Fecal incontinence is the unwanted release of feces or gas due to the loss of anal sphincter control. In healthy women the most common cause is damage to the anal sphincter at the time of delivery (obstetrical trauma). The internal anal sphincter is the distal extension of the inner circular smooth muscle of the distal colon and rectum; it is continuously contracted to prevent involuntary loss of stool and is not under voluntary control. The external anal sphincter is a striated muscle that also forms a circular tube around the anal canal and it is under voluntary control; its function is directly related to its structural integrity.
Incontinence of feces as a result of damage to the anal sphincter must be distinguished from stool seepage due to poor bowel control secondary to conditions such as hemorrhoids, inflammatory bowel disease, fistula-in-ano, rectal prolapse. True fecal incontinence must also be distinguished from fecal urgency that may be due to an underlying medical condition. Women suffering from a rectovaginal fistula may also experience involuntary loss of feces but the anal sphincters are intact and function normally.
Childbirth is considered the most common underlying cause of fecal incontinence in women. Damage to the external and/or internal anal sphincter and damage to the pudendal nerve (compression, overstretching) at the time of birth are believed to be the mechanism of injury. While injury leading to fecal incontinence can occur following a spontaneous vaginal delivery, it is more frequently seen following operative vaginal deliveries (forceps) or traumatic lacerations (third and fourth degree lacerations) associated with extended episiotomies. Other factors that increase the risk of developing fecal incontinence include:
Subsequent vaginal delivery in a previously damaged anal sphincter
Prolonged second stage of labor as a cause of injury leading to fecal incontinence is further supported by the fact that women undergoing cesarean section before entering labor or during the early stages of labor do not experience alterations in anorectal function. Women who undergo cesarean sections following a prolonged arrest of dilatation in the later parts of the first stage of labor or following a prolonged second stage of labor experience an increased incidence of perineal dysfunction and complaints of fecal incontinence at their 6 weeks postpartum visit.
Functional and anatomical assessment of the integrity of the anal sphincters is essential before a successful treatment is attempted. Endoanal ultrasonography, pelvic magnetic resonance imaging (MRI) and defecography are some of the studies used to delineate the extent of anatomical and physiological disruption. Treatment is tailored to the degree of fecal incontinence. From conservative treatment of mild fecal incontinence, to biofeedback and a variety of surgical procedures including the implantation of an artificial sphincter have been attempted with varied results.
Fecal incontinence as a result of obstetrical trauma can be the most debilitating condition affecting an otherwise normal healthy young woman. The involuntary passage of stool creates soilage of undergarments and is socially debilitating due to the psychological loss of self-esteem which leads to social isolation and sometimes severe depression. Because of its social stigma, many women will suffer in silence and be reluctant to volunteer it as a complaint. Fecal incontinence is one of the top leading causes of admission of patients to long- term care facilities in the United States.
Medical providers attending labor and delivery are responsible for the diagnosis and management of complications that arise during the first and second stages of labor. If you believe that you or your loved have been misdiagnosed, victims of a traumatic delivery or wrongly treated and suspect the postpartum complications may be the result of a medical provider’s error that was diagnosable, avoidable and/or preventable, you may have a valid cause of action. The injury may be the result of a medical provider's mistake in handling your condition and the result of medical negligence. Dr. Borten has over 35 years of experience as an obstetrician and gynecologic surgeon to fully evaluate the merits of your potential case. Allow the Boston area medical malpractice attorneys at Gorovitz & Borten help you assert your rights and get the compensation you deserve.
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