ArticleThe American journal of gastroenterology2012
Obstetric trauma, pelvic floor injury and fecal incontinence: a population-based case-control study.
Article in The American journal of gastroenterology, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers.
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Who cites it
47 citing papers in PubMed, 114 citations in OpenAlex.
- Clinical Trial: Effectiveness and Safety of a Novel Anal Insert Device for Treatment of Faecal Incontinence.Alimentary pharmacology & therapeutics · 2026Trial
- Validating endpoints for therapeutic trials in fecal incontinence.Neurogastroenterology and motility · 2016Trial
- Effects of clonidine in women with fecal incontinence.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2014Trial
- Thickening of the internal anal sphincter: correlation with external rectal intussusception and associated features at MR proctography and anal manometry.Abdominal radiology (New York) · 2026Article
- WNT3a induces external anal sphincter fibrosis and dysfunction in rabbits.American journal of physiology. Gastrointestinal and liver physiology · 2026Article
- Change in faecal incontinence pattern after gastric bypass surgery: related to change in anal sphincter thickness?International journal of colorectal disease · 2026Article
- Anal sphincter reconstruction for fecal incontinence: Techniques, outcomes, and future directions.World journal of gastrointestinal surgery · 2025Review
- Size of Pelvic Outlet as a Potential Risk Factor of Fecal Incontinence: A Population-Based Exploratory Analysis.Clinical and translational gastroenterology · 2025Article
- Association between geriatric nutritional risk index and fecal incontinence in individuals with stroke: mediating roles of systemic immune inflammation index and oxidative balance scores.Frontiers in nutrition · 2025Article
- Garg incontinence scores: New scoring system on the horizon to evaluate fecal incontinence. Will it make a difference?World journal of gastroenterology · 2024Review
- Pelvic floor dysfunction: prevalence and associated factors.BMC public health · 2023Review
- Underdiagnosis of internal anal sphincter trauma following vaginal delivery.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2023Observational
- Change in Urgency Status Among Ulcerative Colitis Patients: Understanding a Potential Unmet Patient Need From the CorEvitas Inflammatory Bowel Disease Registry.Gastro hep advances · 2023Article
- Faecal incontinence in adults.Nature reviews. Disease primers · 2022Review
- Inadequate Rectal Pressure and Insufficient Relaxation and Abdominopelvic Coordination in Defecatory Disorders.Gastroenterology · 2022Article
- Understanding the physiology of human defaecation and disorders of continence and evacuation.Nature reviews. Gastroenterology & hepatology · 2021Review
- A multicenter study of anorectal pressures and rectal sensation measured with portable manometry in healthy women and men.Neurogastroenterology and motility · 2021Article
- Surgical Treatment Alternatives to Sacral Neuromodulation for Fecal Incontinence: Injectables, Sphincter Repair, and Colostomy.Clinics in colon and rectal surgery · 2021Review
- Fecal Urgency: Clinical and Manometric Characteristics in Patients With and Without Diarrhea.Digestive diseases and sciences · 2020Article
- Constipation and Fecal Incontinence in the Elderly.Current gastroenterology reports · 2020Review
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesCurrent concepts based on referral center data suggest that pelvic floor injury from obstetric trauma is a major risk factor for fecal incontinence (FI) in women. In contrast, a majority of community women only develop FI decades after vaginal delivery, and obstetric events are not independent risk factors for FI. However, obstetric events are imperfect surrogates for anal and pelvic floor injury, which is often clinically occult. Hence, the objectives of this study were to evaluate the relationship between prior obstetric events, pelvic floor injury, and FI among community women.
methodsIn this nested case-control study of 68 women with FI (cases; mean age 57 years) and 68 age-matched controls from a population-based cohort in Olmsted County, MN, pelvic floor anatomy and motion during voluntary contraction and defecation were assessed by magnetic resonance imaging. Obstetric events and bowel habits were recorded.
resultsBy multivariable analysis, internal sphincter injury (cases-28%, controls-6%; odds ratio (OR): 8.8; 95% confidence interval (CI): 2.3-34) and reduced perineal descent during defecation (cases-2.6 ± 0.2 cm, controls-3.1 ± 0.2 cm; OR: 1.7; 95% CI: 1.2-2.4) increased FI risk, but external sphincter injury (cases-25%, controls-4%; P<0.005) was not independently predictive. Puborectalis injury was associated (P<0.05) with impaired anorectal motion during squeeze, but was not independently associated with FI. Grades 3-4 episiotomy (OR: 3.9; 95% CI: 1.4-11) but not other obstetric events increased the risk for pelvic floor injury. Heavy smoking (≥ 20 pack-years) was associated (P=0.052) with external sphincter atrophy.
conclusionsState-of-the-art imaging techniques reveal pelvic floor injury or abnormal anorectal motion in a minority of community women with FI. Internal sphincter injury and reduced perineal descent during defecation are independent risk factors for FI. In addition to grades 3-4 episiotomy, smoking may be a potentially preventable, risk factor for pelvic floor injury.
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