What is the prevalence of fecal incontinence during the first trimester of pregnancy?

Prevalence of Fecal Incontinence in First Trimester of Pregnancy

Fecal incontinence affects approximately 40.8% of pregnant women during the first trimester, with most cases involving flatus incontinence rather than solid or liquid stool incontinence. This high prevalence indicates that fecal incontinence is a common but underrecognized issue during early pregnancy that significantly impacts quality of life. 1

Prevalence and Types of Fecal Incontinence in First Trimester

• In a cross-sectional study of 228 pregnant women, 40.8% reported some form of fecal incontinence in the previous 4 weeks, with the majority experiencing flatus incontinence (72 patients) rather than solid stool (15 patients) or liquid stool (6 patients) incontinence 1
• The mean Wexner score (measuring severity of fecal incontinence) was 3.82 (range 2.0-13.0) among affected women, indicating mild to moderate severity in most cases 1
• Quality of life was significantly affected in most subscales of the Medical Outcomes Study Short Form 36 for women experiencing fecal incontinence during pregnancy 1

Risk Factors for Fecal Incontinence During Pregnancy

• Defecatory symptoms already present in early pregnancy are highly predictive for continued symptoms at 12 months postpartum, with the exception of fecal incontinence 2
• Common risk factors for fecal incontinence include diarrhea (OR=53), history of rectocele (OR=4.9), and stress urinary incontinence (OR=3.1) 3
• Iron supplementation (OR=3.5) and past constipation treatment (OR=3.58) are associated with constipation during pregnancy, which can contribute to fecal incontinence 4
• No significant differences were found in age, BMI, history of previous deliveries, trimester of pregnancy, or stool consistency between pregnant women with and without fecal incontinence 1

Relationship to Other Gastrointestinal Issues in Pregnancy

• Constipation affects 20-40% of pregnant women and can contribute to fecal incontinence through overflow mechanisms 3
• Constipation prevalence rates during pregnancy are reported as 24% in the first trimester, 26% in the second trimester, and 16% in the third trimester 4
• Physiological changes during pregnancy that contribute to both constipation and potential fecal incontinence include:
  • Increased progesterone levels slowing GI motility 3
  • Hormonal changes affecting sphincter tone 3
  • Mechanical pressure from the growing uterus 3

Clinical Implications and Management

• Fecal incontinence during pregnancy has a notable impact on quality of life and should be addressed proactively 1
• Management options for pregnancy-related constipation and associated fecal incontinence include:
  • Increasing dietary fiber intake to approximately 30g/day 3
  • Ensuring adequate fluid intake, particularly water 3
  • Using safe osmotic laxatives such as polyethylene glycol or lactulose when necessary 3
  • Bulk-forming agents like psyllium husk or methylcellulose, which are safe during pregnancy due to minimal systemic absorption 3

Comparison with Urinary Incontinence

• While fecal incontinence affects about 40.8% of pregnant women, urinary incontinence has a prevalence of 18.96% in the first trimester, increasing to 39.76% in the third trimester 1, 5
• Both conditions significantly impact quality of life during pregnancy, affecting physical, mental, and social domains 1, 5