Elective cesarean does not preserve anal continence

Clinical Question

Can an elective cesarean delivery avoid maternal pelvic trauma and preserve anal continence?

Bottom Line

The available evidence does not support the belief that elective cesearan delivery preserves anal continence. (LOE = 2b-)


Nelson RL, Westercamp M, Furner SE. A systematic review of the efficacy of cesarean section in the preservation of anal continence. Dis Colon Rectum 2006;49:1587-1595.  [PMID:17006613]

Study Design

Systematic review


Unknown/not stated


Various (meta-analysis)


Elective cesarean delivery is occasionally undertaken with the belief that avoiding maternal pelvic trauma will prevent vaginal and anal injury. These investigators searched only MEDLINE and reference lists of relevant publications for potential studies assessing the impacts of cesarean deliveries and vaginal deliveries on anal continence. Other evidence-based sources such as the Cochrane Registry were not searched. Eligible studies included 15 reports enrolling a total of 14,450 women undergoing 3010 cesaean deliveries and 11,440 vaginal births. The authors do not report whether the search or evaluation of the individual trials was done by more than 1 individual. Only 1 of the 15 studies was a randomized controlled trial; the rest were cohort studies and cross-sectional surveys. The methodological quality of the individual trials was poor, including inadequate length of follow-up, nongeneralization of results (eg, only breech presentation or only primiparous women), and nonobjective, nonblinded asssessment of outcomes. Overall, a formal sensitivity analysis of the various trials was unable to find any significant benefit of cesarean delivery in the prevention of incontinence of feces or gas. The authors found no evidence of hetereogeneity of the results or publication bias. Although the overall quality of the evidence is very poor, the authors argue that what exists is the best evidence available and it clearly shows no evidence to support the oft-held belief that elective cesarean delivery preserves anal continence.