Ryan Stewart, DO
Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 14, 2026

Is fecal incontinence common after childbirth?

Accidental bowel leakage after childbirth is more common than most women realize, but it is rarely discussed openly. In a large prospective study of first-time mothers, anal sphincter tears doubled the risk of fecal incontinence: 27% at six weeks and 17% at six months, compared with about 8 to 11% in women who delivered without a recognized tear. Sphincter injuries occur in roughly 1 to 5% of vaginal deliveries, and many go undiagnosed. Even when recognized and repaired, persistent muscle gaps show up on ultrasound in about a third of women after their first birth.

What often surprises patients is the timing. More than 65% of women with bowel leakage at six weeks recover by six months. But nearly half of the cases present at six months are new, not carryover from the early postpartum period. And because compensatory mechanisms can mask an old injury for years, some women first notice symptoms around menopause or later.

Why childbirth is a risk factor

• Anal sphincter tears: the internal and external sphincter muscles can be partially or completely torn during delivery. The internal sphincter is responsible for resting continence, and persistent internal sphincter gaps are the strongest driver of symptom severity after repair.
• Nerve injury: the pudendal nerve can be stretched or compressed during the second stage of labor. About 80% of women show some evidence of nerve changes on EMG after vaginal delivery.
• Pelvic floor trauma: broader muscle and connective tissue disruption weakens overall pelvic support for the bowel.

Risk factors for sphincter injury include forceps delivery (the strongest modifiable risk factor), vacuum delivery, midline episiotomy, fetal occiput posterior position, prolonged second stage, large baby, and first vaginal delivery. These risks compound when combined: forceps plus episiotomy carries an odds ratio of about 25 for sphincter tear.

Fourth-degree tears have consistently worse outcomes than third-degree tears. In one study, persistent internal sphincter gaps were found in 78% of women after fourth-degree tears versus 20% after third-degree tears.

What treatment looks like

I approach fecal incontinence the same way I approach most pelvic floor problems: we talk about what is bothering you most, and together we figure out what makes sense to try. There is no single path that works for everyone.

Options we might consider include:

• Pelvic floor physical therapy: this is more than just Kegels. A pelvic floor PT works on muscle strength, coordination, relaxation, endurance, breathing patterns, postural habits, and the surrounding hip and core structures. I have pelvic floor physical therapists in my office, which makes it easy to coordinate care. Biofeedback and electrical stimulation can be added when needed.
• Stool optimization: sometimes the fix is straightforward. Getting stool to the right consistency with fiber, fluid, and dietary adjustments can make a real difference. Loperamide can help with urgency-type leakage.
• Sacral neuromodulation: I think of this as a bowel pacemaker. A small device stimulates the sacral nerves to improve bowel control. More than 80% of patients get at least a 50% reduction in leakage episodes, and results hold up over years. It works even in women with sphincter defects, which is a common misconception. An anal sphincter defect is not a contraindication.
• Devices: vaginal bowel control devices and anal inserts are newer options that some patients find helpful while deciding on longer-term treatment.

I do not offer injectable bulking agents for fecal incontinence. Sphincter repair surgery is rarely something I recommend outside the immediate postpartum setting, because long-term results are disappointing. Studies show full continence rates drop to as low as 0 to 14% after five or more years, and about a quarter of patients have wound-related complications. For most women with chronic fecal incontinence, sacral neuromodulation is a better fit.

When to seek help

If you are experiencing any accidental leakage of stool or gas, whether it started right after delivery or showed up years later, it is worth having evaluated. Fewer than 30% of women with this problem ever bring it up with a doctor, and fewer than 3% with symptoms actually receive a diagnosis.

I treat fecal incontinence regularly. I take it seriously, and I can help.

References

1. Borello-France D, Burgio KL, Richter HE, et al. Fecal and urinary incontinence in primiparous women. Obstet Gynecol. 2006;108(4):863-872. doi:10.1097/01.AOG.0000232592.82165.78
2. Richter HE, Fielding JR, Bradley CS, et al. Endoanal ultrasound findings and fecal incontinence symptoms in women with and without recognized anal sphincter tears. Obstet Gynecol. 2006;108(6):1394-1401. doi:10.1097/01.AOG.0000243776.23210.11
3. FitzGerald MP, Weber AM, Howden N, Cundiff GW, Brown MB. Risk factors for anal sphincter tear during vaginal delivery. Obstet Gynecol. 2007;109(1):29-34. doi:10.1097/01.AOG.0000242611.56491.21
4. Richter HE, Nager CW, Burgio KL, et al. Incidence and predictors of anal incontinence after obstetric anal sphincter injury in primiparous women. Female Pelvic Med Reconstr Surg. 2015;21(4):182-189. doi:10.1097/SPV.0000000000000160
5. Meyer I, Richter HE. Impact of fecal incontinence and its treatment on quality of life in women. Womens Health (Lond). 2015;11(2):225-238. doi:10.2217/whe.14.66
6. Goldman HB, Lloyd JC, Noblett KL, et al. International continence society best practice statement for use of sacral neuromodulation. Neurourol Urodyn. 2018;37(4):1823-1848. doi:10.1002/nau.23596
7. Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019;31(6):485-493. doi:10.1097/GCO.0000000000000584
8. Brown HW, Dyer KY, Rogers RG. Management of fecal incontinence. Obstet Gynecol. 2020;136(4):921-936. doi:10.1097/AOG.0000000000004054

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Frequently Asked Questions

Can a sphincter injury be repaired years later?

In some cases, yes. Delayed sphincter repair can be performed, though long-term results are less predictable than acute repair at delivery. For many women with older injuries, sacral neuromodulation (a bowel pacemaker) is a better option with more durable results.

I had a fourth-degree tear. Am I at higher risk?

Yes. Fourth-degree tears involve both the anal sphincter and rectal lining, and carry higher rates of bowel leakage than third-degree tears. In one large study, 26% of women with fourth-degree tears reported fecal incontinence at six months compared with 15% after third-degree tears.

Should I tell my OB about gas leakage?

Yes. Involuntary gas leakage can be an early sign of sphincter weakness. Bringing it up lets your doctor evaluate and potentially address it before stool leakage develops. Only about 10 to 30% of women with bowel leakage ever mention it to a doctor, so you would not be alone in finding it hard to bring up.