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Fecal incontinence after pregnancy

by Jan Seski, MD

For most people, there are problems you talk about and those you don't. Fecal incontinence -- involuntary loss of liquid, solid stool or gas from the anus at inappropriate times -- is one of those problems no one likes to discuss. It can be embarrassing, uncomfortable and virtually unspoken among its many sufferers, which include a large population of new mothers.

About one percent of the general population is afflicted with this condition, which can be mild or severe in nature. In fact, this is a more common problem than many women may realize. Fewer than one-half of patients with fecal incontinence may report the symptoms to their physicians. They may feel that this is a socially devastating disorder, but with knowledge and support, women can get the help they need with medication or surgery. 

How does it happen?
Fecal incontinence can result when a woman experiences a tear from the vagina into the rectum during childbirth, damaging the anal sphincter muscle. Rectal muscles may be stretched a bit following normal childbirth, but will return to normal in a few weeks. The muscle works much like a pouch with a drawstring, opening and closing with controlled muscle contractions. Should the muscle become damaged or torn, control is lost. 

What can be done?
Oftentimes the tear can be repaired immediately after birth. However, the extent of the tear may not be visible to the naked eye. If incontinence persists, a small ultrasound tube can be inserted into the rectum to reveal missing muscle tissue. In addition, diarrhea, often a symptom of fecal incontinence, causes dehydration, debilitation and infection. The causes of diarrhea are many, yet the result is similar with fecal incontinence and management problems will occur. That's why it's so important to alert your physician about this problem as soon as it arises.

Fecal incontinence that develops over time and not as a direct result of childbirth or injury is often more difficult to repair because it is related to the aging of the body, which is generally irreversible. The other most common causes of fecal incontinence include:

  • medications
  • treatment therapies such as chemotherapy or radiation therapy
  • infectious disorders such as AIDS
  • medical conditions
  • neurogenic disorders
  • enteral tube feeding
Treatment is available
Overall, people do not cope well with any type of incontinence, so fecal incontinence remains humiliating and degrading. Society generally, and wrongly, views losing control of one's excretory functions as losing self-control. They are not the same thing. Fecal incontinence is a physical problem that can be treated.

About the Author: Dr Jan Seski is the director of the Division of Gynecologic Oncology at the Allegheny General Hospital in Pittsburgh, PA. He can be reached at 1-888-244-2800.

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