Severe tears & pelvic floor injury
Bowel Accidents After Birth: When It's a Missed Sphincter Injury
The short answer
Bowel urgency, soiling or accidents after birth are not something you have to live with, and they're not "normal". The most common cause is an injury to the anal sphincter, the muscle that controls your back passage, during a vaginal birth. Sometimes that injury was recognised and repaired. Often it was missed, or the repair failed. Tests such as an endoanal ultrasound can show the damage, and there are treatments that help. If the injury was missed, poorly repaired, or followed a birth that was badly managed, a compensation claim may be possible.
The symptom no one wants to say out loud.
It might have started with wind you couldn't hold. Then the urgency: the panicked rush to the toilet, not always in time.
Maybe you've had an accident in public, or at work, or in front of your partner. Maybe you wear pads every day, plan every outing around toilets, and carry spare underwear in your bag.
And maybe you've never told anyone the full extent of it, not even your GP, because the shame feels unbearable.
Please hear this: losing bowel control after birth is an injury. It is not a personal failing, and you deserve real help.
A literature review by University of Adelaide researchers found that obstetric anal sphincter injury is a predominant cause of anal incontinence. It also found women's experiences of living with it are still poorly understood and under-supported.
What faecal incontinence after birth can look like
- Leaking wind you can't control
- Urgency: having only seconds to reach a toilet
- Passive soiling: staining or leakage you don't feel happening
- Accidents with loose or solid stool
- Difficulty cleaning after a bowel movement
- Wind or faeces from the vagina, which can signal a fistula and needs urgent assessment
Healthdirect's guide to faecal incontinence lists complications from vaginal birth among its causes. The Royal Hospital for Women's procedure on severe tears notes that the most common ongoing symptoms in women after these injuries are leaking wind and urgency.
Why it happens
The anal sphincter
Two rings of muscle around the back passage. The external sphincter lets you hold on when you choose. The internal sphincter keeps you sealed without thinking about it. A third degree tear injures one or both. A fourth degree tear goes through them into the bowel lining.
In plain terms: if these muscles are torn and don't heal properly, the "door" to your bowel no longer closes reliably.
Bowel control problems after birth usually come from one or more of:
- A sphincter tear that was missed and stitched as a minor tear, or not stitched at all
- A sphincter tear that was recognised but not repaired well, or the repair broke down
- Nerve damage from a long pushing stage or a difficult instrument birth
Forceps carry a higher risk of severe tears and changes to bowel control than vacuum, as RANZCOG notes in its instrumental birth statement.
What should have happened
At the birth.
The national care standard says you should be offered a careful examination after a vaginal birth, including a rectal examination, to identify third and fourth degree tears. If you suspect this didn't happen, my article on severe pelvic floor damage and incontinence after childbirth explains how these injuries are identified, and when missing them may be negligence.
After a severe tear.
The Royal Hospital for Women's third and fourth degree tear procedure sets out what good care looks like:
- repair in theatre by an experienced doctor
- antibiotics, and stool softeners or laxatives to avoid straining
- a physiotherapy referral at the time of repair
- a doctor's review before you go home
- specialist clinic reviews at around 4 weeks and 4 months
A UK hospital's patient information on severe tears similarly tells women to report wind or faecal leakage or staining, and describes follow-up in a urogynaecology clinic.
When you raised symptoms.
If you told a midwife, GP or obstetrician about bowel problems, you should have been referred for specialist assessment, not reassured. Being dismissed is something I've written about in when being dismissed by a doctor becomes a legal issue.
If this is landing for you, and you've been living with this quietly, I'd be glad to listen, with care and complete discretion.
Tests and treatment
Tests.
- Endoanal ultrasound: a small probe shows whether the sphincter muscles are intact or torn. It can detect damage years after the birth.
- Anorectal manometry: measures how strongly the sphincter muscles squeeze.
- Examination by a colorectal surgeon, urogynaecologist or pelvic health physiotherapist.
Treatment.
- Pelvic floor and sphincter physiotherapy, sometimes with biofeedback
- Diet and medication to firm stools and reduce urgency
- Continence products to manage day to day
- Surgery to repair the sphincter, in some cases
- Nerve stimulation treatments, for some women when other treatments haven't worked
The Australian Physiotherapy Association's position statement on physical birth trauma notes the role of endoanal ultrasound in detecting these injuries, and of referral to colorectal surgeons where needed.
For support now, Continence Health Australia has information on incontinence after pregnancy and childbirth, and the free National Continence Helpline, through Pelvic Floor First, is on 1800 33 00 66.
Why getting it addressed now matters
Sphincter injuries don't just affect the months after birth. A large Swedish study, reported by the University of Gothenburg, found that women with a sphincter injury at birth had roughly double the rate of faecal incontinence decades later. The rate was 23.8% compared with 11.7%, and higher again after injuries in two births. Women with a sphincter injury also had about three times the risk of another one in their next birth.
That matters for your health, for planning any future births, and, if a claim is possible, for making sure the claim accounts for the future.
When it may be negligence
A claim may be worth exploring if:
- your sphincter tear was missed at the birth
- it was recognised but repaired poorly, or not in the right setting
- you weren't given the follow-up care a severe tear needs
- your symptoms were dismissed, delaying treatment
- the birth was mismanaged, or you weren't told the risks of forceps. See birth injuries and medical devices.
I've written more about this injury in "I can't control wind after birth" and in "It's just part of having a baby". For what a claim can cover, including future surgery, continence care and lost income, see living with a pelvic floor injury, and what a claim can cover.
Frequently asked questions
Is it normal to have bowel accidents after giving birth?
No. It's not uncommon, but it's not normal, and it usually means something has been injured. Please ask for a specialist assessment.
Can a sphincter injury be found years after the birth?
Yes. An endoanal ultrasound can show sphincter damage long after the birth.
I'm too embarrassed to see my GP.
That's completely understandable. You could start by calling the National Continence Helpline on 1800 33 00 66, where continence nurses talk about this every day.
Is there a time limit for a claim?
Yes. Time limits often run from when you knew, or ought to have known, about the injury and its cause. Please get advice early.
A closing thought
You've been carrying something very private, very heavy, and very alone.
So here's a gentle question: who is one person, a nurse, a physio, a doctor or a lawyer, you could tell the whole truth to this month?
Keep reading: Maternal birth injuries: what we must talk about · Delayed and missed diagnosis claims
This article is general information only. It is not medical or legal advice, and it doesn't replace advice from your own doctor, midwife or physiotherapist. Reading it does not create a lawyer–client relationship. If you are in crisis, please call Lifeline on 13 11 14 or 000 in an emergency.
