Department Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium.
Int Urogynecol J. 2021 Sep;32(9):2325-2336. doi: 10.1007/s00192-021-04723-z. Epub 2021 Mar 31.
Pregnancy and childbirth are considered risk factors for pelvic floor dysfunction, including anorectal dysfunction. We aimed to assess the effect of obstetric events on anal incontinence and constipation after delivery.
We systematically reviewed the literature by searching MEDLINE, Embase and CENTRAL. We included studies in women after childbirth examining the association between obstetric events and anorectal dysfunction assessed through validated questionnaires. We selected eligible studies and clustered the data according to the type of dysfunction, obstetric event and interval from delivery. We assessed risk of bias using the Newcastle Ottawa Scale and we performed a random-effects meta-analysis and reported the results as odds ratios (ORs) with their 95% confidence intervals. Heterogeneity across studies was assessed using I statistics.
Anal sphincter injury (OR: 2.44 [1.92-3.09]) and operative delivery were risk factors for anal incontinence (forceps-OR :1.35 [1.12-1.63]; vacuum-OR: 1.17 [1.04-1.31]). Spontaneous vaginal delivery increased the risk of anal incontinence compared with caesarean section (OR: 1.27 [1.07-1.50]). Maternal obesity (OR:1.48 [1.28-1.72]) and advanced maternal age (OR: 1.56 [1.30-1.88]) were risk factors for anal incontinence. The evidence on incontinence is of low certainty owing to the observational nature of the studies. No evidence was retrieved regarding constipation after delivery because of a lack of standardised validated assessment tools.
Besides anal sphincter injury, forceps delivery, maternal obesity and advanced age were associated with higher odds of anal incontinence, whereas caesarean section is protective. We could not identify obstetric risk factors for postpartum constipation, as few prospective studies addressed this question and none used a standardised validated questionnaire.
妊娠和分娩被认为是盆底功能障碍的危险因素，包括肛肠功能障碍。我们旨在评估产科事件对产后肛门失禁和便秘的影响。
我们通过搜索 MEDLINE、Embase 和 CENTRAL 系统地综述了文献。我们纳入了产后妇女的研究，这些研究通过验证问卷评估了产科事件与肛肠功能障碍之间的关系。我们选择了合格的研究，并根据功能障碍类型、产科事件和分娩后间隔时间对数据进行聚类。我们使用纽卡斯尔-渥太华量表评估了偏倚风险，并进行了随机效应荟萃分析，报告结果为比值比（OR）及其 95%置信区间。使用 I ²统计评估了研究之间的异质性。
肛门括约肌损伤（OR：2.44 [1.92-3.09]）和剖宫产是肛门失禁的危险因素（产钳 OR：1.35 [1.12-1.63]；真空 OR：1.17 [1.04-1.31]）。与剖宫产相比，阴道自然分娩增加了肛门失禁的风险（OR：1.27 [1.07-1.50]）。母亲肥胖（OR：1.48 [1.28-1.72]）和高龄（OR：1.56 [1.30-1.88]）是肛门失禁的危险因素。由于研究的观察性质，关于失禁的证据确定性较低。由于缺乏标准化的验证评估工具，我们没有检索到关于产后便秘的证据。
除了肛门括约肌损伤、产钳分娩、母亲肥胖和年龄较大外，剖宫产还与更高的肛门失禁几率相关，而剖宫产则具有保护作用。我们无法确定产后便秘的产科危险因素，因为很少有前瞻性研究解决这个问题，而且没有研究使用标准化的验证问卷。
