to or after delivery. [12] An open conversation with a health care professional can provide insight into your specific situation and help select the proper remedy.

-Dr. Edward F. Group III, DC, ND, DACBN, DABFM

References:

  1. Kumar R, Ooi C, Nicoll A. Anal incontinence and quality of life following obstetric anal sphincter injury. Arch Gynecol Obstet. 2012 Mar;285(3):591-7. doi: 10.1007/s00404-011-2003-x. Epub 2011 Jul 29.
  2. Gjessing H, Backe B, Sahlin Y. Third degree obstetric tears; outcome after primary repair. Acta Obstet Gynecol Scand. 1998 Aug;77(7):736-40.
  3. Bols EM, Hendriks EJ, Berghmans BC, Baeten CG, Nijhuis JG, de Bie RA. A systematic review of etiological factors for postpartum fecal incontinence. Acta Obstet Gynecol Scand. 2010 Mar;89(3):302-14. doi: 10.3109/00016340903576004.
  4. Fornell EU, Matthiesen L, Sjödahl R, Berg G. Obstetric anal sphincter injury ten years after: subjective and objective long term effects. BJOG. 2005 Mar;112(3):312-6.
  5. Ryhammer AM, Bek KM, Laurberg S. Multiple vaginal deliveries increase the risk of permanent incontinence of flatus urine in normal premenopausal women. Dis Colon Rectum. 1995 Nov;38(11):1206-9.
  6. O’Boyle AL, O’Boyle JD, Magann EF, Rieg TS, Morrison JC, Davis GD. Anorectal symptoms in pregnancy and the postpartum period. J Reprod Med. 2008 Mar;53(3):151-4.
  7. Sundquist JC. Long-term outcome after obstetric injury: a retrospective study. Acta Obstet Gynecol Scand. 2012 Jun;91(6):715-8. doi: 10.1111/j.1600-0412.2012.01398.x. Epub 2012 Apr 30.
  8. Fritel X, Schaal JP, Fauconnier A, Bertrand V, Levet C, Pigné A. Pelvic floor disorders 4 years after first delivery: a comparative study of restrictive versus systematic episiotomy. BJOG. 2008 Jan;115(2):247-52. Epub 2007 Oct 25.
  9. Labrecque M, Eason E, Marcoux S. Randomized trial of perineal massage during pregnancy: perineal symptoms three months after delivery. Am J Obstet Gynecol. 2000 Jan;182(1 Pt 1):76-80.
  10. Nygaard IE, Rao SS, Dawson JD. Anal incontinence after anal sphincter disruption: a 30-year retrospective cohort study. Obstet Gynecol. 1997 Jun;89(6):896-901.
  11. Mellier G, Delille MA. [Urinary disorders during pregnancy and post-partum]. Rev Fr Gynecol Obstet. 1990 Oct;85(10):525-8.
  12. Rasmussen JL, Ringsberg KC. Being involved in an everlasting fight–a life with postnatal faecal incontinence. A qualitative study. Scand J Caring Sci. 2010 Mar;24(1):108-15. doi: 10.1111/j.1471-6712.2009.00693.x. Epub 2009 Oct 11.

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