Q: I’ve heard that women who give birth naturally can have problems with loss of control of bowel movements later. Why are women affected?

Ask Our Expert About Childbirth and Fecal Incontinence

About Our Expert

Robert Sinnott, D.O., is a colon-rectal surgeon at Lehigh Valley Health Network.

• I’ve heard that women who give birth naturally can have problems with loss of control of bowel movements later. Why are women affected?
• How does fecal incontinence happen?
• Isn’t losing bowel movement control a disease of aging?
• Can it really be caused by a poor diet?
• It's embarrassing to talk about this with my doctor. Do I need to tell him?
• How does the doctor diagnose the problem? Are the tests painful or uncomfortable?
• What are the treatment options?
• What types of surgery would be considered?
• Can I prevent fecal incontinence?

Q: I’ve heard that women who give birth naturally can have problems with loss of control of bowel movements later. Why are women affected?

A: The loss of control of bowel movements (fecal incontinence) happens when muscles around the anus are not working properly. It may involve just losing a small amount of gas or liquid waste or lacking control of a solid bowel movement.

A recent study found that fecal incontinence is more common than once thought, especially in women. Seven percent of the 3,500 women surveyed reported a loss in bowel movement control at least once a month. Women are affected more than men because their anal muscles or nerves may be damaged during vaginal (natural) childbirth. Women who have had a difficult vaginal delivery or an episiotomy (when tissue is cut to widen the birth canal), are at higher risk.

Q: How does fecal incontinence happen?

A: Normal control of bowel movements depends on many factors: the reflexes of muscles around the anus, the ability of the rectum to feel sensation and swell (part of the natural bowel movement process), and proper functioning of the colon or digestive tract.

Although the most common reason is injury to the anal muscles during child delivery, other causes include:

• Surgery or trauma that causes damage to anal muscles or the nerves surrounding these muscles
• Illness such as stroke or spinal cord injury
• Aging and lifelong strain
• Inflammatory bowel disease
• Conditions associated with chronic diarrhea or constipation
• Chemotherapy
• Cancer of the rectum or anus

Q: Isn’t losing bowel movement control a disease of aging?

A: No, fecal incontinence is not necessarily associated with growing older, even though aging is a risk factor. It can affect adults of all ages. According to a Mayo Clinic survey, the disorder affects more than 2 percent of the entire U.S. population. Those at higher risk include not only women who have had babies, but also the elderly, mentally ill or institutionalized patients, gay men and patients with neurologic disease.

Q: Can it really be caused by a poor diet?

A: No, fecal incontinence cannot be caused by poor diet. But a poor diet can worsen the condition because it creates loose and watery stools.

Q: It's embarrassing to talk about this with my doctor. Do I need to tell him?

A: Yes, it is important to tell your doctor because:

• No matter how serious the problem seems, incontinence is a condition that can be treated and cured in most cases.
• Fecal incontinence may be a sign of another serious disease.
• It can affect the quality of your life by forcing you to change your social and physical activities.

Your doctor understands that losing bowel movements can be embarrassing for you to discuss, but he needs to know your symptoms in order to treat the problem. Remember that you’re not alone—fecal incontinence is more common than you think. The problem will not go away on its own, so don’t let embarrassment keep you from a healthy, active lifestyle.

Q: How does the doctor diagnose the problem? Are the tests painful or uncomfortable?

A: First, the doctor will meet with you and examine your medical history. He or she will ask questions like, 'How is it affecting your life?' A physical exam will help determine your muscle function and locate any external deformities. Then, they can find the problem using a series of easy, painless outpatient tests, which include:

• Rectal ultrasounds, which provide a real-time look at the anal muscles and allow doctors to pinpoint the exact location of a tear.
• Manometry, which measures the pressure and strength of the anal muscles.
• Pudendal Nerve Tests, which test for damage to the nerves that stimulate the anal muscles to contract.

Once the tests have confirmed the cause of your fecal incontinence, your doctor will make recommendations for treatment.

Q: What are the treatment options?

A: Once the underlying cause is identified, most patients’ condition can be cured or significantly improved without surgery. Initial treatment can involve a combination of the following therapies:

• Diet modification: Most patients will benefit from altering their diet to avoid foods that may cause loose or watery stools, such as dairy, fast foods or greasy foods.
• Medication: Taking medications to change the consistency of the stool may provide relief, especially when away from home. A number of over-the-counter and prescription anti-diarrheal medications are available.
• Exercise: Muscle-strengthening exercises called Kegel exercises help to strengthen the muscles of the anus through contraction and release.
• Biofeedback: Biofeedback training is like physical therapy for the anal muscles. A pressure probe or a sensing electrode on the skin attaches to a visual or sound display where you can see when the proper anal muscles are being used.
• Secca procedures: Radiofrequency energy is a new way to strengthen the anal sphincter muscles.

Q: What types of surgery would be considered?

A: In severe cases of muscle injury, patients may require surgery to regain control. The most common surgical procedure is sphincteroplasty, in which two ends of the anal muscle are overlapped and sewn in place to restore the complete circle of muscle. Only a small percentage of patients undergo muscle transposition, in which surgeons transplant buttock or inner thigh muscles to strengthen the anal canal. Artificial sphincters or colostomy bags are devices implanted only in rare, difficult cases.

Q: Can I prevent fecal incontinence?

A: Since fecal incontinence is most often caused by trauma, prevention is not always possible. During childbirth, a long labor, episiotomy and the use of forceps should be avoided, if possible. Women who deliver their babies by Cesarean Section (C-section) are at much lower risk.

If you think you might be at risk, you can help prevent fecal incontinence by eating a healthy diet free from foods that may cause loose or watery stools, and doing Kegel exercises to strengthen the anal muscles and the pelvis.

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