Women who develop faecal incontinence caused by traumatic childbirth face the prospect of having to live with the condition for life.

A study published in The Lancet medical journal suggest that surgery to correct the condition soon after birth does not guarantee lasting improvement.

One third of women develop structural damage to the anal sphincter after their first vaginal delivery, and a third of these develop abnormal bowel function.

Andrew Malouf and colleagues from St Marks Hospital, Harrow, assessed the long-term effects of anal sphincter repair surgery on 47 women who had undergone surgery between 1990 and 1992.

The study showed that although the surgery appeared to work in the short-term, after five years the effect had worn off.

Although 71% of patients reported improvement in their overall bowel control following anal-sphincter surgery, no patient was fully continent at long-term follow-up.

Failure of the repair surgery was identified in 50% of patients, and numerous reasons were suggested. These included:

• Progressive deterioration with time
• Nerve damage during the birth process
• The operation contributing to the damage

Counselling is important

Dr Malouf said: "Patients require adequate preoperative counselling that, although most will improve after the procedure, continence is rarely perfect, many have residual symptoms and some may develop new evacuation disorders.

"With realistic expectations, however, many patients will be satisfied by even slight symptom improvement."

The study follows research by the National Maternity Hospital in Dublin which showed many women who experience incontinence problems after childbirth suffer in silence.

Valerie Donnelly, one of the researchers, said: "Many studies show women are too embarrassed or are not thinking about themselves after the birth or think it is a natural consequence of childbirth."

The study, published in The Lancet, looked at 59 women who had two children within a four-year period.

Thirteen suffered faecal incontinence after the first birth.

Eight continued to have problems into their second pregnancy and for seven of these, their symptoms worsened after the second birth.

Five of the 13 regained continence before the second birth, but two became incontinent again as a result of a second vaginal delivery.

Five of the women developed incontinence only after the second delivery. Three of these had had unseen injuries the first time around which were picked up through internal tests.