Anyone else had a buttonhole tear?

[Gardencentregroupie]

I had a buttonhole tear when I had DD. It was too high up to be repaired direct, so they had to cut me and create a 4th degree tear to do the repair.

I'm expecting DC2 now and unsure as to whether I should give birth vaginally or opt for a CS. Not many people seem to have buttonhole tears, and I don't know why it happened, or if the scarring means I'm likely to tear again. I'd love to hear from anyone else who has experienced this.

[Gardencentregroupie]

Bump

[pinguina16]

Hi gardencentrgroupie,
I don't know anyone who has suffered a fistula. I don't feel super qualified to answer but will give it a go (I was seriously injured myself).

You are absolutely entitled to discuss the mode of delivery of your second child with an obstetrician. The RCOG recommends it.
www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-third--or-fourth-degree-tear-during-birth.pdf

I don't know about fistula but I do know that for 3d and 4th degree tears, there is an increased risk of suffering a severe tear again.
www.rcog.org.uk/en/news/bjog-release-new-study-examines-mode-of-delivery-following-a-perineal-tear-and-recurrence-rate-in-subsequent-pregnancies/

Personally I would also ask the obstetrician how many cases like yours they have dealt with. If they don't sound experienced enough or can't give you answers, I'd look into asking a uro-gyanecologist or a colorectal surgeon.
You seem to have made a good recovery? Have you been left with incontinence or sex issues?

Might also be worth contacting the bladder and bowel foundation.

Amongst the women I know who suffered severe tears, those with issues have opted for no more children (me) or C-section (2 ELCS) and the one with no incontinence opted for a vaginal delivery.

[Gardencentregroupie]

Thanks for replying :) I have an appointment with the consultant in a few weeks time, so I'll be discussing it then. I've had some issues with wind and sometime faecal urgency, but no real incontinence and no sex problems so I got off fairly lightly all things considered.

I was just hoping that someone else had experienced the same thing, it does seem to be pretty unusual. (Wasn't I lucky!)

[pinguina16]

Buttonhole tears are not as common as 3d and 4th degree tears in the UK but the physio who followed me said she regularly had patients with fistula (I'm in London).
Have you tried the Birth Trauma association Facebook page? Or looked in the General Health forums here on MN?

[arielle500]

Hey! So sorry your going through this :,( there are two groups on facebook you might want to check out, obstetric fistula and 3rd and 4th degree support.

As for my story, i had my baby and ended up with a 4th degree with a skin bridge (fistula/buttonhole). Basically i tore through absolutely everything and theres a tiny bit of skin on the outside holding me together, it was not repaired at the time and im still living with it day to day. I know how worried you are, having to decide what to do, i would really recommend those two groups on fb as they have alot more information regarding borths after this type of trauma.
Personally i am opting for csection next time as i dont want my incontinence to get any worse.
Sending my love!!

[Liznlily]

Hey there,

Not sure whether you've sorted this now or made a decision?

I'm a midwife and personally I would suggest an elective LSCS. Sounds like you had an horrendous delivery and the risk of repeat tear and/or worsening of symptoms with such severe damage previously is quite high. The damage you describe is not as simple as a 3rd/4th degree.

Please do let me know if you'd like any further advice?

Liz :)

[Mumof2brazilOz]

Hi Gardencentregroupie, sorry to be answering this so late. I am a VBAC because during my 1st pregnancy I failed to progress. Second time round I had a button hole tear which has been repaired twice. I have had both wind and faeces coming through the fistula and was wondering if u ladies have seen/suffered the same thing?! During my second repair job I had both Gino and colorectal surgeons working on it and 2 days later things were just as bad as they were Before surgery. If I happen to fall pregnant again I would have a CS.