A Cochrane review included 21 cohort studies and population based surveys with a total of 31 698 women having had 6 028 caesarean deliveries (CD) and 25 170 vaginal deliveries (VD) as the index event prior to anal continence assessment. The 7 best studies (n=7385) fulfilled the three following criteria: age adjustment, assessment of incontinence after 4 months postpartum and women categorized as CD with no history of prior VD. Odds ratio for fecal incontinence in these trials approached 1.0. Only one trial demonstrated a significant benefit of CD in the preservation of anal continence, however the incontinence incidence was extremely high, 39% in CD and 48% in VD, questioning the timing and nature of continence assessment. There was no difference in continence preservation in women have emergency versus elective CD.