Faecal Urgency/Incontinence After Giving Birth
After giving birth, some women will report ongoing problems of severe urgency and incontinence to liquid stool.
There may be a feeling that the bowels are going to open at any moment, potentially leading to episodes of incontinence if defecation cannot be deferred before a toilet is reached. Upon opening the bowels, the patient may feel like she cannot control her sphincter well.
Liquid stool is often more problematic to control. If a patient suffers with watery stools then she may have episodes of frank incontinence. There can also be occasional episodes of partial incontinence, with staining of the underwear. Pads may be used to 'catch' the staining. The can also be difficulty discriminating wind (flatus) from faeces.
Investigations for faecal urgency
If a patient has difficulty maintaining continence after giving birth, a GP should feel that further investigation is required and refer a patient to a physiology unit for anorectal physiology. During this appointment, the patient's anal sphincter will be tested, including: resting pressures, squeeze pressures, 5-second squeeze increment and involuntary squeeze increment. The length of the anal sphincter and sensory function will also be noted.
These tests should confirm whether or not there is an underlying injury that has not been repaired, which in turn is causing a patient's symptoms. A defect in the external anal sphincter represents a 3A or 3B tear. A defect in both the internal and external anal sphincter represents a 3C tear or a 4th degree tear.
Missed perineal tear found
If a missed perineal tear is detected, a suitable course of treatment should be recommended. Because of the delay in treatment, a surgical repair may not be advisable. A surgical repair performed shortly after the birth will often lead to a successful outcome. But for reasons that are unknown, the long-term results of a delayed surgical repair (called a secondary repair) are not good. Only around 40% of women will have satisfactory continence five years after a secondary repair.
Therefore the patient may be told to try conservative treatment before a surgical repair is attempted. This can include a course of biofeedback, sacral neuromodulation and rectal irrigation.
Will treatment be effective?
Treatment can lead to an improvement in symptoms. After this the patient's condition will not spontaneously improve further and will deteriorate due to the effects of age and menopause.
The patient can suffer significant psychological trauma as a consequence of their missed 3rd degree tear. Such symptoms can impact upon the patient's day-to-day living in terms of employment, domestic and social life. This impact will continue as long as the patient remains symptomatic.
Was your tear missed?
If you have found out that your 3rd degree tear was initially missed, please get in touch with us to discuss making a compensation claim.
Please call us on 0800 234 3300 (or from a mobile 01275 334030) or complete our Online Enquiry Form.
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