“I Can’t Make It to the Toilet in Time”: Bowel Urgency and Leaking After a Third or Fourth Degree Tear
Urgency, leaking poo, soiling and not being able to hold wind are common after a third or fourth degree tear, and they are some of the least talked about. They usually come from the anal sphincter, the muscle that was injured. Many women improve over the first months, especially with pelvic health physiotherapy, but ongoing symptoms are a reason to be investigated, usually with an endoanal ultrasound, not a reason to wait. This guide explains what the different symptoms can mean, whether it is “just the stool softeners”, what doctors check, what treatments exist, and when it can point to something having gone wrong.
She knows every public toilet between home and the shops. She doesn’t drink coffee before she leaves the house. She has a spare pair of undies and wipes in the nappy bag, and they aren’t for the baby. Six months after a 3b tear, no one in her life knows, not even her partner, how often she doesn’t quite make it.
If you can’t hold on, can’t hold in wind, or keep finding marks in your underwear you can’t explain, please hear this first: it is common after a third or fourth degree tear, it is not your fault, and it is not something you just have to live with. It is one of the most under-reported problems after birth, mostly because women are too embarrassed to say it out loud. I’m a lawyer, not a doctor. But I spend a lot of time with women living with this, and I can tell you what it usually means, what can be done, and when it can point to something having gone wrong.
- poo or wind is coming from your vagina
- you have suddenly lost control of your bowels, or it is getting worse rather than better
- you have bleeding from the back passage, or severe pain when you open your bowels
- you have a fever, a smell, or your stitches feel hot or open
Call your GP, midwife or maternity unit and say you had a third or fourth degree tear. If you feel very unwell, go to your nearest emergency department.
What it can mean
Anal incontinence
Any involuntary loss of wind (flatus), liquid or solid stool. It includes urgency, where you have very little warning and can’t hold on, and passive soiling, where stool leaks without you being aware of it.
In plain terms: if you can’t hold wind, can’t make it to the toilet in time, or keep finding marks in your underwear, that is anal incontinence. It is a medical symptom with medical causes, not a hygiene problem.
After a third or fourth degree tear, these symptoms usually come from the muscle that was injured: the anal sphincter. It is actually two rings of muscle, and they do different jobs.
Pattern 1Urgency: “when I need to go, I need to go now”
What women describe
- Very little warning before needing to open your bowels
- Running to the toilet and not always making it
- Planning outings around toilets
- Being scared to leave the house
What it can point to
- Weakness or a gap in the external sphincter, the muscle you squeeze to “hold on”
- The repair of the external sphincter not holding
- Loose stools making a weak sphincter work harder
Pattern 2Soiling: “skid marks I can’t explain”
What women describe
- Marks or leakage in underwear without feeling it happen
- Needing to wipe again and again
- Wearing a liner every day
What it can point to
- Damage to the internal sphincter, which keeps you closed at rest without you thinking about it
- A 3c or fourth degree tear, or an internal sphincter injury that was missed
- Scarring that stops the area closing completely
Pattern 3Wind: “I can’t hold it in”
What women describe
- Wind escaping without warning
- Wind you can feel coming from the vagina rather than the back passage
- Avoiding meetings, gyms and social situations
What it can point to
- Sphincter weakness, which our article “I can’t control wind after birth” covers in detail
- If it comes from the vagina, a possible fistula: see our article on obstetric fistulas
Over timeDoes it get better?
Often, yes. Many women have some urgency or trouble holding wind in the first weeks, and it improves as swelling settles and the muscles heal, especially with pelvic health physiotherapy. UK hospital information suggests that around six to eight in ten women have no symptoms a year after a third or fourth degree tear.
But that means some women do still have symptoms at a year, and for them waiting longer is rarely the answer. If you are not steadily improving by your follow-up review, or you are still having accidents at three months, it is time to be properly investigated.
Back to the overview“Is it just the stool softeners?”
It is a fair question, and women ask it all the time. Stool softeners and laxatives are an important part of protecting a fresh repair, but if your poo becomes very loose, even a healthy sphincter has to work hard, and an injured one may not cope. The Queensland Clinical Guideline on perineal care specifically warns against routinely combining bulking agents with osmotic laxatives after a sphincter injury, because of an increased risk of faecal incontinence.
So if your stools are loose, it is worth asking whether your laxative dose is right. But if you still have urgency, soiling or trouble with wind once your poo is soft and formed, the stool softeners are not the whole explanation, and you should be assessed.
What doctors usually check
- Your symptoms in detail: how often, how much warning you get, wind versus liquid versus solid, and the effect on your life. Some clinics use a short scoring questionnaire.
- An examination of the perineum and a gentle rectal examination, to feel the tone of the sphincter at rest and when you squeeze.
- An endoanal ultrasound, a small probe in the back passage that shows whether there is a gap in the external or internal sphincter.
- Anorectal manometry, which measures the pressure the sphincter can hold at rest and when squeezing.
- A check for a fistula if anything is coming from the vagina.
- A plan, often starting with pelvic health physiotherapy and bowel management.
What can help
- Pelvic health physiotherapy, including sphincter and pelvic floor training, often with biofeedback, which shows you on a screen whether you are squeezing the right muscles.
- Getting your stool consistency right, with advice on fibre, fluids, and medicines that firm loose stools, from your GP or a continence nurse.
- Bowel habit training, such as going at a regular time after breakfast, which some women find makes days far more predictable.
- Specialist treatments if physiotherapy isn’t enough, such as nerve stimulation or a surgical repair of the sphincter (sphincteroplasty) by a colorectal surgeon. These are discussed case by case.
- Practical support: the National Continence Helpline on 1800 33 00 66 can talk you through options and products. Some people with permanent and severe incontinence may be eligible for the Continence Aids Payment Scheme, which has its own eligibility rules.
Questions to ask
1. What grade of tear did I have, and was my sphincter repaired? 2. Could my symptoms mean the sphincter repair hasn't held, or that part of the injury was missed? 3. Can I have an endoanal ultrasound and anorectal manometry? 4. Can I be referred to a pelvic health physiotherapist who does biofeedback? 5. Is my laxative or stool softener dose right for me now? 6. Should I see a colorectal surgeon or a perineal clinic? 7. What are the options if physiotherapy doesn't help enough? 8. What should I know about this before another pregnancy?
If you find it hard to say the words in an appointment, it is completely fine to hand over a written list. Many women do.
What the guidelines say you should be offered
The national Third and Fourth Degree Perineal Tears Clinical Care Standard expects individualised follow-up after discharge, with referral for your physical, emotional, psychological and sexual health. The Queensland guideline recommends a physiotherapy referral before discharge, an obstetric review at 6 to 12 weeks, continence clinic review where available, and lists endoanal ultrasound and anorectal manometry for persistent incontinence. The Royal Hospital for Women in Sydney books its OASIS clinic follow-up at four weeks and four months.
The Mater Mothers’ Hospital tells women plainly that ongoing problems with bladder or bowel control “will require medical review and further management”. That is the right message. Bowel symptoms after a severe tear are a reason to be seen, not a reason to be patient.
When it can point to something going wrong
Ongoing bowel symptoms do not, by themselves, mean someone was negligent. A carefully repaired sphincter can still leave some weakness. But it can point to a problem with care if, for example:
- the sphincter injury was missed and recorded as a second degree tear, so it was never repaired (see “Nobody told me how bad my tear was”)
- a 3b, 3c or fourth degree tear was repaired in the birth room by someone without the right experience
- there was no rectal examination before or after the repair
- the repair broke down or became infected and that wasn’t recognised (see My stitches smell, came apart or feel open)
- you reported urgency or leaking and were told it was normal, and never investigated or referred
- no one talked to you about your bowel symptoms before your next birth
How the law looks at it
Whether care was negligent is judged against what was widely accepted as competent professional practice at the time. In New South Wales, section 5O of the Civil Liability Act 2002 (NSW) provides that a professional is not negligent if they acted in a way that was widely accepted by peer professional opinion as competent practice, unless that opinion is irrational. Other states have similar rules. The national standard and state guidelines are strong evidence of what competent practice looks like. In a claim, an independent expert, usually an obstetrician, is asked to compare your care against that practice, and a colorectal or urogynaecology expert may be asked whether better care would probably have made a difference to your symptoms.
Time limits apply. In New South Wales, a claim generally has to be started within three years of when you knew, or ought to have known, that you had been injured, that the injury was caused by someone’s fault, and that it was serious enough to justify a claim, with an outer limit of 12 years (Limitation Act 1969 (NSW) s 50C). Other states and territories have their own rules, so it is better to ask early than to wait.
If your bowel control has been affected, it is also worth knowing that compensation is assessed on the effect on your whole life: work, relationships, exercise, future treatment and care. Our guide to how much compensation for a third or fourth degree tear explains how that works. Our article on pelvic floor damage and incontinence after childbirth and our birth injury map may also help.
In my practice
Of everything women tell me after a severe tear, this is the thing they find hardest to say. It often comes up near the end of a first conversation, almost as an afterthought, after we have talked about the pain, the birth and the stitches. “And there’s also… the bowel thing.”
When we look at the records, I often see the same gap. The symptom was there early, sometimes noted by a midwife on day two or three, and then it disappears from the notes. No one asked again. In my doctoral research on patterns of failure in medical negligence, this is a recurring shape: a symptom that is embarrassing to raise is a symptom that is easy for the system to miss, unless someone deliberately asks.
So let me be the one who asks. If this is happening to you, it matters. It is treatable far more often than women are told. And you deserve to have someone look properly.
Drawn from the experiences of many women I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What she noticed. From the first weeks she couldn’t hold wind, and a few times she didn’t make it to the toilet. By six months she had stopped going to the gym and turned down a work trip because she was frightened of being stuck without a bathroom.
What she was told. At her six week check, that it was early days and to keep doing her pelvic floor exercises. Later, that it was probably the breastfeeding hormones, and that it would settle. No one suggested an ultrasound or a referral.
What the records showed. A 3b tear repaired in the birth suite overnight. No rectal examination recorded after the repair. A midwife’s note on day two recorded “unable to control flatus”, and nothing about bowels again after that. An endoanal ultrasound a year later showed a defect in the external sphincter.
How she felt. “I thought it was just me. That my body was broken and I had to manage it,” she said. Learning there was a physical reason, and a treatment pathway, didn’t undo the year she had lost. But it gave her something to do other than hide.
Both/and: it is common, and it is not something to accept
Both things are true. Bowel symptoms after a third or fourth degree tear are common, and many improve. And “common” does not mean “normal”, or “nothing can be done”. You can know that lots of women experience this, and still expect to be investigated and treated.
The bigger picture
RANZCOG’s Birth Trauma Roundtable Final Report (July 2026) called pelvic floor dysfunction one of the most common and least recognised consequences of childbirth, noting that symptoms often appear months or years later and that Medicare funds only a single postnatal attendance between four and eight weeks. If you have felt that there was nowhere to take this, you were not imagining it. That is all the more reason to ask, clearly and in writing, for a referral.
Support
- National Continence Helpline: 1800 33 00 66, free advice from nurse continence specialists, run by the Continence Foundation of Australia.
- PANDA (Perinatal Anxiety & Depression Australia): 1300 726 306, or panda.org.au.
- Birth Trauma Australia: birthtrauma.org.au, information and peer support for physical and emotional birth trauma.
- Our guide to finding support after birth trauma.
You are not dirty, broken or weak. You had an injury to a muscle that does one of the most important jobs in your body, and you are managing the consequences while caring for a baby. That takes enormous strength. You deserve care that matches it.
With care,
Rosemary
Frequently asked questions
Is it normal to not be able to hold poo after a third degree tear?
Some urgency or difficulty holding wind is common in the early weeks after a third or fourth degree tear, and it often improves. Ongoing accidents, soiling or urgency are not something to accept, and should be investigated, usually with an examination and an endoanal ultrasound.
Will I be incontinent forever after a fourth degree tear?
Not necessarily. Many women improve with time and pelvic health physiotherapy, and for those who don’t, there are further treatments, including specialist surgery. Around six to eight in ten women have no symptoms a year after a third or fourth degree tear.
Why do I have skid marks after giving birth?
Passive soiling, where stool leaks without you feeling it, can be a sign that the internal anal sphincter was injured. It is worth raising with your GP and asking whether you need an endoanal ultrasound.
Could my stool softeners be causing the leaking?
Very loose stools can make leaking worse, and your dose may need adjusting. But if you still have urgency or soiling once your stools are soft and formed, the softeners are not the whole explanation and you should be assessed.
What is an endoanal ultrasound?
A short test using a small probe in the back passage to look at the anal sphincter muscles. It shows whether there is a gap in the external or internal sphincter, which helps decide on treatment and on your options for a future birth.
What treatments are there for bowel incontinence after childbirth?
Options include pelvic health physiotherapy with biofeedback, managing stool consistency, bowel habit training, nerve stimulation and surgical repair of the sphincter. A colorectal surgeon or perineal clinic can advise what suits you.
Is bowel incontinence after birth caused by negligence?
Not always. It can point to a problem if the sphincter injury was missed, poorly repaired, not checked with a rectal examination, or if your symptoms were not investigated or referred. Time limits apply, so it is worth getting advice early.
Questions about your care?
If your bowel control has been affected and your tear wasn’t recognised, repaired or followed up properly, we can talk it through with you, confidentially. There’s no cost to find out where you stand.
- Is this normal? Recovery week by week
- My stitches smell, came apart or feel open
- “Nobody told me how bad my tear was”
- “I can’t control wind after birth”
- I can’t hold it, or make it to the toilet in time (you are here)
- Sex after a third or fourth degree tear
- Still can’t sit, months later
- Caesarean or vaginal birth next time?
- Could my tear have been prevented?
- “I feel broken, and no one understands”
- How much compensation for a third or fourth degree tear?
References
- Australian Commission on Safety and Quality in Health Care. Third and Fourth Degree Perineal Tears Clinical Care Standard. Sydney: ACSQHC, 2021. safetyandquality.gov.au
- Australian Commission on Safety and Quality in Health Care. Recovering from a third or fourth degree perineal tear (information for women). safetyandquality.gov.au
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Birth Trauma Roundtable Final Report. July 2026. ranzcog.edu.au
- Royal College of Obstetricians and Gynaecologists. The Management of Third- and Fourth-Degree Perineal Tears. Green-top Guideline No. 29, 2015 (published on the RANZCOG website). ranzcog.edu.au
- Queensland Clinical Guidelines. Perineal care. Guideline MN18.30. Queensland Health. health.qld.gov.au
- Royal Hospital for Women, South Eastern Sydney Local Health District. Third and fourth degree tears: repair and management. Clinical Business Rule, 2023. seslhd.health.nsw.gov.au
- Mater Mothers’ Hospital. Recovering from third and fourth degree perineal tears (patient information). mater.org.au
- Gloucestershire Hospitals NHS Foundation Trust. Third and fourth degree tears following childbirth (patient information). gloshospitals.nhs.uk
- Services Australia. Continence Aids Payment Scheme: who can get it. servicesaustralia.gov.au
- Civil Liability Act 2002 (NSW), including ss 5D, 5O, 12, 15, 16 and 33.
- Limitation Act 1969 (NSW) s 50C.
Client stories in this article are composites drawn from many women’s experiences and have been changed so that no one can be identified. They do not describe any individual client.
Written by Dr Rosemary Listing, PhD (Law). Rosemary is a medical negligence lawyer and Of Counsel at Peter Evans & Associates. She has practised since 2013 and worked on many hundreds of claims, including for women injured during childbirth. Her doctoral research examined patterns of failure in medical negligence, and she is a Sessional Lecturer in Health Law at the University of Newcastle. She is responsible for all content published under her name.
Rosemary is not medically qualified. Clinical information in this article is drawn from, and checked against, the national Clinical Care Standard, RANZCOG publications and state clinical guidelines listed in the references. Legal information reflects the law as at the review date.
Last updated 27 October 2026. First published 27 October 2026. Next review April 2027.
Cite this article: Listing, R. (2026, October 27). “I Can’t Make It to the Toilet in Time”: Bowel Urgency and Leaking After a Third or Fourth Degree Tear. Reframe Legal. https://reframelegal.com/cant-make-it-to-the-toilet-after-birth/
This article is general information only. It isn’t medical or legal advice about your situation, and reading it doesn’t create a lawyer and client relationship. If you are worried about your health, please see your doctor, midwife or hospital. If you are in crisis, call 000 or Lifeline on 13 11 14. Legal services are provided by Peter Evans & Associates.
