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Postpartum psychological distress associated with anal incontinence in the EDEN mother–child cohort: Postpartum psychological distress and anal incontinence

Xavier Fritel 1, * B. Gachon 1 Mj Saurel‐cubizolles 2
* Corresponding author
2 CRESS - U1153 - Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique
UPD5 - Université Paris Descartes - Paris 5, CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
Abstract : OBJECTIVE: To estimate the prevalence of flatus-only and faecal incontinence, to describe their risk factors, and to analyse the association between anal incontinence and psychological distress over the first 1 year postpartum. DESIGN: Cohort study from pregnancy to 12 months postpartum SETTING: Two university hospital maternity wards in France POPULATION: 2002 pregnant women were recruited between 2003 and 2006. Data on anal incontinence was available for the 1632 women who comprise the sample for analysis. METHODS: Women were enrolled during pregnancy. A postal questionnaire was sent at 4 and 12 months postpartum. MAIN OUTCOME MEASURES: Anal (flatus-only and faecal) incontinence was assessed at 4 months postpartum. Mental health was assessed at 4 and 12 months postpartum by the Edinburgh Postpartum Depression Scale (EPDS) and use of antidepressant drugs as well as by self-rated mental health. RESULTS: At 4 months postpartum, the prevalence for flatus-only incontinence was 14.4%and for faecal incontinence 1.7%; multivariate analysis, restricted to women reporting no anal incontinence before the index pregnancy, showed that continuing breastfeeding at 4 months was related to a higher risk of de novo postpartum anal incontinence (OR=2.23). Women who reported anal incontinence at 4 months were more frequently depressed (EPDS ≥ 10 or antidepressant use) at 12 months postpartum: 36.0% of those with faecal incontinence were depressed, 23.3% of those with flatus-only incontinence, and only 14.8% of the continent women. CONCLUSION: Postnatal faecal incontinence was rare but associated with poorer maternal mental health. Postnatal screening should be encouraged, and psychological support offered.
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Xavier Fritel, B. Gachon, Mj Saurel‐cubizolles. Postpartum psychological distress associated with anal incontinence in the EDEN mother–child cohort: Postpartum psychological distress and anal incontinence. BJOG: An International Journal of Obstetrics and Gynaecology, Wiley, 2019, Epub ahead of print. ⟨10.1111/1471-0528.16075⟩. ⟨inserm-02434970⟩

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