One of the symptoms of pelvic organ prolapse that women find highly stigmatizing is fecal incontinence (FI). Regardless when it occurs, women are typically devastated, but when it occurs during an act of intimacy, the impact is difficult to move past. The fear of a repeat episode, the fear of judgement by an intimate partner, the fear of never again having a normal sex life can create a significant roadblock in a woman's life. Fecal incontinence is one of those POP symptoms women struggle to admit to, much less talk about openly. But as in all aspects of POP, it is possible to find balance again, once you understand the right path and a few tools to utilize. A brave patient in APOPS’s following agreed to share her journey in the interests of providing hope for others walking this particular walk.
Where were you in your POP journey when fecal incontinence occurred, had you been diagnosed, had you already been treated for POP with non-surgical or surgical treatments?
I had been diagnosed at 24 with rectocele (grade 3), cystocele grade 2, and slight uterine prolapse (I am assuming grade 1). At 27, I had a full hysterectomy (related to cervical issues), along with a rectocele repair, sacrospinous ligament fixation, and perineoplasty. I had some fecal incontinence prior to the surgery (maybe twice I can recall) and several times after my surgery.
How devastating did you initially find the diagnosis of POP and were you in a relatively balanced emotional state of mind regarding this condition when fecal incontinence occurred?
I was more shocked at first. I thought it was so embarrassing, but I began working in women’s health about 4 months after my initial diagnosis and began educating myself. Being a nurse, I’ve been very open with pretty much anyone willing to listen. I wasn’t as bothered by the fecal incontinence emotionally because it didn’t happen immediately, and it wasn’t often. I guess I was at a good place with it. Talking about fecal incontinence has been my coping mechanism with it.
How old were you when you experienced fecal incontinence during an act of intimacy?
I was 28, and about 10 months post-surgery.
What exactly occurred during your FI episode?
It occurred during climax, and I had no idea it had happened until my partner noticed.
How did your partner react, was he freaked out, did he laugh it off, shrug it off, not react at all?
He was great about it. At first he laughed it off, but when he saw I was devastated, he assured me it wasn’t a big deal. And continues to do so the few times we’ve talked about it. I cried in the shower afterwards. The days following I was so depressed. The day after, I cried pretty much on and off all day.
What anxiety do you have about FI occurring again during intimacy?
I’ve been intimate once since and I have to say I am terrified it will happen again. The stress did impact my ability to climax; I was unable to relax to enjoy intimacy and I felt very emotional afterwards.
What steps did you/will you take to prevent a repeat episode?
I make sure to go to the bathroom before. I did sort of schedule sex (our schedules kind of roadblock us sometimes).
Did you have an open conversation with your intimate partner about what occurred?
Yes. I explained no matter how supportive he has been, this is still my huge struggle. I think this was the straw that broke the camel’s back for my feelings towards intimacy post-surgery. It’s been a process of recovery and I’m still not there yet. I start another round of physical therapy next week (I wasn’t great about going after my 6-week appointment because of scheduling conflicts and childcare). I am sure I place excess emphasis on this event, and I have conflicting feelings towards how my body has changed after surgery. I also have thick permanent surgical sutures that have been impacting intimacy. But simply talking about it helps me cope.
Obviously women react differently to experiencing FI. Here’s a few things to consider:
Fecal incontinence is usually a much bigger deal to the women who experience it than it is to their intimate partners. The focal point for men is often satisfying their women sexually or in reaching their own orgasm, and anything else occurring is not of high concern during intimacy.
Post surgery, nerves take longest to heal, up to a year. If you are experiencing FI, contact your surgeon and ask for input. He/she is familiar with your pelvic particulars and may be able to shine a bit of light on next steps from the medical perspective, which may involve an exam. In general, behavior modification is often a valuable tool. Moving forward, take steps to radically reduce the possibility of FI occurring by:
1. Pay attention to what you eat prior to intimacy. This is a good idea in general, even if there aren't FI issues. There’s nothing like releasing a blast of gas during an act of intimacy to make women squirm. Avoid foods that will increase likelihood of digestive issues.
2. Pay attention to the state of your "guts" prior to intimacy. If you have had a stressful day or ate a half hour prior to intimacy, it increases the risk of FI in those experience it.
3. Pay attention to what position you take during intimacy. Experiment with a variety of positions with female on the bottom or side. Avoid being on top.
Moving forward: humor heals. We women clean baby poop, puppy poop, cat poop, parent poop, and don't think twice about it other than dealing with smell or mess in the moment. But if incontinence happens to us, we are totally freaked out. Everyone comes into this world pooping in their pants, and goes out the same way. We really need to get past the anxiety about leakage regardless what type or orifice it comes out of. Being able to joke comfortably about FI takes a bit of time, but humor is incredibly healing. The first time being intimate after an episode of FI, a woman is going to be nervous, so take it slow. Talk to your partner about your anxiety while sharing a glass of wine to relax. And if you are too nervous to give it a go in your bed, maybe it’s time to experiment with shower sex.