A Woman’s Body After Birth: the Anus

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Very little is written about the changes in a woman’s body after birth. As many of the changes are ‘messy’ or make women feel embarrassed, woman are reluctant to discuss them, even if their closest friends. In the fifth of a multi-part series, Jodi Cleghorn looks at the changes to the anal sphincter and surrounding tissue in the weeks after giving birth.

The Anus

During a vaginal birth the anus and surrounding tissues flare outwards. It can take days for the tissues in this region to return to normal. “I remember going to the toilet and freaking out because my bottom felt turned inside out,” says Lily. “I had no idea if this was normal and was too embarrassed to say anything to anyone and stressed that something was wrong with me. I was afraid if I had a bowel movement everything would just fall out. When I saw my birth photos, I understood why it was like that after birth. I wish I had have known before, though.”

It is estimated that around a third of women will come out of pregnancy with hemorrhoids that may continue to itch or burn after birth. Many women how escape the discomfort of hemorrhoids find that the physical stress of labour and birth or the strain of early bowel movements twist or become restricted blood vessels creating hemorrhoids for the first time. Those already suffering from hemorrhoids may have additional ones, or more pain.

The first bowel movement after birth is often fraught with fear and concern. Like the perineum and vagina, the anus is vulnerable after birth, and straining can put unwanted pressure on the entire area.

Fiona was scared by the advice she got. “I was told, don’t tear, don’t force, just let it come,” says Fiona. “It sort of felt like the birth again. You don’t force it out; you wait and breathe without all the instincts telling you what to do.”

Women are often stiff and sore after birth and sitting is uncomfortable or downright painful. Christina remembers, “It was painful to go to the toilet — to sit down, to sit on the toilet.”

Lots of women take a gentle laxative to ease the process. “I was really freaking out about that first poo,” says Nickole. “It took a couple of days, and painkillers…and Metamucil to help get it moving. And it wasn’t that nice an experience. I just remember sitting in the ward and every one asking have you done a poo yet?”

“I wish I’d known the importance of preventing dehydration to avoid very large, hard stools,” Mandi says, “and the importance of perineum support and correct toilet positioning for bowel movements.” Many women drink pear or prune juice to soften stools.

A very small percentage of women suffer from anal dysfunction after birth. It occurs more commonly in women who have had an injury to the anal sphincter muscles, even if the injury was repaired at the time. Women who have episiotomies are most at risk. They may have difficulties in holding their stools or gas.

An American study showed that 26.6% of women who had an injury to their sphincter at birth had fecal incontinence at six weeks, dropping to 17% at six months. That was compared with 11.2% of women without a sphincter injury at six weeks and 8.2% at six months.(1)

There is a growing body of anecdotal evidence that damage to the bowel during cesarean sections is causing fecal incontinence also.

More common though is ‘gas incontinence’ with women finding, embarrassingly, they pass gas more often and without the control they had before birth. The intensity, duration and feelings a woman has towards the changes to her vagina and perineum are what makes her experience uniquely her own.

The type of birth (especially if an instrumental birth is accompanied by an episiotomy), any serious perineal tears, the size of the baby, the general health of a woman, the softness of stools and the ease of bowel movements will all have an impact to some extent on the post-birth changes to the anus and surrounding tissues.

References

1. “Faecal and urinary incontinence in primiparous women” by Borello-France D, Burgio KL, Richter HE, Zyczynski H,Fitzgerald MP, Whitehead W, Fine P, Nygaard I, Handa VL, Visco AG, Weber AM, Brown MB in Obstetrics and Gynaecology (2006:4)

Yoni Yearning and Checking Changes are used with the permission of Annie Evett

Jodi Cleghorn is a mother, writer and editor, feminist and social geographer. Jodi is the co-author of Reclaiming Sex After Childbirth: the survival guide with Annie Evett, with whom she co-owns the Reclaim Sex After Birth website. Jodi lives in Brisbane, Australia with her partner Dave, son Dylan, the fish of Bo and Keats the Cat.

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