Is fecal incontinence after childbirth normal?

Fecal incontinence, also known as postpartum fecal incontinence (Arabic) or bowel control loss, is the loss of normal bowel function, resulting in the leakage of solid stool, liquid stool, mucus, or gas. This can be a temporary symptom or a long-term issue. In some cases, postpartum fecal incontinence can result from vaginal delivery, where the muscles and tissues of the rectum may be stretched or torn as the fetus passes through the birth canal. The anal sphincter muscle can also be damaged during vaginal delivery. Some women experience short-term bowel control problems immediately after childbirth, which improve within a few days or a few weeks. However, for other women, the problem may not appear until later in life, or a minor problem may worsen with age as the anal sphincter naturally weakens. [1]

Causes of Postpartum Fecal Incontinence

There are many causes for postpartum fecal incontinence, most notably: [1]

• Anal sphincter injury: Tearing or weakening of the anal sphincter, the muscles responsible for closing the anus, can occur during vaginal delivery.
• Nerve damage: The nerves that control bowel and rectal function may be affected during childbirth, impacting the body's ability to sense the urge to defecate or to control it.
• Digestive problems: Certain digestive disorders, such as irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD), can contribute to fecal incontinence.
• Chronic constipation or diarrhea: Chronic constipation can lead to rectal stretching and muscle weakening, while frequent diarrhea can make it difficult to control stool.

When should you see a doctor?

If you are experiencing fecal incontinence after childbirth, it is important to talk to your gynecologist. You may feel embarrassed, but telling your doctor is the first step toward getting appropriate treatment. You should consult your doctor if: [1]

• Symptoms persist for more than a few weeks after childbirth.
• Symptoms worsen over time.
• Fecal incontinence impacts your daily quality of life or causes you psychological distress.
• You notice any other signs, such as anal bleeding, severe pain, or unexplained changes in bowel habits.

Diagnosis

To determine the cause of fecal incontinence, your doctor will ask about your medical history and symptoms. You may be asked to keep a daily stool diary to note when leakage or bowel movements occur and what other symptoms you notice. A physical examination may include an inspection of the vagina, anus, and rectum to look for signs of muscle weakness or loss of nerve reflexes. In some cases, additional tests may be needed, such as: [1]

• Anorectal Manometry: This test measures the strength of the anal sphincter and the function of the nerves in the rectum and anus. [2]
• Nerve tests: To check whether the nerves connected to the rectum and anus are functioning correctly.
• Imaging tests: Such as an ultrasound to evaluate the structure of the muscles and tissues.

Available Treatment Options

The type of treatment depends on the cause and severity of the problem. Treatment may include: [1]

• Lifestyle and dietary modifications: Dietary changes, such as increasing fiber in cases of constipation (about 25 grams daily for adult women) or avoiding foods that cause diarrhea or gas, may help improve symptoms. [1]
• Kegel exercises: These exercises strengthen the pelvic floor muscles that support the bladder, uterus, and rectum, and can help improve bowel control. [1]
• Medications: Your doctor may prescribe medications to control diarrhea, reduce gas, or prevent constipation.
• Bowel training: This involves training yourself to defecate at regular times each day.
• Biofeedback: A technique that helps you improve the function of your anal sphincter muscles by monitoring muscle activity on a screen.
• Surgery: In some severe cases, surgery may be necessary to repair a torn anal sphincter.

Medical references

• Accidental Bowel Leakage
• Anorectal manometry