A Cochrane review [Abstract] 1 included 21 cohort studies and population based surveys with a total of 31 698 women having had 6 028 caesarean deliveries (CD) and 25 170 vaginal deliveries (VD) as the index event prior to anal continence assessment. The 7 best studies (n=7385) fulfilled the three following criteria: age adjustment, assessment of incontinence after 4 months postpartum and women categorized as CD with no history of prior VD. Odds ratio for fecal incontinence in these trials approached 1.0. Only one trial demonstrated a significant benefit of CD in the preservation of anal continence, however the incontinence incidence was extremely high, 39% in CD and 48% in VD, questioning the timing and nature of continence assessment. There was no difference in continence preservation in women have emergency versus elective CD.
A meta-analysis 2 included 23 non-randomized trials and 1 RCT with a total of 29 597 women with vaginal delivery and 6 821 women with CD. Vaginal delivery was found not to be a significant predictor of postpartum combined fecal and flatus incontinence compared to CD (OR 0.74, 95% CI 0.54 to 1.02; 6 trials, n=18 951). VD was also not a significant predictor of faecal incontinence (OR 0.89, 95% CI 0.76 to 1.05; 14 trials, n=29 367). VD was not a significant predictor of gas incontinence (OR 0.96, 95% CI 0.79 to 1.18; 6 trials, n=6 724). Faecal incontinence at 3 months often resolved at 1 year.
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