For many women, postpartum recovery comes with unexpected challenges. While much of the focus is placed on the physical healing from birth, certain topics are often left out of the conversation—one of the most significant being fecal incontinence. If you’ve been struggling with this, know that you’re not alone. In fact, studies show that up to 25% of women may experience some form of fecal incontinence after childbirth.

In this post, we’ll break down how common fecal incontinence is postpartum, the primary causes behind it, and the most effective treatments for regaining control and confidence.

What Is Postpartum Fecal Incontinence?

Fecal incontinence is the involuntary loss of stool or gas, ranging from small leaks to a complete inability to control bowel movements. It can be distressing and embarrassing, yet it's a common issue many new moms face, particularly after vaginal deliveries that result in severe perineal tearing or nerve damage.

How Common Is It?

While fecal incontinence may feel isolating, it is surprisingly common in postpartum women. It occurs most often after vaginal deliveries, with higher risks for those who have experienced significant tearing during birth. Despite its prevalence, the topic is seldom discussed openly, leaving many women unsure of whether their symptoms are normal or how to seek help.

Studies suggest that up to 10-25% of women experience some form of fecal incontinence after childbirth, with the likelihood increasing if there was a 3rd or 4th-degree perineal tear or nerve damage during delivery.

The Top Two Causes of Postpartum Fecal Incontinence

1. 3rd or 4th Degree Perineal Tears

One of the leading causes of postpartum fecal incontinence is severe perineal tearing during childbirth. 3rd-degree tears are sub categorized into A & B depending on what structures are involved. [A side note if you live in the United States this level of detail is not provided in charts yet]. A 3A tear extends through the vaginal muscles and at least 50% into the external anal sphincter (EAS), while a 3B passes through the EAS at least 50% into the internal anal sphincter. And 4th-degree tears involve both the external and internal anal sphincters, as well as the mucosa lining the rectum.

These tears can lead to a loss of control over the sphincter muscles, resulting in difficulties managing bowel movements. Even if repaired surgically, the recovery process can take time. These muscles may not fully regain their strength and coordination right away, leaving many women dealing with symptoms like fecal leakage or the inability to make it to the bathroom in time.

2. Pudendal Nerve Injury

Another key factor contributing to fecal incontinence is pudendal nerve injury. The pudendal nerve controls the muscles of the pelvic floor, including the anal sphincter. During childbirth, especially during a prolonged second stage of labor or when forceps are used, this nerve can be stretched or compressed, leading to temporary or even permanent damage.

When the pudendal nerve is injured, it can disrupt the normal communication between the brain and the muscles responsible for bowel control. This can result in either fecal incontinence or a reduced ability to sense the urge to defecate until it’s too late. The nerve damage may take months to heal, and in some cases, symptoms can persist without proper intervention.

Treatment Options for Postpartum Fecal Incontinence

Every third and fourth degree tear should be surgically repaired immediately after birth. The style of repair depends on the severity of the tear, but some repairs work better than others. Unfortunately, the repair may not be enough fortunately there are effective treatments available to help you regain control.

Pudendal nerve damage generally requires time for the nerve to heal. Some women notice a return to function after their first postpartum period, owing to the increased production of estrogen. However, there are supplemental treatments that can help support the nerve as it’s healing by addressing muscular and boney barriers.

Here are the most recommended options:

1. Pelvic Floor Physical Therapy

One of the first-line treatments for postpartum fecal incontinence is pelvic floor physical therapy. Working with a pelvic floor therapist can help strengthen and coordinate the muscles of your pelvic floor, particularly the anal sphincter. Treatment is based on the specific symptoms of the fecal incontinence meaning you have some ability to hold in a fart or stool versus zero control, and where you are in your recovery. This may include bowel retraining, dietary and lifestyle adjustments, pelvic floor strengthening exercises, manual therapy for scar tissue or muscle tension, nerve glides, and more to guide recovery and restore bowel control.

2. Bowel Retraining

Bowel retraining is a technique used to re-establish normal bowel habits. It involves creating a regular bathroom schedule and practicing techniques like urge suppression and correct toileting posture. This helps the anal sphincter gradually regain its control over time.

3. Dietary Adjustments

Diet plays a critical role in bowel control. If you're experiencing fecal incontinence, a high-fiber diet can bulk up your stool, making it easier to control. Staying hydrated is equally important to avoid constipation, which can strain weakened muscles and worsen incontinence.

4. Medications

In some cases, medications may be prescribed to help manage bowel movements. Stool bulking agents, such as psyllium, can make stools easier to control. In more severe cases, your healthcare provider may recommend anti-diarrheal medications to reduce the frequency and urgency of bowel movements.

5. Surgical Interventions

If conservative treatments don’t provide enough relief, surgical options may be considered. This might involve a sphincteroplasty, a procedure to repair damaged anal sphincter muscles, or other reconstructive surgeries designed to restore pelvic floor integrity.

Conclusion

Fecal incontinence after childbirth is more common than many realize, particularly after significant tearing or nerve damage. While it’s rarely talked about, it’s crucial to know that help is available. By addressing the root cause of the incontinence and using a combination of pelvic floor therapy, bowel retraining, and other treatments, most women can experience significant improvement and regain their quality of life.

If you're dealing with fecal incontinence after a 3rd or 4th-degree tear or pudendal nerve injury, don’t wait to seek help. A pelvic floor specialist can guide you through a personalized recovery plan to regain control and confidence postpartum.