Bowel Incontinence From Childbirth Not Cured by Surgery
Jan. 25, 2000 (Minneapolis) -- Most women have continuing or even new bowel
problems after surgery to repair an anal sphincter that's damaged while giving
birth, according to British researchers who published their findings recently
in the journal The Lancet. Although the surgery typically corrects the
problem initially, the problems gradually come back, so patients can have
recurrent or new difficulties a few years later.
Anal sphincters are the muscles that coordinate bowel movements. They may be
damaged during vaginal deliveries. As many as one in three women have some
degree of anal-sphincter trauma during their first vaginal delivery. Women will
present to their physician with soiling weeks or even months following
"[A]lthough most patients improve after the procedure, [bowel control]
is rarely perfect," the authors write. Their study involved questionnaires
and telephone interviews with patients who had had repair surgeries at least
five years previously. The surgery in the study, called overlapping anterior
anal-sphincter repair, is one way to correct the damage for severe
"We're not opposed to [the] surgery," co-author Christine S. Norton,
RN, MA, tells WebMD. "The right people [need to be selected.] Those with
severe symptoms are more likely to be satisfied ... while those with mild
symptoms are more likely to be disappointed." She is a nurse specialist at
St. Mark's Hospital in Harrow, England; her focus is patients with bowel
In this 55-patient study, 38 patients were eligible for the analysis. Of
these, none was fully able to control both stool and gas passage. Six of the 38
had complete relief from urgency, the inability to postpone a bowel movement.
Twenty still required an incontinence pad and 25 said their bowel problems
restricted their lifestyle in some way.
"[A] high proportion of women presenting with incontinence have
structural sphincter damage," the authors write. Incontinence is the
inability to prevent a bowel movement resulting in soiling. Incontinence pads
are often used so daily activities can continue more easily.
Several factors can increase the risk of damage to the anal sphincter during
birth. These include a forceps-assisted birth and a baby that weighs over 8
lbs., 14 oz. Another risk is a posterior presentation, in which the back of the
baby's head presses against the mother's spine, also known as "sunny-side
up." Episiotomy does not prevent the damage, the authors write.
"There is room for reasonable disagreement among physicians as to
whether it is advisable to overlap muscle tissue, [as was done by these
investigators]," Leslie A. Sharpe, MD, tells WebMD. "Another repair
technique ... sews into the sphincter's surrounding tissue. ... These two
techniques may differ in how well the repair holds up over time." Sharpe, a
clinical associate professor of obstetrics and gynecology at the University of
Minnesota in Minneapolis and an attending physician at Health Partners and
Regions Hospital in St. Paul, Minn., was not involved in the study.