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Bowel Issues

Diminished control over the bowels—whether it is stool (fecal matter) or gas—can be distressing and embarrassing. Bowel disorders and anal incontinence in women are more common than once believed. By age 45, bowel issues are eight times more prevalent in women than men. They develop in some 25 percent of women who have had a previous vaginal delivery that may have caused damage to the nerves, muscles and connective tissues of the pelvic floor and particularly, the anal sphincter muscles.

Conditions and Symptoms

  • Fecal incontinence/urgency often develops when the external anal sphincter muscles undergo partial or complete tearing during vaginal delivery. These muscles normally provide constant involuntary pressure at the anal sphincter, even when you are sleeping. Childbirth or other trauma can weakened the sphincter muscles, compromising your ability to voluntarily contract them until you reach a toilet.

    Fecal incontinence symptoms may include:
    • Frequent sudden urges to defecate
    • Trouble urinating unless the bowel is emptied
    • Never feeling finished after trying to defecate
    • Accidental soiling of underwear

  • Flatal incontinence frequently results from injury to less visible internal sphincter muscles during delivery. These muscles make the rectum a high-pressure area, giving you the ability to sense the presence of gas and appropriately control the passing of it. When these muscles are injured, you may find it difficult after childbirth and/or during your post-reproductive years to avoid passing gas in social situations no matter how you change your diet or bowel habits.
  • A weakened pelvic floor after childbirth can affect the overall function of your bowels. They may become slower and weaker, leading to straining and constipation. Diminished functioning of nerves and muscles or a shift in anatomy or both can lead to a range of bowel problems such as hemorrhoids (during and after pregnancy) and fistulas—abnormal openings between the vagina and the bladder, urethra and bowel.

Diagnosis and Treatment

Your NorthShore pelvic health specialist will ask about your medical history and symptoms; conduct a thorough physical exam; and may perform an in-office ultrasound test.  

At the Center for Pelvic Health, we offer a wide array of treatment options for bowel issues, including:

  • Lifestyle and behavior modification—Dietary changes to enhance regularity, retraining your bowel movements and pelvic strengthening exercises are just a few of the first-line solutions that can improve or eliminate fecal incontinence in at least 50 percent of cases.
  • Medication (softeners, laxatives, lubricants) and hormonal remedies
  • Nonsurgical approaches:
    • Biofeedback to learn to identify and strengthen pelvic muscles could help to improve bowel control in up to 72 percent of cases.
    • Pelvic floor stimulation
    • The Intersim pelvic pacemaker, used for urinary urge incontinence and other bladder problems, is currently under study at NorthShore for its effectiveness in improving bowel control. A small battery-powered device implanted under the skin in the back, the pacemaker provides constant stimulation to the pelvic nerves.

Optimally, surgery to repair an anal sphincter injured during childbirth should take place immediately in the delivery room. Years later, healing becomes more complicated. However, if all treatment options fail, some women may benefit from surgery. At NorthShore’s Center for Pelvic Health, our specialists are skilled in the latest surgical advances for fecal incontinence, including:

  • Anal spincteroplasty is the most common surgical approach. Involving an incision in the perineum extending to the anal opening, the torn edges of the anal sphincter are stitched back together, recreating its circular donut shape. Often the edges of the circle are overlapped during surgery, forming a double-layer of muscle where the “defect” previously existed. This procedure is known as an “overlapping” sphincteroplasty.
  • Post-anal repair, levatorplasty and other procedures that utilize nearby muscles to wrap around and strengthen the anal sphincter are performed on rare occasions, usually by colorectal surgeons.
  • Artificial anal sphincter, an uncommon procedure, may be considered an option for highly symptomatic patients who have failed other repairs.

For More Information

To schedule an appointment with one of our specialists, please call 224.251.CFPH (2374).