CAPS Study: Childbirth and Pelvic Symptoms

The Childbirth and Pelvic Symptoms (CAPS) study was a prospective cohort study performed by the Pelvic Floor Disorders Network to study postpartum fecal and urinary incontinence in primiparous women.  The primary goal of the study was to estimate and compare the prevalence and incidence of postpartum urinary and fecal incontinence (UI and FI, respectively) in 3 cohorts of primiparous women: (1) those who had anal sphincter disruption during vaginal delivery; (2) a control group of women without clinically apparent anal sphincter disruption during delivery; and (3) a second control group who underwent a cesarean delivery without labor.  The cohorts were interviewed at 6 weeks and 6 months following delivery to identify symptoms of UI and FI symptoms using the Fecal Incontinence Severity Index and the Medical, Epidemiological, and Social Aspects of Aging Questionnaire, respectively.  A total of 921 women participated in this study; 407 in the Sphincter Tear cohort, 390 in the Vaginal Control cohort, and 124 in the Cesarean Control cohort. Of these, 837 (91%) completed interviews at 6 weeks, 759 (82%) at 6 months, and 728 (79%) provided data at both time points.  The study found that women with clinically recognized anal sphincter tears are more than twice as likely to report postpartum fecal incontinence than women without sphincter tears. Cesarean delivery before labor is not entirely protective against pelvic floor disorders.