Ahmed Shalabi, MD, is a colorectal surgeon on staff at Banner Del E. Webb Medical Center. His office can be reached at (623) 974-7858.
Question: I had an episiotomy with my second child and have since noticed an issue with occasionally leaking stool. Is this common and what can I do about it?
Answer: Incontinence, particularly fecal incontinence, is a subject many people neglect to discuss, even with physicians, because they are embarrassed. Considering that an estimated 6.5 million Americans suffer from fecal incontinence, it’s a topic well worth addressing.
Fecal incontinence is the inability to control one’s bowels, which causes stool to unexpectedly leak from the rectum. This leakage can range from an occasional slight loss of stool when passing gas to a complete loss of bowel control. Trauma or damage to the sphincter muscles and surrounding nerves is a primary cause of fecal incontinence.
While everyone knows having children strains a woman’s body, many fail to recognize the strain it has on the muscles and nerves associated with bowel control. Childbirth can tear or cause damage to the sphincter muscles and/or nerves in the pelvic floor. A difficult childbirth requiring an episiotomy or use of forceps further increases the potential for damage and risk of incontinence.
Other common causes of fecal incontinence in both men and women include rectal prolapse, rectocele, and nerve damage linked to conditions such as diabetes, Alzheimer’s disease, multiple sclerosis, stroke and spinal cord injuries. Additionally, congenital nerve defects, nerve loss associated with straining from bowel movements, inflammatory bowel disease, chronic constipation, frequent diarrhea and muscle loss associated with aging may increase the risk. In fact, elderly individuals account for about 30 percent of those afflicted with fecal incontinence.
Treatment options, which range from diet modification to surgical repair, vary based on the cause and severity of one’s condition. After reviewing a patient’s symptom history and performing a few tests, a surgeon can identify the source and determine the best treatment.
Diet modification to treat incontinence often involves increasing fiber and fluid intake and avoiding alcohol, caffeine, artificial sweeteners and foods with a high sugar content. Surgical options can include sphincter repair, muscle transfer, nerve stimulation and more. When other treatment options have been exhausted or don’t apply, a stoma may be necessary.
As with most health conditions, early diagnosis and treatment yields the best results. Women who are pregnant or have had children should mention incontinence issues to their OB/GYNs. Additionally, men and women should discuss incontinence concerns with their primary care physicians and request a referral to a colorectal surgeon.
Communication is key. Doctors can’t treat conditions they don’t know exist.