Anal incontinence after childbirth is under-reported because women rarely volunteer it and are often not asked. A focused set of questions at the postnatal review catches most of it. Ask about control of flatus, about loose or solid stool leakage, and about urgency — the inability to defer defaecation for a few minutes. A validated score such as Wexner or St Mark's turns answers into a number that can be followed. Any positive answer after an obstetric anal sphincter injury warrants referral to a perineal or pelvic floor service, and persistent symptoms after a second-degree tear deserve the same attention.
- Ask directly about flatus control, stool leakage and urgency.
- Record a validated score so symptoms can be tracked over time.
- Refer women with symptoms after sphincter injury to a specialist perineal or pelvic floor service.
- Discuss the implications for mode of delivery in a future pregnancy when symptoms persist.
Why it matters
Most postnatal anal incontinence is found only when someone asks.
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