B006 A Systematic Review of the Efficacy of Cesarean Section in the Preservation of Anal Continence

Abstract

Objective Elective primary Cesarean section is performed largely to avoid maternal pelvic trauma that may result in anal incontinence. Its efficacy in this regard has not been thoroughly assessed.Methods The search was from 1966 through August, 2005, including both randomized and nonrandomized reports. Eligible studies included women having either vaginal delivery or Cesarean (C) section. Faecal and/or flatal incontinence was reported as an outcome and risk was calculable from the reported data. In the nonrandomized studies adjusted odds ratios were also extracted and additional data obtained from authors to adjust risks for age and parity. Sensitivity analyses were done using quality indicators – age and parity adjustment, time to continence assessment and mode of prior delivery.Results A total of 15 studies were found eligible, encompassing 3010 C sections and 11 440 vaginal deliveries. The summary relative risk for faecal incontinence was 0.91, 95% CI = 0.74–1.14, for flatus; 0.98, (0.86–1.13). The number needed to treat by C. section was 167 to prevent a single case of faecal incontinence. In five studies judged to be of high quality, the summary relative risk was 0.94 (0.72–1.22) and number needed to treat 198.Conclusion Caesarian section does not prevent anal incontinence. The incontinence associated with delivery may in fact be incontinence caused by pregnancy.