{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T21:20:07Z","timestamp":1783459207983,"version":"3.55.0"},"reference-count":38,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007212","name":"V\u00e4stra G\u00f6talandsregionen","doi-asserted-by":"publisher","award":["ALFGBG\u2010966115"],"award-info":[{"award-number":["ALFGBG\u2010966115"]}],"id":[{"id":"10.13039\/100007212","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007212","name":"V\u00e4stra G\u00f6talandsregionen","doi-asserted-by":"publisher","award":["ALFGBG\u2010933810"],"award-info":[{"award-number":["ALFGBG\u2010933810"]}],"id":[{"id":"10.13039\/100007212","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007212","name":"V\u00e4stra G\u00f6talandsregionen","doi-asserted-by":"publisher","award":["VGFOUREG\u2010967583"],"award-info":[{"award-number":["VGFOUREG\u2010967583"]}],"id":[{"id":"10.13039\/100007212","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003744","name":"Stiftelsen Handlanden Hjalmar Svenssons","doi-asserted-by":"publisher","award":["HJSV2022018"],"award-info":[{"award-number":["HJSV2022018"]}],"id":[{"id":"10.13039\/501100003744","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>It is still poorly understood to what extent various obstetric and non\u2010obstetric factors contribute to anal incontinence in women from a lifetime perspective. This study aimed to assess the contribution of pregnancy, delivery mode, obstetric anal sphincter injury (OASI), and age on anal incontinence in women aged 40\u201364\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>Data from the Swedish Medical Birth Register and the Total Population Register were linked to responses to an anal incontinence questionnaire collected in 2014 and 2015. The study included 13\u2009480 women, 20\u2009years from first birth, with BMI data: 4192 nulliparas, 2411 with two cesarean deliveries, and 6877 with two vaginal deliveries. Women were matched by exact age and BMI (\u00b13\u2009units), yielding three cohorts of 1961 women each. A subgroup analysis compared vaginally delivered women without OASI to those with one or two OASIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prevalence of fecal incontinence was highest in women with 2 vaginal deliveries (14.2%) and lowest in those with 2 cesarean deliveries (10.2%,\n                      <jats:italic>p\u2009&lt;<\/jats:italic>\n                      \u20090.001). Fecal incontinence was significantly higher in nulliparous women (12.9%) compared with the cesarean group (\n                      <jats:italic>p\u2009&lt;<\/jats:italic>\n                      \u20090.01). Both bothersome fecal (\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.001) and anal (\n                      <jats:italic>p\u2009&lt;<\/jats:italic>\n                      \u20090.001) incontinence were more common following vaginal delivery compared to cesarean delivery. Among women with 2 vaginal deliveries, the prevalence of fecal incontinence nearly doubled in those with OASI compared to those without (23.3% vs. 13.7%,\n                      <jats:italic>p\u2009&lt;<\/jats:italic>\n                      \u20090.01). Women with OASI reported a greater symptom burden, demonstrated by a higher Jorge\u2010Wexner score (2.38 vs. 1.42,\n                      <jats:italic>p\u2009&lt;<\/jats:italic>\n                      \u20090.001), increased use of protective products (7.8% vs. 3.0%,\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.025), and a higher reported impact on daily lifestyle (20.7% vs. 10.1%,\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.002). Only women with two vaginal deliveries showed a significant age\u2010related increase in fecal incontinence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long\u2010term fecal incontinence was more common and severe after vaginal delivery, particularly with OASI. An age\u2010related effect on fecal incontinence was observed only among vaginal deliveries. Even with complete prevention of OASI through perineal protection, a significant age\u2010related increase in fecal incontinence between 40 and 62\u2009years would remain, arising solely from the effect of vaginal delivery. Preventing OASI remains an important obstetric target to reduce fecal incontinence later in life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70226","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T13:03:24Z","timestamp":1779109404000},"page":"1221-1229","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Age\u2010related long\u2010term effects of vaginal delivery, pregnancy, and sphincter injury on anal continence: A matched cohort study"],"prefix":"10.1111","volume":"105","author":[{"given":"Ida E. K.","family":"Nilsson","sequence":"first","affiliation":[{"name":"Gothenburg Continence Research Centre, Institute of Clinical Sciences Sahlgrenska Academy at Gothenburg University  Gothenburg Sweden"},{"name":"Department of Obstetrics and Gynecology S\u00f6dra \u00c4lvsborg Hospital  Bor\u00e5s Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jwan","family":"Al\u2010Mukhtar Othman","sequence":"additional","affiliation":[{"name":"Gothenburg Continence Research Centre, Institute of Clinical Sciences Sahlgrenska Academy at Gothenburg University  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5050-0343","authenticated-orcid":false,"given":"Jennie","family":"Larsudd\u2010K\u00e5verud","sequence":"additional","affiliation":[{"name":"Gothenburg Continence Research Centre, Institute of Clinical Sciences Sahlgrenska Academy at Gothenburg University  Gothenburg Sweden"},{"name":"Department of Obstetrics and Gynecology Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigvard","family":"\u00c5kervall","sequence":"additional","affiliation":[{"name":"Gothenburg Continence Research Centre, Institute of Clinical Sciences Sahlgrenska Academy at Gothenburg University  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6171-9182","authenticated-orcid":false,"given":"Mattias","family":"Molin","sequence":"additional","affiliation":[{"name":"Statistical Consultancy Group  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0400-5509","authenticated-orcid":false,"given":"Ian","family":"Milsom","sequence":"additional","affiliation":[{"name":"Gothenburg Continence Research Centre, Institute of Clinical Sciences Sahlgrenska Academy at Gothenburg University  Gothenburg Sweden"},{"name":"Department of Obstetrics and Gynecology Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7355-8644","authenticated-orcid":false,"given":"Maria","family":"Gyhagen","sequence":"additional","affiliation":[{"name":"Gothenburg Continence Research Centre, Institute of Clinical Sciences Sahlgrenska Academy at Gothenburg University  Gothenburg Sweden"},{"name":"Department of Obstetrics and Gynecology S\u00f6dra \u00c4lvsborg Hospital  Bor\u00e5s Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"e_1_2_13_2_1","first-page":"13","volume-title":"Incontinence 7th Edition","author":"Milsom I","year":"2023"},{"key":"e_1_2_13_3_1","first-page":"413","volume-title":"Incontinence 6th Edition","author":"Salvatore S","year":"2017"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-bioeng-061008-124823"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2006.01.003"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.12017"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016340903576004"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.08.051"},{"key":"e_1_2_13_9_1","volume-title":"Swedish","author":"Socialstyrelsen","year":"2025"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.06.021"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(96)02692-9"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-005-1304-7"},{"issue":"2010","key":"e_1_2_13_13_1","article-title":"Cesarean delivery for the prevention of anal incontinence","volume":"17","author":"Nelson RL","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-019-02029-3"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.09.104"},{"key":"e_1_2_13_17_1","unstructured":"Statistical register's production and quality National Medical Birth Register. 2021\u20109\u20107547. 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