Development and Validation of a Tool to Identify Anal Incontinence in Pregnant and Postnatal Women

• Published in: Diseases of the colon & rectum Vol. 66; no. 12; pp. 1562 - 1569
• Main Authors: Tucker, Julie, Juszczyk, Karolina, Murphy, Elizabeth Mary Anne
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-12-2023
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1097/DCR.0000000000002966

Neuromuscular and mechanical damage to the pelvic floor because of pregnancy and birth can result in anal incontinence. Pregnant and postnatal women are rarely screened for anal incontinence by clinicians who specialize in the care of these women, and no screening tool has been developed for routine use in these women.
To develop and validate a tool for use in everyday clinical practice in the care of pregnant and postnatal women.
The study includes 2 test phases with separate data sources. Phase 1, test, and re-test phase of the Bowel Screening Questionnaire in health professionals and women who were pregnant or had recently birthed (n = 45). Phase 2 included a pilot of the tool as compared to two current scoring systems (n = 358).
Large tertiary hospital in South Australia.
Phase 2: prospective recruitment of 358 prenatal parous women attending a first antenatal appointment.
To evaluate the reliability and validity of the developed tool.
Test-retest agreement in phase 1 was excellent for each of the 6 items with each kappa statistic being between 0.83 and 1.0. In phase 2 agreement between new and existing tools was fair to good for the detection of anal incontinence symptoms addressed as a composite question (kappa between 0.41- 0.71). Anal incontinence was detected in 191 (53%) of women utilizing the new tool, and there was a lower prevalence reported using the Vaizey score (n = 118) and Wexner score (n = 129). Completion rates of the new tool were 99%, higher than both the Vaizey score (33%) and Wexner scores (36%).
Sample size limits generalization of findings.
The questionnaire is reliable and valid reporting a high incidence of bowel incontinence, with predominant symptoms of rectal urgency and flatus as precursors for worsening function.