Long-term evaluation of the impact of delivery modalities on anal continence in women with Crohn's disease.

Summary Context Crohn's disease (CD) and sphincter injury during childbirth are two risk factors for anal incontinence (AI). The long-term risk of developing AI in women with CD after childbirth has never been studied. Goal The main objective of the study is to assess the risk of developing severe AI after childbirth in women with CD. Methods A retrospective study was performed in women with CD who gave birth in a French “Level 3” maternity hospital between 2000 and 2015. The primary endpoint was severe AI as defined by a Wexner score ≥ 9 or a St. Mark's score ≥ 9, at least five years after childbirth. The association between delivery route and occurrence of severe AI was assessed by univariate and multivariate analyses. Results Forty-six women were included, 32 of whom were delivered vaginally and 14 by Caesarean section. Thirty-one percent of the women had severe AI according to the Wexner score, and 41% according to the St. Mark's score. Two factors were associated with severe AI: vaginal delivery and the occurrence of an obstetric perineal injury: (crude OR = 8.89, 95% (CI: 1.03–76.57) and crude OR = 4.16, 95% (CI: 1.06–16.27) respectively for AI defined by the Wexner score, and crude OR = 6.8, 95% (CI: 1.30–35.41) and crude OR = 4.3, 95% (CI: 1.23–15.2) for AI defined by the St. Mark's score). After adjusting for confounding factors, only vaginal delivery was associated with severe AI (adjusted OR = 22.86, 95% CI: 1.52–931.28 for a Wexner score ≥ 9 and adjusted OR = 16. 11 (95% CI: 1.43–533.26) for a St Mark score ≥ 9). Conclusion Vaginal birth was associated with the development of severe long-term AI in women with CD.