Anal incontinence in nulliparous women before and during pregnancy – findings from the MAMMI Study

Context and background: International research findings show that some women experience anal incontinence (AI) postpartum. Recent research findings recognise the need for knowledge of women’s pre-pregnancy health because... [ view full abstract ]

Context and background:
International research findings show that some women experience anal incontinence (AI) postpartum. Recent research findings recognise the need for knowledge of women’s pre-pregnancy health because some morbidities, including AI, pre-exist pregnancy. There are no data on AI rates in nulliparous women before or during pregnancy in Ireland.
Aim:
To determine the prevalence of AI in nulliparous women before and during pregnancy.
Methodology:
This multi-centre, multi-strand mixed methods cohort study aims to identify the prevalence of a range of health problems in 2,600 first-time mothers before and during pregnancy and at 3, 6, 9 and 12 months postpartum. Data are collected through self-completion surveys, from women’s maternity care records and from in-depth interviews with sub-samples of women experiencing morbidities.
Ethical approval was granted by the University and site hospitals, and the study commenced in February 2012.
This presentation focuses on the prevalence of AI before and during pregnancy in 2,173 nulliparous women recruited up to July 2015.
Key findings:
Before pregnancy, 5.2% of women (n=113) leaked minor or major amounts of liquid and/or solid bowel motion. One-third (34.2%, n=742) passed wind involuntarily, with 4.6% (n=34) passing major amounts. Of those who leaked liquid/solid bowel motion, more than two-thirds (69.6%, n=79) did not speak to a healthcare professional about AI. In pregnancy, prevalence of AI was 3.7% (n=81), with almost two-thirds of women (63%, n=51) experiencing new-onset AI. Just under half of all women (45.7%, n=992) passed minor, and 9.2% (n=200) passed major, amounts of wind involuntarily. More than 92% (n=73) of women who leaked liquid/solid bowel motion did not talk about it to a healthcare professional.
Conclusion:
AI is not normal, but most women with AI did not discuss it with healthcare professionals before pregnancy or during pregnancy. Findings suggest that opportunities for promoting anal continence are being lost; many women are left with unmet health needs and without timely advice that could help them become continent.