Symptoms of Anal and Urinary Incontinence Following Cesarean Section or Spontaneous Vaginal Delivery

Abstract

Evidence is accumulating that vaginal delivery has adverse effects on the integrity of the pelvic floor, and many women today request elective cesarean delivery in the hope of avoiding postpartum pelvic floor dysfunction. It is not, however, certain that operative delivery does protect against pelvic floor dysfunction in the long term. This study compared the prevalence of urinary and anal incontinence in 200 women having only spontaneous vaginal deliveries and 195 having only cesarean deliveries for 10 years after the index delivery. A self-administered questionnaire provided information on lower urinary tract and anorectal symptoms. At the time of the study, women in the vaginal delivery and cesarean section groups had average ages of 40 and 41.5 years, respectively. Episodes of stress urinary incontinence and the use of protective pads both were more frequent in the vaginal delivery group. There were, however, no significant group differences in symptoms of urinary urgency or urge incontinence. Fecal urgency, but not stool incontinence, was significantly increased in the vaginal delivery group. A majority of women in both groups with severe stress and urge urinary incontinence, who had symptoms at least once a week, also had flatus incontinence. Apart from an increased risk of flatus incontinence in women with a history of obstetrical injury to the anal sphincter, multivariate regression analysis disclosed no significant association between mode of delivery and symptoms of incontinence. The investigators conclude that, at least for 10 years after initial delivery, cesarean section is not associated with a major reduction in urinary or anal incontinence compared with vaginal delivery.