Frequency of persistent anal symptoms after first instrumental delivery.

Purpose: This study was designed to evaluate persistent anal symptoms after first instrumental delivery beyond the postpartum period.

Methods: This prospective study was performed in a cohort of primiparas who underwent instrumental delivery from January 1, 2001 to September 30, 2002. Questionnaires for anal symptoms were completed in the maternity ward on the day after delivery and by mail or telephone up to 12 months after the end of the inclusion period. Symptoms of fecal incontinence (solid and/or liquid stool) and precursor symptoms (flatus incontinence, soiling, and/or fecal urgency) were recorded.

Results: Of the 212 females who completed the first questionnaire, 159 (75 percent) responded to the second. Overall, 8.8 percent of females had solid and/or liquid stool incontinence, 7.5 percent had involuntary flatus, 8.2 percent had symptoms of fecal urgency, and 24.5 percent experienced new anal symptoms, Of the five females with third-degree tears, none complained of anal incontinence. The only significant difference in delivery data between females who did and did not develop new anal symptoms was larger fetal head size in the new symptom group (96.4 vs. 93.9 mm, respectively; P < 0.05).

Conclusions: Frequency of new anal symptoms other than incontinence beyond postpartum period is underestimated in primiparas after instrumental delivery. Only fetal head size was found to predict occurrence of persistent anal incompetence after instrumental delivery.