Anal incontinence is the loss of control or involuntary release of gas or stool or a combination of both. This is a very embarrassing and stressful condition. More women than was previously thought experience anal incontinence following childbirth. In the current issue of "Obstetrics and Gynecology", Jamie Lo, M.D. and colleagues report that some women experience anal incontinence up to two years postpartum. The researchers surveyed women in the state of Utah who reported postpartum anal incontinence. Their quality of life was assessed every six months for a period of two years. The respondents included 1,050 women. Anal incontinence impacted their emotional well- being, ability to care for their babies, and social and traveling experiences. Among this group only 10 percent of the women sought medical attention for anal incontinence during the first six months of giving birth. When symptoms persisted for one year, 13.5 percent of affected women sought help. In cases where the condition lasted for two years following childbirth, 16.7 percent of the women sought medical intervention. (1)
A review of available research reports indicates that anal incontinence in postpartum women is a complication of childbirth. Pregnancy and delivery can cause damage to the muscles and nerves of the pelvic floor. During delivery, the anal sphincter can be damaged. The role of the anal sphincter muscles is to contract and prevent the uncontrolled release of stool. The risk of anal incontinence increases with an assisted vaginal delivery. An article in the February 2002 issue of the Canadian Medical Association Journal, indicated a strong association between the incidence of anal sphincter injury and first time vaginal delivery, use of forceps in the delivery, and an episiotomy. An episiotomy is a surgical incision performed in the late stage of labor. The purpose is to enlarge the vaginal opening, prevent tearing, and aid in the delivery of the baby. (2)
Treatment for anal incontinence is dependent upon cause and severity. The first step is communication. A woman needs to inform her health care provider of this occurrence. Health care providers need to ask their postpartum patients if they are experiencing incontinence. Keeping a food diary to monitor what foods produce loose stools or increased gas is helpful to determine what dietary modification can be made. Kegel exercises strengthen the muscles of the pelvic floor. A biofeedback program which monitors if the patient is doing the exercise correctly and if the muscles are responding is a means of correcting anal incontinence. (3)
(1) Obstetrics & Gynecology, April 2010, volume 115, issue 4
(2) www.ncbi.nlm.nih.gov
(3) www.mamahealth.com
Maryann Gromisch is a registered nurse with clinical experience in medical, surgical, and critical care nursing. She has experience assisting a gastroenterologist in a private practice setting.