Fecal incontinence from early pregnancy to 12 months postpartum: A longitudinal cohort study from Tuscany

Introduction: Fecal incontinence (FI) during pregnancy and after childbirth is an underrecognized condition that may affect women's physical, psychological, and social well-being. Evidence on its prevalence and determinants over the full perinatal period remains limited. This study aimed to assess the evolution of FI from early pregnancy to 12 months postpartum and to identify sociodemographic, clinical, obstetric, and care-related factors associated with symptom severity and occurrence. Material and Methods: We conducted a prospective cohort study using data from a regional longitudinal maternity survey administered through the hAPPyMamma application in Tuscany, Italy. Women who completed all questionnaires, including the Wexner scale, between March 2019 and March 2023 were included. The time points were first and third trimesters (T0–T1), and three, six, and 12 months postpartum (T2–T4). FI prevalence and mean Wexner scores were calculated at each time point. Determinants of FI occurrence and severity were examined, respectively, through panel logistic and linear regression models adjusted for sociodemographic, clinical, obstetric, and pathway-related variables. Results: A total of 10 576 women completed all follow-up assessments with no missing data. FI prevalence ranged from 3.5% at T0 to 5.5% at T2, declining to 3.0% at T4. Mean Wexner scores varied only modestly across the study period, from 5.6 at T0 to 4.2 at T4, indicating overall mild but persistent symptoms throughout pregnancy and the postpartum period. Adjusted panel regression models confirmed the significant association of older age, overweight, non-Italian nationality, lower education, lower income, high-risk pregnancy, discomfort during pregnancy, operative delivery, perineal tears, episiotomy, higher neonatal birthweight, difficult access to services, and examinations not booked by the women themselves with FI severity or occurrence. FI symptoms were more severe at T1–T2 and more likely to occur at T1–T3 compared with T0. Pelvic floor muscle training was not protective. Conclusions: FI affects a minority of women but persists across pregnancy and postpartum, with several identifiable risk factors. Systematically integrating FI screening into antenatal and postnatal care may support earlier identification and more timely management, thus improving maternal health outcomes and strengthening continuity of care.