GP's role in supporting women with anal incontinence after childbirth injury: a qualitative study

Background Obstetric anal sphincter injury is the most common cause of anal incontinence for women, which often has profound impacts on women's lives. GPs offer a first line of contact for many women, but we know that very few women experiencing anal incontinence postnatally report discussing it with their GPs. Aim To identify key ways in which GPs can support women with anal incontinence caused by childbirth injuries. Design and setting A qualitative study investigating women's experiences with their GP, and GPs' perspectives about providing such care. Method This qualitative study combined two phases: first, a series of in-depth semistructured interviews with women experiencing anal incontinence caused by childbirth injuries (n n = 41); and second, focus groups with GPs (n n = 13) stratified by experience. Thematic analysis was conducted and relevant themes from across the two datasets were examined. Results Mediating factors in GP care for women with anal incontinence caused by childbirth injuries centred around three key themes: the role of the GP, access and pathways, and communication. Conclusion The findings demonstrate multifactorial challenges in identifying the problem and supporting women experiencing anal incontinence after childbirth injury in primary care settings. Many GPs lacked confidence in their role in supporting women, and women were often reluctant to seek help. Those women who did seek help often experienced frustrations consulting with their GPs. In a context where women are often reluctant to ask for help, their concerns are not always taken seriously, and where GPs do not routinely ask about anal incontinence, potential anal incontinence after childbirth injury appears to be often missed in a primary care setting.