Pain, bleeding, itching, and other bowel-related problems after childbirth are not merely a matter of physical discomfort. A study conducted by researchers from Wroclaw Medical University shows that more severe pelvic floor symptoms, particularly colorectal-anal symptoms, are associated with more severe depressive symptoms and lower self-esteem.
The study included 120 women aged 18 or older who were at least 3 months postpartum. Participants completed three standardized questionnaires: the Pelvic Floor Distress Inventory-20 (PFDI-20), which assesses symptoms of pelvic floor dysfunction, the Rosenberg Self-Esteem Scale, and the Beck Depression Inventory. The study was conducted between June and December 2025.
The most commonly reported anorectal symptoms were pain, experienced by 45.83% of the women, bleeding by 42.5%, and itching by 41.7%. In the study group, 23.33% of the women had low self-esteem. Mild depressive symptoms were found in 30%, moderate symptoms in 13.33%, and severe symptoms in one participant.
"Pelvic floor and anorectal problems are still considered taboo. Women often feel ashamed or embarrassed, or worry that their problems will be dismissed," says Justyna Mazurek, PhD, DSc, from the Department of Clinical Physiotherapy and Rehabilitation at Wroclaw Medical University.
The more severe the symptoms, the poorer the well-being
The analysis showed that greater severity of pelvic floor dysfunction symptoms, particularly colorectal-anal and urinary symptoms, was associated with more severe depressive symptoms and lower self-esteem. The strongest positive association was found between the overall severity of pelvic floor dysfunction symptoms and the severity of depressive symptoms. In the multivariate analysis, the presence of anorectal symptoms remained significantly associated with both self-esteem and the severity of depressive symptoms. In addition, among women who had given birth vaginally, perineal tearing was independently associated with more severe depressive symptoms.
"Chronic symptoms such as pain, fecal or gas incontinence, or difficulty with bowel movements can cause discomfort, a sense of losing control over one's own body and lower self-esteem. They may also lead to social isolation and reduced participation in family or professional life," explains Dr Mazurek.
As Natalia Kuciel, PhD, principal investigator of the research project, emphasizes, such problems can come to dominate everyday life.
"Anorectal problems, particularly fecal incontinence, severe pain during defecation or bleeding, can make bowel movements begin to define a patient's daily life," she says.
The problem does not end with the postpartum period
The authors point out that anorectal symptoms can persist long after childbirth and affect not only physical comfort, but also social functioning, body image and mental health. Shame, a sense of losing control over one's body and withdrawal from everyday activities may be particularly important factors.
"Symptoms associated with anorectal disorders may persist long after the perineum has healed following childbirth. They are often recurrent or chronic, which is why early diagnosis and comprehensive, interdisciplinary care are extremely important," emphasizes Dr Natalia Kuciel from the Department of Clinical Physiotherapy and Rehabilitation at Wroclaw Medical University.
Rectal bleeding, in particular, requires medical consultation.
"A physician should always assess rectal bleeding and should not be ignored. It may accompany hemorrhoidal disease or an anal fissure, but other potential causes must also be ruled out," Dr Kuciel stresses.
A broader approach to postpartum health is needed
According to the research team, the findings support assessing not only physical symptoms in women reporting pelvic floor problems, but also their psychological well-being. The authors point to the need to combine urogynecological and proctological care with psychological support and routine assessment of depressive symptoms in patients with severe complaints.
"Postpartum care should be interdisciplinary because pelvic floor problems rarely concern only one organ or one medical specialty," emphasizes Dr Justyna Mazurek.
The researchers note that the study was cross-sectional and involved a relatively small group of women. The data were based on participants' self-reports and were not confirmed by clinical examination. Therefore, the findings do not allow conclusions to be drawn about a cause-and-effect relationship between physical symptoms and mental health.
"After childbirth, a woman should not disappear behind the role of a mother. She also needs attention, care and space to reconnect with her body, her needs and her everyday life," concludes Dr Natalia Kuciel.
