Author:
- Markaryan Daniil Rafaelevich senior researcher at the Department of Surgery of the International Scientific and Research Center, coloproctologist, oncologist, surgeon
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About 11% of women experience the problem of anal incontinence after childbirth. At the same time, the delicacy of the issue and the uncertainty that the doctor is sufficiently qualified and will undertake treatment often prevents patients from seeking help.
In no case should you tolerate or put up with stool or gas incontinence as a “usual consequence of childbirth”; such problems cannot be solved on their own. Modern medicine makes it possible to successfully treat incontinence in women after childbirth, and at the University Clinic of the Moscow State University. M.V. Lomonosov we specialize in complex treatment of this problem! We not only perform high-tech operations to restore anatomical defects of the sphincter apparatus, but also carry out complex treatment together with leading medical organizations in Russia, which return young mothers to a full life.
Symptoms and degrees of pelvic incontinence after childbirth
The concept of postpartum incontinence may include:
- fecal incontinence after childbirth;
- gas incontinence after childbirth;
- urinary incontinence after childbirth.
This triad can exist together or in various combinations.
Incontinence can vary in degree, from mild incontinence of gas or loose stools to a complete lack of sensation and control when emptying the rectum or bladder. In the latter case, the sensitivity of the pelvic area seems to be switched off from the normal functioning of the body.
In addition to physical discomfort, with various types of incontinence, women are always tormented by psycho-emotional problems associated with the inability to lead the same social and family life, distancing from loved ones and even from their own child, which is fraught with serious consequences. Therefore, you need to seek help as early as possible.
Symptoms
Bloating during lactation is no different from flatulence that occurs before childbirth or in a woman outside the period of bearing a child. Let's look at the most common clinical situations in turn, in the development of which the patient is worried about excessive gas formation.
Rehabilitation after caesarean section
Although this surgical option is considered common and, in general, routine, women face various consequences. One of the most common and expected is intestinal dysfunction. The activity of peristalsis decreases, which causes bloating and flatulence after childbirth. In addition, the patient may be concerned about:
- weakness;
- lack of appetite;
- difficulty urinating;
- pain in the suture area.
During the normal course of the postoperative period, intestinal motility is restored within 2-3 days. Then the unpleasant bloating disappears and the stool passes. If necessary, drug stimulation is performed using prokinetic drugs (“Domperidone”).
Signs of dysbiosis
This term refers to an imbalance in the intestinal microflora, in which pathogenic strains begin to dominate over beneficial bacteria. It may occur during antibiotic therapy or surgery. This affects the immune system and the mechanism of food digestion - fermentation and putrefactive processes intensify. Abdominal bloating after childbirth is combined with symptoms such as:
- Abnormal stool (constipation, diarrhea, their alternation).
- Rumbling in the stomach.
- Soreness (bursting, monotonous or cramping in nature without clear localization).
- Nausea, less often vomiting.
- Unpleasant taste in the mouth.
A nursing mother may experience frequent headaches and complain of increased fatigue and weakness.
Manifestations of IBS
The leading etiological factor is stress, although researchers also name excessive physical activity (including increased risk of difficult childbirth), infectious diseases, and taking medications as possible provocateurs. Women often suffer from irritable bowel syndrome long before giving birth. Pathology can be recognized by the following signs:
- frequent episodes of bowel dysfunction such as constipation or diarrhea (alternation of these conditions is also likely);
- gases in the intestines with a symptom of flatulence (excretion through the rectum);
- abdominal pain;
- feeling of incomplete defecation;
- the presence of mucus in the stool.
The abdomen may swell due to nervous experiences, in situations associated with increased anxiety. This is something to look out for when looking for the cause of your symptoms.
Causes of incontinence after childbirth
The main cause of anal incontinence after childbirth is a rupture or severe injury to the perineum and the muscular frame of the anal canal, which can be a consequence of the large size of the fetus during natural childbirth, rapid labor, the use of instrumental methods of fetal extraction, incorrectly performed episiotomy, complications of natural childbirth, etc. .
However, not all damage to the perineum during natural childbirth is accompanied by incontinence. Fecal incontinence after childbirth develops with deep ruptures of the perineum, when not only the vaginal mucosa and skin are damaged, but also the sphincter muscles of the rectum. If possible, repair of such injuries should be carried out immediately after birth, however, due to the relatively rare occurrence of this disease, the algorithm for providing emergency care in the delivery room is still not ideal. Obstetricians-gynecologists with special knowledge in this area can restore the destroyed anatomy of the sphincter and pelvic floor muscles. If, for various reasons, recovery is not possible at the time of injury, the intervention should be delayed for several months and performed as planned to achieve optimal results.
Prevention of atony in the postpartum period in nursing mothers
Many women, both during pregnancy and immediately after the birth of a child, experience problems with bowel movements. reasons contribute to this
: a fairly sharp change in the hormonal background of a young mother, a gradual displacement of the intestines in the abdominal cavity to their original place, despite the remaining pressure of the uterus, weakened and stretched muscles of the abdominal press and perineum, fear of straining due to sutures (imposed in case of cesarean section, episiotomy, ruptures ) and hemorrhoids, an irrationally selected diet, psychological stress associated with caring for a child and a new family status, congenital features of the intestine, for example, elongated sections.
It is advisable to consume foods
, which are natural mild laxatives, are well-known to everyone: muesli, buckwheat, millet and pearl barley, oat bran, black bread, vegetable oils, fresh and cooked vegetables and fruits (carrots, beets, pumpkin, zucchini, spinach, lettuce , broccoli, cabbage, dried fruit compotes, melon, apples, apricots, cherries), fermented milk products.
The body of every woman, especially a breastfeeding woman, is individual. One woman may even benefit from a glass of warm water in the morning. Avoid drinking
strong tea, polished rice, coffee, semolina, white bread, wheat bran, blueberries, quince, pears, currants, strawberries, legumes, walnuts, hard cheese, crackers, chips. These products help slow down peristalsis.
Laxatives
It should not be used by young mothers who are breastfeeding. Since, firstly, it will penetrate into breast milk, and from there into the baby’s body and will most likely cause abdominal pain and diarrhea in the baby, and secondly, laxatives can cause addiction, which subsequently requires an increase in the dose of the laxative. Place one hand on the right iliac zone (right, lower abdomen) and begin to slowly move up to the right hypochondrium, move to the opposite iliac zone. Start with slow stroking, gradually intensifying them and adding slightly pressing, rubbing movements. The procedure is completed with light tapping and stroking.
Physical exercise is an excellent way to stimulate intestinal motility and normalize digestion.
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The work of a mother cannot be underestimated, but fatigue in the first months after childbirth is not so much physical as psychological, everyday due to lack of sleep, from various worries and simply from detrained muscles, which gradually arose during the last months of pregnancy. The very next day after birth and beyond, you can perform exercises to prevent stagnation in the intestines (the basis of the exercises is relaxation and tension of the abdominal and perineal muscles, cross movements, twisting movements)
:
- Lying on your back, arms along your body, legs bent at the knees, take a deep breath and inflate your stomach, hold your breath a little and exhale forcefully through your mouth, while trying to pull in your stomach as much as possible. Repeat 4-8 times.
- Lying on your back, arms along your body, legs bent at the knees. Inhale and tense your pelvic floor muscles, hold your breath slightly, exhale and relax. Repeat 4-8 times.
- The starting position is the same. Simultaneously with inhalation, lift your right leg and left arm up, and while exhaling, lower it. Repeat with left leg and right arm. Repeat 4-8 times.
- Standing, feet shoulder-width apart, arms extended forward. Without lifting your legs, turn your body to the right, moving your right arm back as far as possible, inhale. Return to the starting position, exhale. Repeat on the other side. Perform the exercise several times.
- Standing on all fours, while inhaling, draw in your stomach and perineum, hold your breath for a couple of seconds, and exhale, relax. Repeat.
- Lying on your back, alternately bring your leg bent at the knee and hip joints to your stomach.
The flight of creativity and imagination is not limited! You can invent several exercises for yourself that are comfortable to perform.
Have an easy birth!
Tags: fitness during pregnancy
Treatment of incontinence after childbirth
Before choosing a methodology and algorithm for treating incontinence after childbirth, the doctor must carefully study the results of examinations and the patient’s complaints. Depending on the severity of the injury and its impact on quality of life, the doctor may suggest both surgical and conservative approaches to treatment.
Operation
Surgical intervention, as we touched on above, is not always required. Surgery is recommended when there is damage to the sphincter, visible on ultrasound or MRI, and with the condition that the integrity of the sphincter is physically possible to restore. The operation is performed under general anesthesia. According to world statistics, the effectiveness of surgical intervention reaches 90%.
Minimally invasive effect
If multiple muscle tears are recorded, when it is impossible to put it back together, or, conversely, the muscle tear is small and stitching can only injure it more, it is possible to choose a minimally invasive treatment - stimulation of the sacral nerve roots. The essence of the technique is to stimulate the nerves responsible for the tone of the pelvic muscles with the finest electrodes. Moreover, after a course of treatment, up to 87% of patients note normalization of fecal and/or urinary continence.
Is a stoma necessary?
Very often we are asked whether it is necessary to create an intestinal stoma during these operations. For many years now, modern technologies for restoring the integrity of the anal canal have made it possible to avoid the formation of an intestinal stoma in 90% of cases. Patients in the postoperative period do not experience significant discomfort; they are not limited in walking or sitting. There is virtually no pain after surgery.
What do obstetricians say?
If there was air in the uterus, then for a woman it would mean a huge risk to her life. Why? Because the uterus after childbirth is one continuous wound. Through this wound, air can enter the blood vessels, which can result in an embolism. An embolism is a blockage of the bloodstream.
A particular danger in this case is sex in the first month after childbirth. During active sexual intercourse, air may enter the abdominal cavity. If there are damaged tissues nearby, which happens after childbirth, this threatens with embolism.
The air itself entering the abdominal cavity is not dangerous. However, there is an exception - damaged mucous membranes nearby. After childbirth, the lining of the uterus resembles one huge wound. Healing is slow, as indicated by color-changing lochia (blood discharge).
During active sexual intercourse, air can be pumped into the uterus through the vagina, and from there, through the injured endometrium, it can enter the blood vessels, which will lead to the formation of an embolism. Most often the outcome is fatal, although these cases are quite rare.
Doctors recommend not having sex for 30-45 days after giving birth to avoid such problems.
