Bowel problems are a common symptom of pelvic floor dysfunction, and can affect women of any age.
Faecal incontinence is the loss of bowel control, resulting in involuntary passing of wind, liquid or solid stool.
Some women notice a few ‘skid marks’ in their underwear, or are unable to prevent passing wind. Others may lose some stool without being aware of the loss, or have an extreme urge to get to the toilet and not make it in time.
Whatever the problem, the embarrassment and anxiety it can create can severely affect your confidence, with the fear of repeated accidents always in the back of your mind.
Faecal incontinence is commonly caused by:
Muscle weakness or damage may affect the pelvic floor and the external & internal sphincter muscles which sit just below the pelvic floor muscles.
- The external anal sphincter works to delay a bowel movement if an urge is felt, but it’s not convenient to go to the toilet. If it is weak you will have an urgent need to get to the toilet immediately and may lose some bowel contents if you can’t get there in time.
- The internal anal sphincter works to keep the anus closed throughout the day, unless there is an urge to empty the bowels. If it is weak you may lose small amounts of stool without being aware that it has happened. This may occur when you’re being particularly active (lifting, running), or after you’ve just emptied your bowels.
The most likely cause of damage is childbirth, which can cause the muscles to be stretched or torn. Damage is more likely to have occurred if there is a tear at the back of the vagina (often called a 3rd or 4th degree tear), forceps are used, or if the baby is very large.
You may be aware of difficulty controlling your bowels immediately after the birth, or problems may develop many years later as the pelvic floor and sphincter muscles gradually weaken with age or from years of straining to empty the bowels.
The muscles may also be damaged during surgery to the rectum or anus.
If stools are watery it takes much more muscle control to hold the stool safely in the rectum. As a result, incontinence is more likely with diarrhoea if the pelvic floor or anal sphincter muscles are weak.
Surprisingly, constipation can also result in bowel leakage. If there is a large accumulation of stool sitting in the rectum, mucus can seep around the stool and escape through the anus, often accompanied by small pieces of stool.
Alternately, chronic constipation that results in years of straining to empty the bowels can weaken the pelvic floor and sphincter muscles. Over time, this can cause difficulty in controlling the bowels and result in bowel incontinence and prolapse.