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.