Dupuis O, Madelenat P, Rudigoz R-C
Service de gynécologie-obstétrique, hôpital de la Croix-Rousse, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon 04, France.
Gynecol Obstet Fertil. 2004 Jun;32(6):540-8. doi: 10.1016/j.gyobfe.2004.02.020.
This study was undertaken to review the available data on urinary and fecal incontinence and their association with maternal as well as fetal per partum characteristics.
A Pubmed (Medline search performed between 1999 and 2003 using "urinary incontinence and delivery" and "fecal incontinence and delivery" identified 501 relevant papers. Most of them are retrospective analyses whereas few are randomized controlled trials (RCT).
Two studies performed with computer-stored databases analyzed the risk factors of incontinence among 2,886,126 deliveries. Primiparity, birthweight over 4000 g and all types of assisted vaginal deliveries significantly increased the risk of anal sphincter damage. Results concerning the effect of episiotomy are conflicting. Controlled randomized trials have shown that pelvic floor muscle training during pregnancy as well as planned cesarean section significantly and moderately decrease the risk of urinary incontinence. The only RCT available has shown that planned cesarean section did not reduce significantly incontinence of flatus. Finally the only trial that compare surgical techniques used to repair the anal sphincter did not show any significant difference.
Risk factors for anal sphincter damage during delivery are well known. RCT focusing on how to prevent and how to cure fecal as well as urinary incontinence are urgently needed.
本研究旨在回顾关于尿失禁和粪失禁的现有数据，以及它们与产妇和胎儿分娩期特征的关联。
在1999年至2003年间，使用“尿失禁与分娩”和“粪失禁与分娩”在PubMed（医学文献数据库）中进行检索，共识别出501篇相关论文。其中大多数是回顾性分析，只有少数是随机对照试验（RCT）。
两项利用计算机存储数据库进行的研究分析了2,886,126例分娩中失禁的危险因素。初产、出生体重超过4000克以及所有类型的阴道助产均显著增加了肛门括约肌损伤的风险。关于会阴切开术影响的结果存在矛盾。对照随机试验表明，孕期盆底肌肉训练以及计划剖宫产可显著且适度降低尿失禁的风险。唯一可用的RCT表明，计划剖宫产并未显著降低排气失禁的发生率。最后，唯一一项比较用于修复肛门括约肌的手术技术的试验未显示出任何显著差异。
分娩期间肛门括约肌损伤的危险因素已为人熟知。迫切需要开展聚焦于如何预防和治疗粪失禁及尿失禁的随机对照试验。
