Primary prevention

Obesity, limited physical activity, poor diet, and smoking may increase the risk of faecal incontinence, although firm evidence is lacking. Avoidance of these factors may help.

A number of different interventions have been used in the antepartum period or at the time of delivery to try to reduce perineal trauma. These include maternal perineal massage, manual perineal support, warm compresses, and delayed pushing. There is good evidence that application of warm perineal compresses during pushing reduces the incidence of third- and fourth-degree laceration. High quality evidence to support the other interventions is lacking however.[13]

If there is need for episiotomy, mediolateral episiotomy may be preferred over midline episiotomy, since midline episiotomy has been associated with increased risk of anal sphinter injury. However, mediolateral episiotomy may be associated with an increased risk of perineal pain and dyspareunia.[13]

It is uncertain whether antenatal or postnatal pelvic floor muscle training reduces faecal incontinence at 6-12 months postpartum compared with usual care.[24] However, there is some evidence suggesting short-term benefit of pelvic floor muscle training following pelvic surgery.[25]

Effective management of comorbid conditions such as diabetes mellitus can reduce incontinence. Some interventions need to be eliminated (for example, routine use of episiotomy, liberal use of lateral sphincterotomy, and anal sphincter stretch in women). Caesarean section does not appear to be preventative.[9]

Secondary prevention

Expert opinion suggests that in women with a history of obstetric anal sphincter injury, a caesarean delivery may be offered in subsequent pregnancies if they experienced anal incontinence after the delivery. They should be advised that the absolute risk of a recurrent sphincter injury is low with a subsequent vaginal delivery; however, it is reasonable to perform a caesarean delivery based on patient request after discussion of the associated risks.[13]

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