See also >> Constipation

Fecal Incontinence
Anal incontinence occurs when a woman is not able to control her bowel movements, resulting in accidental passing of stool. This problem affects an estimated 7% of women. Anal incontinence is more common with vaginal delivery than cesarean section because of the potential for damage to the anorectum during vaginal delivery. However, anal incontinence is more common following childbirth of any form, including cesarean section.

Risk Factors
Risk factors include childbirth, vaginal delivery, the use of forceps during to assist vaginal delivery, episiotomy or natural tearing of the tissues during vaginal delivery, aging, neurological conditions, and chronic constipation.

Anal incontinence can occur for several reasons:
  • Abnormal stool consistency – Bowel movements with normal formed consistency are easiest to control. Diarrhea or loose bowel movements are more likely to cause anal incontinence
  • because of both looser consistency and increased urgency. Severe constipation can also sometimes lead to anal incontinence.

Anal sphincter injury - The circular muscles of the anus that allow us to control bowel movements are called the “anal sphincter muscles”. These muscles can be damaged or torn during vaginal delivery. It is estimated that as many as 40% of women experience muscle injuries in this area during childbirth, more commonly when episiotomy or forceps delivery is performed. Injury to the muscles can cause decreased strength resulting in problems postponing passage of bowel movements. In some cases, the muscle damage can be repaired with surgery.

Nerve injury – Injury to the anal sphincter nerves can cause decreased sensation and muscle strength, both of which can contribute to anal incontinence. Nerve damage can be caused by injury during vaginal delivery, chronic constipation, or by illnesses that affect the nerves such as diabetes, spinal cord injury, etc. The nerve damage that occurs during vaginal delivery can often improve with healing of the nerves over the next 1 to 2 years after childbirth.

Prolapse – Rectoceles and other forms of prolapse can sometimes cause anal incontinence by causing stool to be incompletely emptied during bowel movements.

Fistula – Abnormal tracts known as “fistulas” can rarely develop between the rectum and vagina, following vaginal delivery or vaginal surgery. They can also occur spontaneously as a result of diverticulitis or other bowel conditions.

Source: AUGS Foundation

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