Awareness of factors increasing the chances of developing anal incontinence (AI), may enable the implementation of preventive strategies during pregnancy or the postpartum period [1]. To our knowledge, pelvic floor muscle (PFM) function and inter-recti distance (IRD) assessed shortly after delivery and their associations with postpartum AI have not been analyzed. Therefore, the aim of this study was to assess whether PFM function in early postpartum period together with intrapartum characteristics and IRD measurements are associated with AI 3 months after first vaginal delivery.

This was a prospective observational cohort study. Primiparous women after vaginal delivery were invited to participate in this study during hospital stay (24-72 hours after delivery). At this time-point the palpation examination of PFMs function was performed to assess: (1) PFM strength - using Modified Oxford Scale (0-5); (2) PFM endurance (0-10s); and (3) PFM tone (normal/decreased/increased). Intrapartum characteristics were obtained from participant's medical record and included: duration of the second stage of labor, neonatal birth weight, epidural anaesthesia, degree of perineal tear, episiotomy, BMI before pregnancy, weight gain during pregnancy, and self-reported symptoms of UI and AI during pregnancy. IRD was examined using ultrasound imaging. Measurements were acquired 3 cm above and 2 cm below the umbilical level in supine position with knees bent, both during rest and during curl-up task. Three months after delivery women completed online questionnaire (Polish version of Pelvic Floor Distress Inventory (PFDI-20)) to assess the presence of symptoms of AI. To examine factors associated with experiencing symptoms of AI 3 months postpartum a logistic regression was used. Values of p<0.05 were considered significant.

A total of 600 women were invited to participate in this study. Finally, 576 women were recruited in phase 1 during hospital stay (19 did not consent to participate and 5 were excluded due to exclusion criteria). In second phase, 3 months postpartum, 491 participants completed the questionnaire. The mean age of participants was 30 ± 4 years, and the majority of women had a vaginal delivery (92.87%, n=456), while a small proportion underwent assisted vaginal delivery (vacuum extractor, 7.13%, n=35). In bivariate analysis: symptoms of AI and UI during pregnancy, all of IRD values and PFM strength showed a significant association with AI 3 months postpartum. These variables, comprising a single representative measurement of IRD, were included in multivariable analysis and the following results were obtained. Symptoms of AI and UI during pregnancy were associated with significantly higher likelihood of AI 3 months postpartum (OR=5.27, 95% CI 2.12-13.82, p<0.001 and OR=2.13, 95% CI 1.28-3.54, p=0.004, respectively). IRD measured at 2 cm below the umbilical level during curl up task also showed positive association (OR=1.04, 95% CI 1.01-1.06, p=0.001). Moreover, higher values of PFM strength significantly reduced the likelihood of AI 3 months postpartum (OR=0.60, 95% CI 0.42-0.85, p= 0.005). No other statistically significant associations were observed.

This study showed that primiparous women that experienced UI or AI during pregnancy are more likely to develop AI postpartum. To our knowledge, this is the first study that included early postpartum measurements of PFM function (from palpation examination) and IRD. Our results indicate that these variables can be useful for predicting AI at 3 months postpartum and provide evidence supporting the implementation of early postpartum assessment of PFM function and IRD by physiotherapists on hospital wards.

Our results indicate that assessment of PFM function and measurement of IRD in the early postpartum period may help identify women with an increased  likelihood of AI at 3 months postpartum. Further studies are needed to determine whether our observations regarding PFM strength could be targeted with postpartum physiotherapy.

Kearney R, Salvatore S, Khullar V, Chapple C, Taithongchai A, Uren A, et al. Do We Have the Evidence to Produce Tools to Enable the Identification and Personalization of Management of Women's Pelvic Floor Health Disorders Through the Perinatal and Perimenopausal Periods? ICI-RS 2024. Neurourol Urodyn. 2025;44(3):651-60