Postpartum

Bowel Control After a Severe Tear: Get Support

Save

Losing control of gas or stool after a third- or fourth-degree tear is called anal incontinence and reflects injury to the anal sphincter. It is common after severe tears, treatable, and worth raising early. Pelvic floor therapy and, for some, surgical repair or a colorectal referral restore control for many women.

Last updated: July 2026

Talk to a clinician

Gale can help you find a clinician in your state and request a visit.

Find care →

Why do severe tears affect bowel control?

The anal sphincter is a ring of muscle that keeps gas and stool in until you choose to release them. According to ACOG, third- and fourth-degree tears, known together as obstetric anal sphincter injuries, extend into or through that muscle, and when the repair does not fully restore function, leaking of gas or stool can follow 1.

These injuries complicate around 3 in 100 vaginal births overall and are more likely with a first vaginal birth, a large baby, or an assisted delivery 1. Nerve stretching during birth can add to the weakness. A physical exam and, when needed, an ultrasound of the sphincter can gauge how much function was affected. Symptoms may appear right away or emerge later, which is why bowel changes after a known severe tear always deserve follow-up.

What treatments restore bowel control after a tear?

Most people start with conservative, non-surgical treatment, and it helps a large share of them. Pelvic floor muscle training, sometimes with biofeedback, strengthens the sphincter and surrounding muscles and can improve or resolve leaking of gas and stool, often within 3 months of consistent training 3.

Dietary adjustments to firm the stool, bowel-timing strategies, and treating any constipation are frequently added. When conservative care is not enough, a colorectal surgeon or urogynecologist can assess the sphincter with imaging and discuss repair. A course of pelvic floor physical therapy is a common first step, and the coordination it teaches overlaps with the work behind kegel exercises. Progress is usually gradual, and staying with the exercises is what makes the difference.

Who should you see, and how soon?

Any new difficulty controlling gas or stool after a severe tear is a reason to contact your maternity provider rather than wait it out. Postpartum guidance recommends that women who had a third- or fourth-degree tear be reviewed for bowel symptoms and referred to specialist services when symptoms persist beyond 6 to 12 weeks 42.

Early referral matters because sphincter injuries are often more treatable when addressed sooner. A urogynecologist, colorectal surgeon, or pelvic floor therapist may all play a role depending on the findings. If bladder leaking is also present, the guide to leaking urine months after birth covers the overlapping evaluation.

How do the risk and impact change over time?

Bowel control problems from a tear can behave differently across the years. Symptoms present soon after a first severe tear may partly improve as tissues heal over the first 6 to 12 weeks, yet weakness can resurface decades later as muscle strength and estrogen decline around menopause.

A subsequent vaginal birth after a previous severe tear can raise the risk of further injury, which is part of why some women discuss delivery options in a later pregnancy. Younger first-time mothers are the group most often affected, because first vaginal births carry the highest tear risk. Understanding this timeline helps explain why follow-up continues well beyond the early weeks.

When bowel leakage after a tear needs a specialist

Ongoing leakage of gas or stool, an urgency you cannot defer, or soiling is the signal to seek specialist help rather than manage alone. A maternity provider or primary care clinician can begin the assessment and refer you to a urogynecologist or colorectal surgeon experienced in sphincter injuries.

This is a common and treatable problem, and effective options run from pelvic floor therapy through surgical repair. A short note of when leakage happens and what makes it worse gives the specialist a useful starting point. Gale can help you prepare for that conversation by putting your symptoms and birth history in order. If you also feel a heaviness or bulge, the guide to prolapse symptoms explains what an exam checks.

Common questions

It is more common than most people realize after a third- or fourth-degree tear, and it is one of the least-discussed complications of birth. Because it is treatable, raising it with a clinician is worthwhile even though it can feel embarrassing.

Some symptoms improve as the tissues heal over the first weeks, but leaking that persists is unlikely to fully resolve without treatment. Pelvic floor therapy helps many people, and specialists can offer more when conservative care is not enough.

A maternity provider or primary care clinician can begin the assessment and refer as needed. A pelvic floor physical therapist, urogynecologist, or colorectal surgeon experienced in sphincter injuries may all be involved depending on what the evaluation shows.

A later vaginal birth after a previous severe tear can add to sphincter injury for some women, which is why delivery options are sometimes discussed in a subsequent pregnancy. A clinician who knows your history can help weigh this.

Related

Say it back

How would you explain this to someone you love?

Two or three sentences, just as you’d say it. Gale reflects back what you focused on — a mirror, not a quiz.

Talk to a clinician

Gale can help you find a clinician in your state and request a visit.

Find care →

When bowel symptoms after a tear need attention

  • —New or ongoing leakage of gas or stool after a third- or fourth-degree tear is a reason to seek a specialist assessment
  • —Urgency you cannot defer, or soiling that affects daily life, is a reason to ask for a referral to a pelvic floor or colorectal specialist
  • —Severe pain, spreading redness, or foul-smelling discharge at the repair site is a reason to seek prompt clinician review
  • —Fever with worsening perineal pain after a repair is a reason to contact your maternity provider the same day

This article is general health education, not medical advice. Whether bowel symptoms after a severe tear need therapy, imaging, or surgical repair is a decision for a maternity provider, urogynecologist, or colorectal specialist who can examine you.

References

  1. 1.American College of Obstetricians and Gynecologists (2018). ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000002841 ✓Definition and mechanism of third- and fourth-degree obstetric anal sphincter injuries, their approximate frequency of around 3 in 100 vaginal births, and risk factors including first vaginal birth and assisted delivery.
  2. 2.American College of Obstetricians and Gynecologists (2018). ACOG Committee Opinion No. 736: Optimizing Postpartum Care. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000002633 ✓Postpartum follow-up for women who sustained severe perineal trauma and referral to specialist services when symptoms persist.
  3. 3.Woodley SJ, Lawrenson P, Boyle R, et al. (2020). Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD007471.pub4 ✓Pelvic floor muscle training, including for faecal incontinence in postnatal women, as a conservative treatment that can improve or resolve leaking of gas and stool.
  4. 4.National Institute for Health and Care Excellence (2026). Postnatal care (NG194). National Institute for Health and Care Excellence (NICE). link ✓Postnatal care guidance to review bowel symptoms after a severe tear and refer to specialist services when symptoms persist.

4 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

← Back to the health library