Fecal incontinence in women and risks with pregnancy
Subhankar Chakraborty M.B.B.S., Ph.D. and Bradley W. Anderson M.D.
Mayo Clinic, Rochester, MN 55905
Fecal incontinence (FI) is an unintentional leakage of stool (solid or liquid) or gas. The emotional impact of FI often outweighs its physical manifestations. Patients are often embarrassed to disclose this problem to their family, friends and healthcare providers. Providers often neglect enquiring about this problem, causing it to remain undiagnosed. It has been suggested that patients may be more forthcoming if the term “accidental bowel leakage” is used.
The prevalence of FI in community dwelling elder people is believed to be 1 in 6. It is higher (about 1 in 2 people) among those in nursing homes and about 1 in 3 among elderly who are hospitalized. There is no difference in the prevalence of FI between men and women. Dementia, impaired mobility and comorbid illnesses increase the risk of FI in the elderly. Prompted toileting and regular exercises to maintain fitness have been shown to be highly effective in improving stool continence in this population.
Pregnancy itself does not increase the risk of fecal incontinence. Rather, it is injury during vaginal delivery- either instrumentation during delivery (such as the use of forceps or vacuum devices) 1 or perineal tears, particularly 3rd (injury to the external anal sphincter) and 4th (injury to both internal and external anal sphincter) degree tears that increase the risk of fecal incontinence postpartum. The incidence of FI following vaginal delivery has gone down significantly from 1 in 7 two decades ago to 1 in 13 more recently. This may be due to decreased use of vacuum and forceps and more judicious use of episiotomy. After adjusting for other factors, perineal injury after vaginal delivery was not a risk factor for FI that occurred many decades later.2 The median age for onset of FI symptoms in women is around 70 years and the rate of FI was similar between nulligravid and nulliparous women. Similarly, there was no difference in the rate of FI between those who had cesarean section and those who had vaginal delivery. A 2006 consensus conference conducted by the National Institutes of Health concluded that there was insufficient evidence to support a practice of delivery by cesarean section to protect against pelvic floor disorders including FI.2 There is likely a genetic component that predisposes certain women to develop FI when exposed to situations that stress the continence mechanism ( childbirth, obesity, advancing age).
1. Chin K. Obstetrics and Fecal Incontinence. Clinics in Colon and Rectal Surgery. 2014;27(3):110-112.
2. Bharucha AE, Dunivan G, Goode PS, et al. Epidemiology, pathophysiology, and classification of fecal incontinence: State of the Science Summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Workshop. The American journal of gastroenterology. 2015;110(1):127-136.