Clinical Problem: 22 year old female presented 9 weeks after delivery of 8# 10 oz. child with fecal incontinence, gas incontinence, fecal urge, and pelvic pain. She sustained 4th degree laceration and midline episiotomy with tearing of anal mucosa and sphincter muscle. Thick scar tissue was present in the rectal-vaginal septum. Pelvic muscle strength was graded as a “1”.

Past Management: Kegel exercises throughout pregnancy and post-partum, 1 stool softener daily. The fourth degree laceration, anal sphincter, and anal mucosa repaired with vicryl suture.

Current Management: Eliminated stool softener, kegel and accessory muscle exercises, dietary and supplementary fiber, pelvic floor relaxation exercises. Physical therapy consulted for ultrasound for pelvic pain and muscle relaxation. Instructed pt in manual massage of scar line. 14 french catheter inserted via anus with 3-4 cubic centimeters of air was used for pt to contract anal sphincter to prevent catheter's removal. A Vibratex massage wand with an attachment for the anus was used to massage the rectal-vaginal septum scar both vaginally and via anus. A home e-stim unit to strengthen the anal sphincter was prescribed 4 times weekly.

Outcomes: At 4 weeks she was free of gas or fecal incontinence, but still had pelvic pain from the scar. At 12 weeks she had seen improvement in pain enough to have sexual intercourse, and the scar was softer. At 15 weeks pt reported pain was very minimal. No further fecal incontinence or urge, and she continued scar massage at home.

Conclusions: Modalities of biofeedback, electrical stimulation, fiber therapy, pelvic floor exercises, ultrasound, and a vibrator massage wand can be combined with a multidisciplinary team of CWOCN's and a physical therapist to effectively treat a combination of fecal incontinence and urge, pelvic pain, and rectal-vaginal septum scar formation.