Department of Physiotherapy, Østfold Hospital Trust, Fredrikstad, Norway; Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
BJOG. 2014 Feb;121(3):269-79. doi: 10.1111/1471-0528.12438. Epub 2013 Sep 10.
To evaluate the prevalence and predictors of anal incontinence (AI) in late pregnancy and 1 year after delivery.
Prospective population-based cohort study.
Two maternity units in Norway 2009-2010.
Primiparae aged 18 years or over.
Primiparae answered questions on the St. Mark's score about AI during the last 4 weeks of pregnancy. One year later, the same questionnaires were distributed by postal mail. Socio-economic and delivery-related data were obtained from hospital records.
Self-reported AI.
Answers on AI in late pregnancy were obtained from 1571 women, and 1030 responded 1 year later. Twenty-four per cent experienced one and 4.7% experienced three or more AI symptoms in late pregnancy. One year later, this was reduced to 19% and 2.2%, respectively. Multivariate logistic regression analyses were applied. Formed and loose stool incontinence were strongly associated at both time points. The main predictor of AI 1 year after delivery was AI in late pregnancy. Obstetric anal sphincter injury increased the risk of incontinence of stool and flatus (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.7-9.6) after delivery. Urgency was associated with greater age (OR, 1.8; 95% CI, 1.0-3.3) and operative delivery (OR, 2.0; 95% CI, 1.3-2.9).
One in four primiparae experienced AI in late pregnancy. One year later, still one in five suffered from incontinence. Sphincter injury predicted incontinence of stool and flatus, whereas greater age and operative delivery predicted urgency. The identification and adequate follow-up of pregnant women with AI may reduce AI after delivery.
评估妊娠晚期和产后 1 年肛门失禁（AI）的患病率和预测因素。
前瞻性基于人群的队列研究。
挪威的两个产科单位 2009-2010 年。
年龄在 18 岁及以上的初产妇。
初产妇在妊娠最后 4 周时回答圣马克评分关于 AI 的问题。一年后，通过邮寄问卷的方式发放相同的问卷。社会经济和分娩相关数据从医院记录中获得。
自我报告的 AI。
在妊娠晚期获得了 1571 名女性的 AI 答案，其中 1030 名在 1 年后做出了回应。24%的女性在妊娠晚期经历了 1 次 AI 症状，4.7%的女性经历了 3 次或更多 AI 症状。一年后，这一比例分别下降到 19%和 2.2%。应用多元逻辑回归分析。成形和松散粪便失禁在两个时间点都有很强的相关性。产后 1 年 AI 的主要预测因素是妊娠晚期的 AI。产科肛门括约肌损伤增加了产后粪便和气体失禁的风险（比值比[OR]，4.1；95%置信区间[CI]，1.7-9.6）。急迫与更大的年龄（OR，1.8；95%CI，1.0-3.3）和剖宫产（OR，2.0；95%CI，1.3-2.9）相关。
四分之一的初产妇在妊娠晚期经历 AI。一年后，仍有五分之一的人患有失禁。括约肌损伤预测粪便和气体失禁，而年龄较大和剖宫产则预测急迫。对患有 AI 的孕妇进行识别和充分随访可能会减少产后 AI 的发生。
