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Should I have an elcs following 3b tear last time - possibly tmi(20 Posts)
Apologies in advance I'll be describing my possible faecal incontinence issues so stop reading now if you don't want to know! Bit tmi at times! Just could really do with some advice.
DS is nearly 2 and I am 38+4 weeks with my second baby. First time round DS was face presentation and after a long induction I had an episiotomy and 3b tear. I healed amazingly well, no pain really at all, no continence issues. I was good with remembering to do pelvic floors for at least the first few months and had a physio appointment that was positive.
I had an endoanal ultrasound about 14 months later, and some other tests (involved electrodes and balloons and things up my bum - not fun haha) which showed some defect in my muscles. However I remained asymptomatic with no faecal incontinence and only mild stress urine incontinence (e.g. a little bit of wee when I sneezed sometimes or something). However due to the scan results they sent me a letter recommending a csection for future births.
Fast forward to now. Nearly due with number 2 and both midwives and consultant have agreed that a vaginal delivery is likely fine given my quick healing and lack of symptoms as a result of tear. I really want a vaginal delivery as csections scare me for some reason. The healing process sounds difficult and the thought if being cut feels way scarier than labour.
However I've been having some symptoms which I've dismissed and not told anyone, namely that after passing a bm no matter how fastidiously I wipe, there will be poo there on a future wipe for example a few hours later if I have a wee I'll double check and wipe my bum too and will often not get a clean tissue. I didn't tell anyone I think because I didn't want to admit it, and I just put it down to bad wiping but I know that's not true really, I'm very very thorough and often wash myself or hop in the shower too afterwards, in an attempt to feel clean and stop it happening. It's kind of got worse the more heavily pregnant I've become.
This morning I woke up, went straight for a wee and wiped my bum and there was actually quite a lot... Took several wipes to clean up. Then I (gross gross tmi) noticed a little smear on the bedsheet where I'd sat up and turned to get out of bed
But I think what's confused me is my knickers are always clean so it isn't total leaking or something. So it's still tempting to just think I'm not cleaning up properly. Does what I've described count as incontinence? Anyway I did some reading this morning and downloaded my hospitals clinical guidance about 3rd and 4th degree tears and it says that if a woman is asymptomatic but has defect on a scan her chances of becoming faecally incontinent following another vaginal delivery are 30 - 40%!!!! So I've booked to see consultant this week to discuss an elcs instead. I still don't really want that and feel quite upset. But the thought if this becoming worse is awful. I'm still not completely sure what to do though writing it down makes me think I'd probably be mad to have a vaginal delivery. Would like to hear anyone else's thoughts of experiences though. Tia.
I had a 3a tear, have had no problems at all since and have never had any of the testing you describe. It didn't even cross my mind I'd need a c-section til the midwife referred me to the consultant. I was all up for vaginal birth again because (as smug as it sounds) I found it really quite easy first time round. The thought of being cut and the wound plus recovery made me really not want a c-section. However I went to see the consultant and she tried to be very balanced as there is no life threatening reason for ca but she kept leaning towards the fact that I have no problems now but the problems I'd be risking having are awful i.e. faecal incontinence, pain having sex etc. I came away much more inclined to cs and when I go back at 30 weeks I think that's what I'll be asking for, it just seems silly to risk living with those conditions when I don't have to.
Thank you for that. I feel similar, despite the complications I enjoyed my labour and was looking forward to having a hopefully less complicated one this time round. But like you say, if I ended up with one of the horrible possible complications after really being so lucky to miss them before I'd kick myself.
Still, the thought of csection recovery is stressful isn't it. I guess compared to a life time of incontinence maybe it's not so bad. Who knows.
I had a 3a tear. Second time around I tore but much much less severe and it was only because the midwife didn't realise I'd tore the first time (it was all very rapid). I healed so quickly.
I have had the wiping issue as you describe but only after my second but I think that's down to flappy skin in the area I wasn't told about faecal incontinence though.
I did find that I needed to do some core muscle exercises because things felt a bit heavy. Were you referred for physio?
I've only had elcs so can't comment on vaginal birth after a year but my elcs was amazing. Up and about after 12 hours, home the next day, driving 2 weeks later and back at yoga classes after 4 weeks. My scar is tiny and all my bits are in tact. I honestly have no regrets and my next will be a c section without doubt. Good luck whatever you choose
I had a 3a tear with DS1 and have the issue you describe.
After DS2 I only needed a couple of stitches. It's very unlikely you'll have another third degree tear. If you can, walk around during labour and hop into water for pushing stage (this helped me second time around, wasn't an option first time as DS1 had to be monitored).
I had a 3b tear and needed physio after for faecal incontinence which is pretty much as you describe, although the physio really helped.
It became worse while I was pregnant again and 9 months on isn't back to how good I'd got it - and I had a section second time round so I think just pregnancy itself can take its toll. I probably need to do more of the exercises though!
I had my section on the recommendation of the physio - I was very unsure about it but I'm glad I did, and it was actually a wonderful experience. I personally found the recovery easier from the section than I did from the tear.
C sections have their own risks of course so you do have to weigh it up. Could you ask to be referred to a physio to get their opinion? I don't know how it works in different areas but I was able to get appointments very quickly when I was pregnant.
Mine was a specialist in these sorts of issues and was excellent. I did ask her outright for her opinion on a section though - apparently they are not allowed to suggest it.
Also, the physio said to me that although I was unlikely to tear so badly again, the damage already there could be worsened by the birthing process. Just something to bear in mind.
I don't have any experience but just wanted to add that I had an elcs with DD due to a hideous birth with DS, the elcs was absolutely 100% fine, please don't put yourself at risk because of fear of an elcs, there really is absolutely nothing to worry about
3b tear here too first time round, but absolutely no issues afterwards. Referred to Consultant as standard during my second pregnancy - was literally a 5 minute conversation and he had no concerns about a second vaginal delivery. Didn't even mention C Section. No tear as such second time round, but I had what they termed grazing which bled quite a lot and they struggled to stop the bleeding as it was in the scar tissue caused by the surgery from the first birth so the midwife ended up calling in a consultant who put a few stitches in to try sort it out. After so much prodding and poking I was in a lot more discomfort and pain for longer than when I'd been to theatre for suturing after my first, and the recovery time was longer, but no lasting damage.
Another elcs here, seemed to take only a few minutes, virtually stress free, fast recovery afterwards and absolutely no regrets.
Just want to clarify that you now do carry an increased risk of a severe tear again.
Hope the consultant can guide you. All the best.
Given that the team who performed the tests recommended a CS for future births, I would be loath to dismiss the idea. As they have thoroughly examined the area (and weren't even aware of the extent of the symptoms you're experiencing) their advice may be more relevant than that of your midwife and obstetrician.
I'd suggest looking into the risks of faecal incontinence with both birth methods (tchou has provided a useful link and the RCOG website is a mine of useful information) and taking that information with you to discuss with the consultant. It might also be worth taking a list of your CS concerns to discuss too.
I hope all goes well for you.
I had a 4th degree tear with DD1. Recovery took a long time, but no faecal incontinence. I was advised to have a CS for DD2, but said I would prefer vaginal delivery. I had to give birth in a position that enabled the midwife to keep an eye on my scar. Small 2nd degree tear with DD2 and recovery much quicker. My bowels definitely aren't the same as they were before DDs, but no incontinence.
I had a horrible 4 degree tear with first birth. V traumatic. No incontinence but risk is higher.
Had an elcs with second birthing it was excellent. V calm, not traumatic and recovery was significantly easier than last time.
Risk of another serious tear is higher if you've had one before. I would go with the original advice personally.
Wishing you all the best
Thanks for the replies everyone. I'm more worried about the incontinence than tearing the same. They explained the risk of a similar tear really well, just no one mentioned the other issue!! My first baby was such a difficult/unusual presentation they think that caused the tear as opposed to me having particularly big babies for example. It is still a risk though and something to bear in mind. My thinking had been before though that I have a low risk of a bad tear with a vaginal birth whereas a section is a guaranteed risk of stitches etc!
I could ask to see physio. The letter from the team that did the tests is difficult as the consultant said she thought it was a 'stock letter' so it's hard to know what to think. But then that probably doesn't make sense, they'd write it based on the tests.
My mum was wondering if I have piles that are making it difficult to get fully clean (her words were that the lumpy surface area makes it harder), don't know how true this is or really how to tell, not sure if I can feel anything or not. OH feels the doctor I see tomorrow will be able to tell me.
I appreciate hearing other people's experiences of similar symptoms. As I said I didn't really feel sure my symptoms even counted as a form of incontinence or not. I still feel unsure and I feel silly for not saying anything to anyone sooner. Didn't think I was the kind of person to just deny something even to myself!!
I had a 3b tear and like you was very reluctant to have a c section for second baby. Like you I healed well and had no probs after. Had another vaginal birth, second degree tear but still no continence issues. Immediately after and for a week or so I did feel very "heavy" in the back passage iykwim, but that went pretty quickly. All fine now. I think the best thing to do is to speak to as many hcp's as poss to get a good idea of pros and cons. I don't remember being told anything about the risk of being incontinent after a second vaginal birth, probably a good job really
Just to update. Saw doctor today and have booked in for elcs. She thinks at least a 20% chance of faecal incontinence with another delivery and made the point that while it may not make it worse it definitely won't make it better.
Difficult decision and feel a bit weird but think it's the right one.
I've no experience of tearing as ended up with an EMCS with DD but just wanted to say that whilst I didn't find my c section recovery a walk in the park like some do, equally I didn't actually have any complications from it. I didn't get any infections and I have had no lasting issues from it. The scar healed nicely and I didn't even get an overhang.
I'm pregnant again and for various reasons I may need an ELCS this time. I am hoping for a vbac but if I can't I am not as worried about the idea of a c section as I was before my first.
Not sure if I got my point across but I am basically trying to say that I think you have made the right decision for your circumstances and don't worry about the c section as it's not as terrible as you build it up to be.
Yes, remember it is major surgery and try to take it easy afterwards and definitely keep on top of your pain relief, but after a few weeks (I think for me it was after 5 or 6 weeks) you should feel pretty much back to normal. Well as normal as you can be with a newborn!
Good luck and I hope it all goes well
FWIW, I think you've made the right decision. DS was face presentation and I ended up with an episiotomy and forceps which resulted in urinary and fecal incontinence. It's horrible. 1yr of physio and things are getting a bit better. But I wouldn't risk further damage.
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