Postpartum fecal incontinence can be an alarming thought, and while it is less common than urinary incontinence (impacting 7-15% of women). Knowing what to expect if you experience this can help you prepare to get the treatment you need right away should that be necessary.
Fecal incontinence can have a range of symptoms, from uncontrolled gas to feeling like you can’t make it to the bathroom in time to loss of bowel control.
Risk factors for postpartum fecal incontinence
Risk factor for developing fecal incontinence include pregnancy, childbirth, and obstetric anal sphincter injuries (or OASIS) as well as general pelvic floor dysfunction (including urinary incontinence). There are additional risk factors unrelated to pregnancy including being over 65 year old and/or having nerve damage, dementia, or physical disability.
Experiencing fecal incontinence can be incredibly isolating and traumatic. This is in part because there is a lack of conversation about it before birth, which can lead people to feel embarrassed and less likely to discuss their symptoms with a provider. But not talking to a provide can delay treatment and further complications.
The most important thing to know is that there are a range of treatment options available. Talking to your provider is the first step, especially because there are specialized doctors trained to help with these issues.
How does it happen?
Postpartum fecal incontinence can happen after an anal sphincter or rectal mucosa tear during a vaginal delivery. The anal sphincters are the muscles that wrap around the anus and allow you to control gas and bowel movements. When the anal sphincter is damaged, or when it is damaged along with the the rectal mucosa (which can happen during childbirth), this can lead to symptoms like the inability to control gas or bowel movements.
There are a variety of treatments available for those experiencing fecal incontinence, all of which require talking to a healthcare provider about your symptoms. If you feel uncomfortable or anxious to address symptoms you’re having, it can be helpful to bring a support person with you when you go to your appointment. This condition impacts many women and healthcare providers understand that it can be a difficult topic to bring up. So, if you end up having to talk to your provider about fecal incontinence, remember that you do not have to go through this alone. They are here to provide support and treatment.
The best treatment plan will be catered to your specific symptoms and needs, but it’s recommended that you meet your OB/GYN or see a urogynecologist (a doctor who specializes in pelvic floor conditions). They may perform a test as part of the diagnosis process. This may include tests to measure:
- Sphincter tightness
- Nerve damage
- Abnormalities in the bowel or colon
- Pelvic organ function
- Rectum function
Depending on the cause and severity of the symptoms, this is likely how your provider will approach treatment:
When you meet with your provider, their first step will be to prescribe a fiber supplement to bulk the stool as formed stool is easier to control. They will recommend avoiding any foods that cause loose stools (for example dairy and coffee). And some people will also be advised to eat smaller and more frequent meals and integrate more fiber in their diet.
You may also choose to work with a pelvic floor physical therapist to help strengthen your pelvic floor muscles.
If your stools remain loose after integrating the fiber supplement and beginning pelvic floor training, then your provider will likely prescribe an anti-diarrhea medication. Avoid opting for an over-the-counter medication without talking to your provider.
If by 6 months postpartum you’re still struggling with incontinence, then your provider will begin to consider other interventions. The right option for you will be based on the severity of your symptoms, physical exam findings, as well as whether and when you plan to have more children.
For example, your doctor may explore if Sacral Neuromodulation might be a good fit. This is a type of nerve stimulation to control bowel continence (think of it as a little pacemaker for the bowels).
The bottom line: if you’re experiencing fecal incontinence, you have many, many options to feel better and more like yourself. There are many doctors who specialize in this and are here to help.
This content was reviewed by Dr. Lisa Hickman and Dr. Katie Propst. Dr. Hickman runs the Childbirth Pelvic Floor Disorders Clinic at The Ohio State University Wexner Medical Center. Dr. Propst runs the Postpartum Care Clinic at Cleveland Clinic.
- “Vaginal Tears in Childbirth.” Mayo Clinic. Mayo Clinic. October 11, 2019. https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/vaginal-tears/sls-20077129?s=2.
- “Fecal (Bowel) Incontinence.” Cleveland Clinic. Cleveland Clinic. November 30, 2020. https://my.clevelandclinic.org/health/diseases/14574-fecal-bowel-incontinence.
- Mayo Clinic Staff. “Fecal Incontinence.” Mayo Clinic. Mayo Clinic. December 1, 2020. https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/symptoms-causes/syc-20351397.
- Anthony J Lembo, MD. “Patient education: Fecal incontinence (Beyond the Basics).” UpToDate. February 24, 2020. https://www.uptodate.com/contents/fecal-incontinence-beyond-the-basics.