Up to 25% of postpartum people experience anal incontinence
Let’s start with some definitions. Fecal incontinence (FI) is the involuntary loss of solid or loose stool. Anal incontinence includes FI as well as the involuntary loss of gas.
It may surprise you, because I know it surprised me, to learn that studies estimate up to 25% of postpartum people experience symptoms of anal incontinence. That’s one quarter of postpartum people. But as someone working in the field of pelvic health who further specializes in working with pregnant and postpartum people… I feel like I’m one of the few people who should not have been surprised by this. So why was I?
These symptoms are massively underreported.
Not only are they massively underreported, but patients often deny experiencing these symptoms when asked directly. Sometimes it’s because as providers, we ask the wrong question. Sometimes it’s because of a misunderstanding of what qualifies as symptoms of anal incontinence.
Symptoms of fecal and anal incontinence have a massive impact on quality of life and physical, mental and emotional health. These common (and treatable!) symptoms have been linked to social withdrawal, anxiety and depression. It is so important for providers to learn to ask direct questions about sensitive topics in a way that creates a safe environment for a patient to disclose symptoms that may be feel deeply uncomfortable to discuss.
The goal of this blog post is to help you gain a better understanding of the symptoms and causes of as well as treatment options for fecal and anal incontinence.
Symptoms of anal incontinence include:
Passing gas when you don’t intend to
Fecal smearing, or difficulty wiping yourself clean after a bowel movement
Noticing fecal matter in your underwear
Inability to hold in stool when you need to go
While folks who have never been pregnant or given birth can experience fecal and anal incontinence, many of the risk factors associated with the development of symptoms occur during vaginal childbirth.
Risk factors for developing fecal or anal incontinence after childbirth include:
A 3rd or 4th degree perineal tears
Delivery with forceps
Episiotomy
Long duration of pushing
With that said, c-sections are not completely protective against developing FI or AI and folks who birth via cesarean may still develop these bowel symptoms.
Now the we better understand the symptoms and risk factors, let’s talk causes. It’s important to remember that every body is different. The causes of FI and AI can vary from person to person, and often times more than one cause contributes to symptoms.
Potential causes for fecal and anal incontinence include:
Pelvic floor muscle weakness
Your pelvic floor muscles wrap around your urethra and rectum. This bundle of muscles includes both voluntary (muscles we consciously control) and involuntary (muscle we do not need to consciously control) muscles. Both voluntary and involuntary muscles contribute to happy, healthy bowel function. These muscles need to be strong enough to hold stool in. Weakness in these muscles may lead to their inability to do that job, contributing to symptoms like passing gas when you don’t want to, leakage of stool and fecal smearing.
Pelvic floor muscle tension
While these muscles need to be strong enough to hold stool in, they also need to be flexible enough to allow you to fully empty your rectum when you have a bowel movement. If these muscles aren’t flexible enough to allow you to full release, stool and gas may remain trapped in the rectum contributing to many of the same symptoms listed above. We need both length AND strength for ideal muscular function.
Lackluster bowel habits
While muscle strength and flexibility is important, so are bowel habits. If you’re experiencing symptoms of anal incontinence, bowel habits are a key place to look. Going when you need to go, not going when you don’t need to go, and listening to the cues our body gives us can make a huge difference for those experiencing FI or AI. Working with a pelvic floor PT can help assess your bowel routine for areas of improvement.
Diet & Stool Quality
Your diet influences the quality of your stool. Soft, watery stool is much more likely to trigger leakage than fully formed, bulky stool. Eating foods that irritate our gut can contribute to soft, watery stool and thus leakage. Ensuring appropriate fiber intake and a diet of whole foods can bulk up our stool and reduce the incidence of leakage. The internal and anal sphincters are not meant to hold back liquid nor solid, pebble-like stool often associated with constipation. Controlling the quality of our stool plays a huge role in eliminating bowel dysfunction.
If you’re experiencing leakage of gas or stool, a personalized evaluation by a pelvic floor physical therapist can offer you the information and treatment plan that you need.
For more tips on managing pain through pregnancy, preparing for birth or recovering postpartum, sign up for our newsletter! For more on postpartum recovery, check out our 6 week postpartum program, Baby Steps Fitness. And as always, if you’re interested in working with us 1:1 either in our Austin clinic or virtually from anywhere in the world, give us a shout!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.