Fecal incontinence, constipation, hemorrhoids, urinary incontinence, and pelvic organ prolapse are frequent but often unrecognized problems in postpartum patients, according to a recent evidence review.

Despite their effect on quality of life, these conditions are commonly underreported due to stigma, limited screening, and a lack of targeted treatment strategies.

Fecal incontinence affects 7% to 25% of women during the peripartum period. Among those with obstetric anal sphincter injury, the rate of flatus incontinence reaches 40%. At 1-year postpartum, fecal incontinence persists in up to 20% of women, yet fewer than 15% seek medical care.

While vaginal delivery, operative delivery, high birth weight (> 4,000 g), and perineal lacerations are associated with increased risk of fecal incontinence, the condition can also develop in women without these factors—including those who deliver via cesarean—highlighting the multifactorial nature of postpartum pelvic floor disorders.

Diagnosis begins with a digital rectal exam, followed by anal ultrasound and anorectal manometry to assess internal and external sphincter tone. Dynamic imaging tools, such as 4D ultrasound and defecography, provide structural assessment and help monitor response to treatment.

Constipation affects up to 45% of postpartum patients. Contributing factors include hormonal shifts, dehydration, opioid use, and pain during defecation. Evidence for treatment is variable across disorders, with stronger support for some interventions than others. A 2020 Cochrane review of 5 trials (1,208 women) found methodological flaws in most studies. Recommended treatments include dietary fiber (20–30 g/day), hydration, and osmotic laxatives such as polyethylene glycol.

Hemorrhoids occur in up to 85% of pregnancies, especially in the third trimester. Symptoms may resolve after delivery but can persist. Diagnosis is clinical, and treatment includes fiber supplementation, topical corticosteroids, Sitz baths, rubber band ligation for grades I through III, and excisional hemorrhoidectomy for advanced cases.

Pelvic organ prolapse is frequently asymptomatic, making prevalence difficult to quantify. One study found that 51% of 477 women had prolapse at or beyond the hymen without symptoms. Surgical treatment occurs in an estimated 6% to 18% of women. Diagnosis involves physical examination using the POP-Q system and questionnaires such as the Pelvic Floor Distress Inventory.

Urinary incontinence affects up to 40% of postpartum patients. Stress and urgency incontinence are most common. Pelvic floor muscle therapy is first-line treatment. A Cochrane review found antenatal pelvic floor muscle therapy reduced the risk of urinary incontinence beyond 3 to 6 months postpartum.

The authors reported no conflicts of interest.

Source: Current Gastroenterology Reports