Bowel Problems After Childbirth

Bowel problems are common after childbirth. During pregnancy, the organs in your abdominal cavity shift to accommodate the growing baby. It can take some time for your bowel movements to return to normal.

Postpartum diarrhea and constipation are frequent concerns in the weeks and months after childbirth. Roughly 10% of postpartum women also deal with bowel control problems. This includes bowel urgency and fecal incontinence, which describes the inability to control bowel movements.

This article discusses the symptoms associated with postpartum bowel urgency and fecal incontinence. It also covers possible causes, treatment options, and prevention tips.

Possible Symptoms

Following pregnancy and childbirth, some individuals may experience the following symptoms:

• Bowel urgency: This describes the strong urge to defecate, with a feeling of an immediate need to get to a bathroom.
• Passive fecal incontinence: When this occurs, stool leaks out without you knowing.
• Urge fecal incontinence: This describes awareness of the urge to defecate, but stool leaks out before you are able to get to the bathroom.
• Post-defecation leakage: When this happens, stool leaks out after a bowel movement.
• Postpartum diarrhea: This describes loose or watery stools that occur after delivery. Postpartum diarrhea may or may not occur alongside incontinence.
  

What Causes Fecal Incontinence?

Childbirth can cause bowel problems for a variety of reasons. Factors that increase your risk of experiencing urgency and incontinence issues postpartum include:

• Forceps: This medical instrument is sometimes used to help guide a baby's head out of the vagina. It is done if labor isn't progressing, or to help the baby get out quickly for medical reasons.
• Episiotomy: This surgical cut is made in the tissue between the vaginal opening and the anus. While originally thought to help prevent delivery-related damage, it is linked to sphincter injury and fecal incontinence.
• Anal sphincter injury: During delivery, if the anal sphincter experiences trauma, your risk increases for bowel issues, such as fecal incontinence.
  
• Vaginal delivery: When compared to individuals who have a C-section, those who give birth vaginally have an increased risk of postpartum fecal incontinence.
• Age: Individuals who are 35 and older have a higher risk of delivery complications and associated bowel issues.
• Obesity: Pregnant individuals who are considered obese have an increased risk of postpartum fecal incontinence.
  
• Pregnancy: Pregnancy alone increases your risk of fecal incontinence, even without the factors listed above.

What Causes Postpartum Diarrhea?

The causes of postpartum diarrhea aren't always clear, but it could be related to the changes in hormones that happen after you give birth. Uterine contractions as your uterus returns to its normal size may also trigger looser or frequent stools

Postpartum diarrhea could also have more obvious causes. For example, you could be exposed to a stomach bug while you're in the hospital, or the symptom could be caused by medications you're given during and after labor. Stool softeners are sometimes given to help you have a bowel movement after childbirth, but they also have the potential to cause diarrhea. 

How Often Does Fecal Incontinence Happen?

Bowel urgency and fecal incontinence are common the first few months after a vaginal delivery. While less frequent, those who deliver via C-section can also experience these symptoms. In some individuals symptoms go away after months, but for others, symptoms may worsen, and/or return with later pregnancies.

Research suggests that sphincter injuries due to birthing significantly increase the risk of fecal incontinence. About 12% of individuals experience fecal incontinence without having a sphincter injury, while 24% experience this symptom after one injury. The prevalence jumps to 36% if the individual has had two sphincter injuries due to childbirth.

Treatment

Be sure to tell your healthcare provider as soon as possible if you are experiencing bowel urgency and fecal incontinence. Remember, your healthcare provider is there to help you manage your condition.

Treatment will vary depending on your specific needs. Options may include:

• Biofeedback therapy: This treatment uses devices that help you sense and control symptoms associated with both passive and urge fecal incontinence. It also helps strengthen your pelvic floor.
• Sacral nerve stimulation: This method uses painless electric pulses to help stimulate the sacral nerves, which help control the sphincter, rectum, and colon.
• Vaginal balloons: This medical device is placed in the vagina where it can be inflated to put pressure on your rectum. This prevents a bowel movement. Air can be removed when you are ready to have a bowel movement.
• Prescription drugs: You may be given a prescription medication to help treat any underlying condition that may be causing the fecal incontinence.
• Injections: Injections may be given around the anus to help the surrounding tissue enlarge. This helps the sphincter close a bit better.
• Surgery: If less invasive treatments don't work, your healthcare provider may recommend surgery. Surgeries vary depending on the individual's needs, but may focus on repairing any existing damage.

Ways to Manage Fecal Incontinence

To help manage and cope with fecal incontinence, there are some tips to keep in mind:

• Bathroom use: Use the bathroom before heading out and locate a bathroom you can use when not at home.
• Consider different underwear: Wear washable incontinence underwear.
• Be prepared: Keep a change of clothes with you.
• Keep yourself clean: Keep the anal area clean and change underwear and clothes as soon as possible.

Treating Postpartum Diarrhea

If you have postpartum diarrhea without fecal incontinence, you can treat it the same way you would treat any case of diarrhea. Try eating a bland diet and make sure you stay hydrated. If you're breastfeeding, ask your healthcare provider about over-the-counter remedies that are safe for your baby.

See your healthcare provider if:

• Your diarrhea becomes severe or constant
• Your symptoms are accompanied by nausea or vomiting
• If you have blood in your stool
  

How to Prevent Long-Term Problems

Unfortunately, fecal incontinence problems stemming from pregnancy and childbirth can show up years afterward. However, there are steps that you can take to reduce your chance of long-term problems:

• Train your bowels: Training your bowels means going to the bathroom at the same time every day and trying to have a bowel movement. This can take months to adjust to, but it can lead to improvement over time.
• Make diet changes: Eating a high-fiber diet and avoiding foods and drinks that tend to cause fecal incontinence can help reduce symptoms.
• Practice Kegel exercises: Kegel exercises involve tightening and relaxing your pelvic floor muscles in order to build up strength in your anus and rectum.

Summary

While common within the first few months after delivery, some individuals may continue to experience bowel urgency and fecal incontinence.

There are many factors that may increase your risk of experiencing urgency and incontinence issues.

Treatment may include therapies administered by your healthcare provider, as well as pelvic floor exercises, diet changes, and bowel training. In some cases, surgery may be recommended.