If you have become incontinent of faeces after childbirth, what treatment options are available to you?
Incontinence after birth
Being continent of faeces depends upon anatomically and functionally intact anal sphincters, formed stools and to some extent on a “non-irritable” colon and rectum.
During childbirth, the sphincter muscles can be severely damaged. Such injuries are known as third and fourth degree tears. They should be repaired shortly after birth, and most women will go on to make a complete recovery.
Some, however, will not have a successful repair. In other cases, the injury is missed by medical practitioners and a woman will be left with a defect in her anal sphincters. This amounts to medical negligence.
Women who develop complications after birth usually report faecal urgency and leakage. The need to rush to the toilet is a product of external anal sphincter damage. This skeletal type voluntary muscle is employed when stool is felt in the rectum and it allows time to reach a toilet. The fear of incontinence can also lead to a further need to rush to the toilet.
Faecal leakage is a product of internal anal sphincter damage. This smooth muscle sphincter maintains a constant tone, only relaxing when stool distends the rectum.
Treatment for incontinence
If a woman does suffer incontinence after birth, what treatment options are available?
Non-invasive techniques should be trialled first. This might include pelvic floor exercises, as the external anal sphincter can be exercised and in some cases this gives improved function. Unfortunately, however, the internal anal sphincter is involuntary which means it cannot be exercised to improve function.
In addition to pelvic floor exercises, a patient may be advised to take liquid Imodium on a daily basis and attend a course of biofeedback. This option must be trialled before an invasive procedure is performed.
If biofeedback is unsuccessful, a patient may be advised to proceed with a secondary repair of the anal sphincters. Nevertheless, secondary repairs only have a 50% chance of continence in the long term. These repairs should be done in conjunction with biofeedback therapy to get the best outcome.
Should biofeedback fail and a patient is not deemed suitable for a repair, she should have sacral nerve stimulation. This is an alternative approach to the treatment of faecal incontinence, and can work even on patients with major sphincter muscle disruptions.
Should a secondary repair, biofeedback and sacral nerve stimulation all fail, the options for treatment are currently limited.
Compensation for treatment
If your incontinence was caused by medical negligence, you will be entitled to claim compensation for the injuries you have sustained. This will help you pay for any future treatment you may need.