Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
Acta Obstet Gynecol Scand. 2019 Jan;98(1):51-60. doi: 10.1111/aogs.13463. Epub 2018 Oct 29.
Uncertainties remain as to whether a cesarean section is protective for the short-term and long-term development of anal incontinence. Our aim was to explore whether women who had delivered only vaginally were at greater risk of anal incontinence than nulliparous women and women who had undergone cesarean sections only.
Background information, medical history, and data on anal incontinence (defined as fecal or flatus incontinence weekly or more) reported by women participating in a large population-based health survey in Norway (the Nord-Trøndelag Health Study 3) during the period October 2006 to June 2008 were collected and linked to data from the Medical Birth Registry of Norway. The prevalence of anal incontinence was calculated and multivariate logistic regression analyses were applied.
The mean age of the 12 567 women was 49.9 years. The age and educational level of women who had cesarean sections only were similar to those who had a vaginal delivery and obstetric anal sphincter injuries (OASIS). Nulliparous women and those who had a vaginal delivery and no OASIS were older and had higher educational achievements than women who had delivered by cesarean section exclusively, and women with OASIS. One in four women with OASIS reported anal incontinence compared with one in six of the other women (P < .001). Age, educational level, diarrhea, constipation, birthweight, and OASIS increased the risk of anal incontinence in all women. Parity was associated with anal incontinence in parous women only. No differences were found for fecal urgency.
Women with vaginal deliveries complicated by OASIS are at increased risk of anal incontinence. However, no increased risk of anal incontinence was found in nulliparous women or women who had cesarean sections only or vaginal deliveries not complicated by OASIS.
关于剖腹产是否能保护女性短期和长期的肛门失禁发展，目前仍存在不确定性。我们的目的是探讨仅阴道分娩的女性是否比未生育的女性和仅行剖宫产的女性发生肛门失禁的风险更高。
背景信息、病史以及 2006 年 10 月至 2008 年 6 月期间参加挪威一项基于人群的健康调查（特隆赫姆北部健康研究 3 期）的女性报告的肛门失禁（每周或更多次粪便或气体失禁定义为肛门失禁）的数据，这些数据与挪威医学出生登记处的数据相关联。计算肛门失禁的患病率，并进行多变量逻辑回归分析。
12 567 名女性的平均年龄为 49.9 岁。仅行剖宫产的女性与行阴道分娩且存在产科肛门括约肌损伤（OASIS）的女性的年龄和教育水平相似。未生育的女性和仅行阴道分娩且无 OASIS 的女性比仅行剖宫产的女性和有 OASIS 的女性年龄更大，教育程度更高。四分之一有 OASIS 的女性报告存在肛门失禁，而其他女性中则有六分之一报告存在肛门失禁（P<0.001）。在所有女性中，年龄、教育程度、腹泻、便秘、出生体重和 OASIS 增加了肛门失禁的风险。产次仅与经阴道分娩的女性有关。未发现粪便急迫感有差异。
阴道分娩并发 OASIS 的女性发生肛门失禁的风险增加。然而，未生育的女性、仅行剖宫产的女性或无 OASIS 的阴道分娩女性未发现肛门失禁风险增加。
