Fecal Incontinence After Childbirth: Diagnostic and Clinical Aspects

Abstract

The International Continence Society stated that “anal incontinence (AI) is the involuntary loss of flatus, liquid or solid stool that is a social or hygienic problem.” The reluctance of patients to admit the symptoms of AI, even when following childbirth, makes it difficult to establish the true prevalence of this disabling condition. All symptoms related to AI must be investigated and possibly reported with a grading system, which allows to use an objective parameter to evaluate AI, to verify the response to therapy, and to follow up its evolution. Prior to reconstructive surgery it is mandatory an exhaustive examination of the pelvic floor; each damage to the vaginal mucosa and rectovaginal septum must be properly classified and repaired before approaching the posterior compartment. If possible, an immediate repair of the sphincter’s defect performed within 24 h from childbirth is to be preferred: it has been demonstrated that it is associated with less risk of fecal urgency and better long-term results, when compared to delayed sphincteroplasty. Whether it is a primary or a secondary repair, and even if the overlap technique deserves better results, guidelines and papers suggest that an end-to-end or an overlap procedure can be performed at discretion of each surgeon but with the recommendation that, if possible, the internal sphincter is repaired separately and that the surgeon or gynecologist is appropriately trained in these procedures.