Prevalence and Risk Factors Associated with Anal Incontinence among Nulliparous Parturients with Vaginal Delivery in a Nigerian Hospital

Objectives: Anal incontinence may complicate childbirth and this has been grossly under-reported. This study aimed at determining the prevalence and risk factors associated with anal incontinence among nulliparous women undergoing vaginal delivery at a tertiary healthcare center in Nigeria.

Methods: A longitudinal study carried out among 293 nulliparous women delivered vaginally at Ekiti State University Teaching Hospital, Ado-Ekiti between January and March, 2012. Questionnaires were administered at index delivery, nine months and five years assessing for socio-demographic data, subsequent deliveries and anorectal symptoms. Women with sphincter tear at first delivery were compared with women without such injury while risk factors associated with anal incontinence were determined.

Results: A total of 186 women were analysed and prevalence of anal incontinence increased significantly over the study period. Among women with sphincter tear at index delivery, 27.3% and 36.4% of them had anal incontinence at 9 months and 5years respectively, p= 0.002 and among those without sphincter injury, 8.6% and 16.6% of them reported symptoms of anal incontinence at 9 months and 5years respectively, p= 0.037. Maternal age, sphincter tear at index delivery and subsequent vaginal delivery were associated with anal incontinence at 5yrs, p < 0.05. Majority of women with symptoms had flatus incontinence while faecal incontinence was rare.

Conclusion: Though not routinely screened for, anal incontinence does occur among our parturients after the index delivery. It can get worsened with subsequent vaginal deliveries especially if complicated by anal sphincter injury.