Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, Suite 25
Framingham, Massachusetts
Tel: (781) 890-9095
Fecal Incontinence
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:

  • Fetal presentation (occiput posterior)
  • Use of forceps
  • Fetal weight greater than 4,000 grams
  • Perineal tears
  • Prolonged second stage of labor
  • 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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