Thursday, September 16, 1999 Published at 23:27 GMT 00:27 UK
Mothers suffering incontinence in silence
Many women develop faecal incontinence after their first child
Many women are suffering in silence from an incontinence problem caused by childbirth which could worsen with the delivery of a second child, according to researchers.
They believe offering women a Caesarian section for their second child could cut the risk of further distress.
Up to 15% of first-time mothers who opt for a vaginal delivery suffer extensive injury to the muscles and nerves around the anus, leading to incontinence.
Many others may have hidden injuries and no symptoms.
Women with injuries but no symptoms the first time around have a 50% chance of developing incontinence if they go for a vaginal delivery for their second child, say researchers from the National Maternity Hospital in Dublin.
And the condition of those with symptoms, even if most only last six months after birth, is likely to worsen.
The researchers call for a change in attitude to what they call "a devastating social handicap".
They say doctors need to ask women specifically if they suffer from faecal incontinence.
Valerie Donnelly, one of the researchers, said: "Many studies show women are too embarrassed or are not thinking about themselves after the birth or think it is a natural consequence of childbirth."
The study, published in The Lancet, looked at 59 women who had two children within a four-year period.
Thirteen suffered faecal incontinence after the first birth.
Eight continued to have problems into their second pregnancy and for seven of these, their symptoms worsened after the second birth.
Five of the 13 regained continence before the second birth, but two became incontinent again as a result of a second vaginal delivery.
Five of the women developed incontinence only after the second delivery. Three of these had had unseen injuries the first time around which were picked up through internal tests.
The researchers, led by Professor Colm O'Herlihy, say vaginal delivery is the leading risk factor for faecal incontinence and anal injury in women.
Other causes of anal muscle injuries are a long labour and use of instruments to extract the baby, such as forceps.
Giving women an epidural may also increase the risk because it prolongs the second stage of labour.
Risk factors for anal nerve injury include multiple births, use of instruments and a high birthweight baby.
The researchers say studies suggest that a Caesarian section once labour has started may not help prevent a worsening of faecal incontinence following a second birth.
But a planned Caesarian can cut the risk.
They recommend therefore that women with extensive anal injuries after a first vaginal delivery should be offered a Caesarian the second time around.
They also call for more screening of women at risk, early surgery for those with serious muscle injuries and physiotherapy for those with nerve injuries.
They add that women at risk of suffering internal injuries and no symptoms should be advised of the risks of faecal incontinence so they can make an informed choice about whether to have a Caesarian section.
But Mary Newburn, head of policy research at the National Childbirth Trust, warned against rushing towards "rash policy changes".
She said anal injuries could be the result of a badly managed labour, and problems at second birth could be due to poor repair of injuries caused at the first birth.
"It would be a pity if, attempting to prevent one harm, we expose women to another because there are risks related to Caesarian sections," she said.
She added that midwives should routinely ask about faecal incontinence after birth as women may prefer to confide in them than in GPs about such a personal matter.