Fecal incontinence


I am 7 months postpartum with my second child born at home with an unstitched 2nd degree tear. I am sure my midwife misdiagnosed the extent of the tear and I am mad that I did not instruct her to stitch me up as I am now experiencing episodes of fecal incontinence that I did not have even after my 4th degree extended episiotomy from my 1st child 3 years ago.

I am so mad and feel this is the only place I can talk about fecal incontinence. I want to call my midwife and tell her all the problems I'm having and how badly I wish she would have stitched me but what good will that do?

My symptoms:
Impaired control of gas.
Fecal urgency of solid stool.
Stool shape is such that leads me to think I have No anorectal angle left and/or my puborectalis muscle was torn. I.e. a little tail comes out first before the more formed stool. That is often what I cannot control.
I wipe forever to get clean.
Fecal incontinence after an incomplete bowel movement. Oftentimes I don't feel this until it is already out and/or stains my underwear.
Sex can push out fecal material if I had an incomplete evacuation prior.

Can fecal incontinence to this degree happen with a previous anal sphincter injury in a previous childbirth after another much more normal, but fast and upright homebirth with no perineal support?
Should I wait til 2 years postpartum before worrying about this and just continue with Whole Woman techniques in the meantime?
Should I call my midwife about this?
Should I lean more towards firm stool to achieve complete evacuation or more soft stool to avoid worsening the rectocele and having incomplete evacuation with possible stool incontinence afterwards?
Should I be done with having more kids in the future due to the extent of incontinence at this point?
WHY is urinary incontinence just laughed off and easy to 'joke' about but no one Dare say anything about fecal incontinence?

Thank you all for this community!

I am totally out of my depth. You need as much information as possible about this before you make any decisions on possible actions. My heart is sore for you and dear little Seth.

Yes, talk to your midwife. Just tell her the symptoms you are suffering to begin with and hear her out and see what her angle is. I can't image she would think you should put up with this, but you need to consider what her suggestions are. I am sure that she needs to see the tear and how it has healed. To get a proper diagnosis of the situation would appear to be your first move. Then see your local doctor and ask him and then possibly your gyno. And as you are probably quite upset and fearful about this, perhaps could you take your mum with you?

I hope soon there are some ladies who will give you some experienced advice.

Cheers, Fab

I think it's Alemama who had a unstitched tear? She might have some suggestions for you but yeah, this is complicated. You might want to consider a Christine consult phone call. - Surviving

Thank you both for the encouraging words.
Alemama has commented before that her anal sphincter has not been torn, I believe?
Unfortunately, I seem to be one of the few here to have a compromised anal spincter. But I refuse to believe all the doom and gloom associating anal spincter damage with unavoidable long-term fecal incontinence. The anal sphincter is not 'holier than thou' even when intact and untorn. People still deal with IBS, constipation, diarrhea, loud farts, hemorrhoids, fissures, fistulas, rectocele, Crohns, anal itching, etc, etc EVEN with an intact anal sphincter! Am I right??

So I will treat my 'less taut' anal sphincter like I would if I had GERD which is essentially another sphincter 'problem' but of the esophagus instead. Not by drowning myself in medication or high failure surgery, but by eating a balanced diet mostly of homemade food, making subtle changes to keep stool easily evacuated, get to the bathroom calmly and use lopo as needed and not overanalyze wiping or shape of stool, chew my food thouroughly, drink water to get pale urine output, exercise daily, continue posture, have sex regularly and take a bath with Epsom salts and lavender when I have a skid mark to clean.

Again I remind myself that everyone has a 'thing' or physical 'burden' if you will. The choice is ours to make: Will I wallow in it? Or will I make an action plan for success and continue forward managing my blessings?

Peace to all,

I did! My episotomy tore into my anus with my last delivery 8 years ago. I could actually feel the umbilical cord pulsing in my anus. (awesome, right?) I knew that couldn't be good. But, she stitched it up. I have had a lot of issues for the past 8 years, but I have had ibs since I was little. The key for me is to try to aim for the "perfect poop". I eat gluten free and try to eat healthy unprocessed foods. I have started buying some fermented vegetables (Bubbies pickles, Saurkraut, Kimchi).

For me, if it's too soft I can't get it out and I'm miserable (mucus, splinting, nothing helps until it goes away... ugh) Usually a meat, cooked vegetable, raw veg.(salad), and potato usually helps.

In the past few days, I recently added l-glutamine and krill oil since they help with inflammation. The l-glutamine is good for muscle repair, and possibly ibs. Worth a try, right?

Maybe a check from a obgyn just to see, make sure there isn't anything else going on.

Your list of things to be mindful about is a good one, but even better is your attitude. You've given me a blessing. Thanks.

Thank you Mindful..this is just what I needed to hear. I choose to heal this the best I can and make the best of whatever my body presents. This is just the attitude adjustment I've been needing as wallowing in suffering has only brought more suffering and I need to feel that my life is more than managable, that my life is full and blessed and I am able to embrace the experiences I need to in order to grow. This is just another of those experiences. I embrace it.

Hi Mindful

I can hear your distress. Just remember that you did have a fourth degree tear with the first birth, which was stitched. When you became pregnant the second time you did so in a body that had already been stretched once. First time around you started the pregnancy from a tight, nulliparous state. Therefore it is logical that the second pregnancy stretched your tissues in different ways.

The repair of your first (fourth degree) episisotomy may have come adrift during the second birth, and may not have been apparent to the midwife when she stitched you up. Anal sphincter repairs are notoriously difficult to get right.

It may be nothing at all to do with the suturing that your midwife did this time.

I suggest that you do talk it over with the midwife, but do it in the spirit of assuming her competence, not assuming that the fecal incontinence is her fault. I think that way you will get a better hearing, and a less defensive, and more information filled response.

Whatever happens, it looks like the inside anal sphincter has been compromised. Yes, it is a pain having fecal incontinence, the way it complicates emptying, clothes washing, and sex, but it may yet sort itself out with reversion over the next 18 months.

Now you are 7months postpartum it really isn't going to matter whether it is stitched now or later if necessary. I would be waiting to see what reversion you get in 18 months time before deciding whether or not to opt for a repair, which might or might not improve it.

In the meantime you might use panty liners to protect your clothing.

The sex problem might require a bit more ingenuity, and also working with your partner on both of you being able to accept a little soiling as part of sex, and finding ways to keep the soiling isolated, so it doesn't mess up your bed clothes. Antispetic wipes or damp flannels by the bed might help. Using a disposable Bluey (Like the ones you lie on in hospital) under you during sex might also help, or an old nappy or towel. Yukky, but not impossible. I guess you feel a bit ashamed about it. It's not your fault. Sex is messy at the best of times, and messier at the worst of times. But it is good, and it is worth nutting out ways of keeping it good.


Nutting it out, Louise? That might be an Aussie term.....or in regard to the subject, something my old man would say. I love it.

Mindful, I don't mean to make light of your situation. I have such a lack of normal muscle tension around my anus that I often can't control passing gas and soft stools incompletely voided can leave me with soiled panties. It sure doesn't make me feel like I'm "sexy". I initiate - that's how he knows I'm in good enough condition to carry on. He wiped up the poop when I was in labor and didn't get an enema. He taught me how to change diapers and prevent diaper rash. And then he has his own ass to wipe so it's not anything new to him - a little poop. I hope you won't think I'm being vulgar - it's just reality.
Does that help?

Bebe, you have just described what has been pretty much the norm for me, since well before the "discovery" of my 'celes. I have found that WW posture over the years has improved this condition notably. There is much less of a tendency for gas (or worse) to escape without warning. I never thought of it as a lack of muscle tension around the anus. Maybe it is, I don't know. Since discovery of a rectocele, and subsequent posture change which improved the problem, I feel it has more to do with moving the organs back in the general direction where they should be, and the resulting alterations of intraabdominal pressure. You are (or have been) a pessary user so the dynamics may be a bit different. - Surviving

I think you're right. Now that I think about it since I've been more and more aware of tending to posture, I haven't had as many surprise escapes of gas. Part of the problem has been diet, too. That is changing so that I'm less constipated, but with softer stools come the other problem of not being able to get done or clean. Maybe I'll come to happy intestinal maintenance.....working on it.

I feel like I am on a never ending merry go round. When my stool is so loose I can't control it I take Immodium and then I have to push so hard it makes my prolapse worse. Then in a few days I am back to a too loose stool and start the cycle again. I have had a complete hysterectomy several years ago so feel I don't have good options to help myself. I too am in my 70's but am active.

Recently I tried a product called 'colon cleanser' for a stool softener which is mostly psyllium seed husk and it made me feel bloated and gassy. I just noticed it also contains aloe vera which I've been taking in a separate capsule for several months for inflammation (arthritic-like inflammation). Besides my arthritic parts feeling better, in the last few months I haven't been nearly so constipated as I always was. Aloe is commonly recommended for stomach disorders, ulcers, hemorrhoids, etc. I buy it in capsules (whole herb) from a company that sells herbal products (online and by catalog). I think I'll start taking two a day and see if I can't find that happy medium I'm looking for.

Meanwhile, I cannot sit and wait on the toilet - let alone strain. I have developed a habit of being able to poop in the evening after standing at the sink washing the dishes. Key word - standing. Walking also helps. I never make myself go but wait until I'm ready, go to the toilet, and release. That's when things are working okay. My problem with too soft stool is occasional - when I've taken measures to soften it. Louise(?) gave a good description of toilet posture in a thread with a post that may be titled "where are your knickers?" It really really helped me too.

I try to eat or take what I need to keep me moving - shredded wheat, fruit... If I'm constipated, I eat what I know will have the desired effect. Goldenseal also works my bowels, but it's not recommended for continual use. When I'm desperate, I eat mango. It tastes great going in, burns like fire coming out - but it works. It is a never ending process because things change daily and the combinations of changes seem endless. That's why I always praise the Creator for this magnificently made, self-adjusting body, and try to be responsible to nourish and care for it with the powerful foods and herbs he made for us. Since we live in an environment seriously interfered with, sometimes we have to use methods or medicines to counteract the interference.

Has anyone fasted? I would love to hear about it.

Look, I've not experienced what you are currently going through, but I do remember my first go 'round with POP and at 7 months pp thinking, "What!? This is not healed yet!?" And again, at 16 months pp, "What!!!??? I'm still not over this YET!!??" Then suddenly, at about 22 months pp, I felt ready to take on the world again, and have another baby. Suddenly, the management of POP felt, well, quite manageable indeed.

I adore your "commitment to survive" statement. I pledged something similar at one point in my journey, and felt more focused and much more in control as a result. I look at some of my war veteran patients (a rare but treasured patient population where I am), no legs, a head full of combat, dealing with pressure ulcers and having to do "manual bowel programs" (self-digital stimulation in order to have bowel elimination) and yet raising families and skiing and holding down meaningful jobs. I feel like I've got it good in comparison!

I lamented for a good long time about my second degree unstitched tear and it's role in my prolapse. Eventually, I was able to let that go. If I were you, I would get a consult or two regarding your sphincter. Perhaps there is a solution to be had. Otherwise, do you practice Nauli yet? Perhaps this practice could help restore some functional tone.

Over all, I admire you and your attitude. You WILL make it through this!!!

Go ahead and get familiar with your anal sphincter. Really! Feel it. It should feel thick and continuous- like a band all the way around. You can put your thumb in your vagina and your finger in your anus to get a sense of what is going on. If there is a soft spot that does not have the band- then you know you are dealing with a tear. Now, if you are dealing with a tear, then certainly getting your poop just the right consistency is the way to go (no pun intended).
My guess is that if your tear was 4th degree during your home birth, your midwife would not have been qualified to stitch it up- the sphincter retracts immediately and really needs a highly trained individual to go after it- otherwise you end up stitching things that need not be stitched together.

Dear Mindful,
I realize this is an old post, but I am wondering if you could share with me how you are doing now?I saw your update 12 months postpartum, may I ask what lifestyle changes you've made/ work you did to get to that point? I am 38 years old, 12 months postpartum, and with similar symptoms you described at 7 months Postpartum. I suspect I may have a prolapse besides a compromised anal sphincter, though I have yet to see a doctor on this. I've been trying to keep positive, but worry about what the future might hold, especially with 2 young children to care for. Would really love to hear from you, and hear any advise from all. Thank you.

Hi Hope and welcome. We have lots of PP moms on here who are doing great with the Whole Woman work, so I hope you are following the forum and checking around this website. Christine has developed a program that returns us to our natural posture which is the source of pelvic organ support. You can manage and even reverse your symptoms, lose the fear, get on with life. Watch this for an overview (if you haven't already found it) and then feel free to post your questions to this wonderful community. - Surviving

Welcome Hope. You will find these ladies very helpful, knowledgable and comforting. I'm sure that's what you need right now. They will guide you through this healing process and truly give you "Hope". Love the name!

Thank you, Surviving, Safelyheld and Sierra. I do have a lot of fears right now that I need to get over. Will read up as much as possible as you suggested. Thank you for taking time to respond, just hearing from you has brought me some comfort today.