Anal incontinence after childbirth

Abstract

Anal incontinence (AI) after childbirth is a hot topic because of its high prevalence and important social impact. Its management is complex because of a multifactorial mechanism which most often involves in pudendal neuropathy and tissue modifications but also sphincter injuries whose impact is not negligible in the long term. At least three-quarters of symptomatic patients gets recovered within 6 months post-partum due to nerve and tissue regression. Regarding patients with sphincteric obstetric injury, a repair is recommended although its positive effects are degraded in the long run. Transit regularization and anal rehabilitation are the initial approach to AI allowing improvement in to many cases. Sacral neuromodulation is to be reserved for failures of medical treatment or even before sphincter repair and gives interesting results in the short and long term on both AI and associated urinary incontinence. The preventive approach to post-partum AI is paramount and aims to screen at-risk patients, although the indications for a "protective" caesarean section seem to be debatable in recent studies.