to anyone who has an episiotomy wound or c section wound open up

[muslimah28]

hello

well, where to start...not really sure so i'm just going to type and this may end up being a long post....

i just wanted to know if anyone out there has been through what i'm going through and what the recovery was like.basicailly my episiotomy wound opened up after 8 days following birth, by day 11 the whole wound had opened up leaving a 3 inch open cut.

its caused me endless amounts of pain. i was persistent in hassling the doctors and midwives and got a gynae referralafter a while. whilst waiting for the appointment, i did everything to promote healing, leaving the wound exposed by not wearing undies, salt baths, arnica, keeping it clean etc etc. this helped 2 inches of the wound to heal by itself by the time i went to teh gynaecologist.

but in that time there was also a major growth of granulation tissue.

i have now had this cauterised 3 times, the last time included cutting some of the granulation tissue out under local anaesthetic.

the actual episiotomy has now nearly healed. but i'm still in lots of pain.i thought this was nerve pain now as i couldn't see any reason why the wound would be causeing the pain if it was nearly closed.

but yesterday i examined the area and found some large granulation tissue internally which wasn't there when i last looked (about a week ago).

i know from another threadwhich was an amazing support to me ('midwife shrieking in labour etc', started by the DH of someone who went through exactly what i have been through) that many people have cauterisations. but i only remember people mentioning having this procedure done a couple of times.

my next appointment isin 2weeks, and if necessary, that would be the fourth cauterisation.

a friend of a friend has been through this rare scenario too, and her advice was not to have too much surgery, the more you have the more likely there will be granulation tissue because you're creating a new wound.

i just dont know what to do. idon't really know what my question is even, i guess id just like to hear from people who have been through this in a similarly severe case, and maybe how you got better, how long it took, and even just that you did get better.

thank you for reading.

bump

anyone out there who can give me some words of support?

Hey,

I can't offer you any direct advice on this, but can you get a referral to a consultant gynae if you haven't already?

What you seem to be describing seems a very serious case, and I'm wondering if your GP or even the hospital can get you to someone even more senior?

I know a girl in my antenatal class had a small cliterol tear. Her wording was whilst it wasn't nice being seen by about 8 doctors in ever increasing order of seniority (this was immediatly post birth), she did eventually get the right treatment and she is now fine. (In her case after much consideration they decided to leave it, in her case this turned out to be the right action).

Take care

Katy

I can't really offer much useful advice. My caesarean wound opened up at one end due to a haematoma (massive build up of blood behind the scar which forced it open). It remained open for six weeks during which time it slowly seeped blood. I found it hideous - held me back both physically and emotionally - and wondered if it would ever heal. The guidance I received on it was sparse - after the initial diagnosis at A&E midwives had no idea what it was, my GP was equally stumped at how to treat it and really I was left to it. The scar 'granulated' after about four weeks, which I was reassured was part of the healing process.

You've got your second appointment in two weeks time and so you can mention the new/interior granulation/scar tissue. Or if you're not happy with waiting that long then you're perfectly entitled to push for a quicker appointment or ask to see a more senior specialist. Are you seeing a specialist gynae? The prevailing wisdom might be to leave it alone and allow time to heal it, but equally it might require further care. Not necessarily further cauterisation but perhaps some management of the scar further down the line. I had cortisone injections into my scar after six months to break down the chronic scar tissue and adhesions the haematoma left me with and it really helped.

It will get better. The body does heal itself and you have done absolutely everything right in terms of wound management and chasing referrals and support. You're just very unlucky with this. I felt like I'd never heal - that I'd have a hole in my stomach for years and I'd never be able to move forwards and just enjoy 'normal' motherhood, but I did heal and I healed well. I pushed for the care I needed and it sounds like you're doing that too.

I'm not sure I've been much help as my issues aren't that similar but I just wanted to reply and say hang in there. It will get better. From what you've written it sounds like you're doing everything you need to do and doing it absolutely right.

thanks for both of your posts. i was beginning to lose hope of ever getting a reply. its really nice to hear from others, to be reminded to'hang in' is so powerful.

its good to be reminded of the amazing power of the body to heal.

my apointment in 2 weeks is with a consultant gynaecologist, and he's very good. i'm lucky enough to have got a referral to a private hospital, under the NHS. i did consider trying and getting a quicker appointment but my consultant is on holiday until next week so it would have t be with someone else. and id rather see the same person cos its horrible having to go through the whole history repeatedly. i had to do this when i had homevisits from the midwives post birth as they'd lost my notes, and i had a horrible birth and it was really horrible having to go through it again each time...

im also glad to have the two weeks to be able to make a decision about whether to have more surgery, as i expect that's what will be offered to me. and im very confused about it.

what i'm not sure about is whether to go ahead with further surgery asi don't know if it will help. my sister's friend went through a similar thing to the same extent as me andher advice was not to have too much surgery as she feels eventually the surgery just made things worse. now she probably wont be able to have kids again,even by C section as she cannot really do anything to get pregnant so to speak

most people i've come across here on MN have one surgery, maybe 2,and then it's OK. i would really love to hear from someone who has had persistent granulation like me to see how they managed it longer term. but MN seems very quiet this last two weeks.

at least i have my baba to get me through all this. like you said Katy on another thread, i do love being a mum! and my faith has really helped me too to keep me strong.

sometimes you just need someone to say to you 'itll be alright'. thanks both of you for replying.

One thing I've sometimes found helpful, especially around senior staff, is after discussing the options simply ask 'what would you recommend'. Sometimes this can elicite very useful answers and explanations, especially if a situation is complex. (you don't have to necessarily do it)

I've generally found that the higher up the medical qualification ladder you go, the more likely staff are to answer questions with considered opinions and to outline the pros and cons of different courses of action.

Also if you are able to calmly outline your concerns, he might be able to address them directly, and remember different people have different concerns.

You might find in your situation there is no one 'best' solution, but a sensible discussion with an expert about possible risks and benefits of different actions may give you the information you need? (I always find junior staff have to toe the party line, very senior staff are more likely to discuss options.

I had a really good appointment with my physio this morning. He was lovely, listened to everything, took everything seriously, we talked about what to do next and I'm back in on Monday morning. Whilst I'm really upset about all the physical problems I have, it helps a lot that I feel he's really on board IYSWIM.

Take care

Katy

Few other thoughts:

I know nothing about your situation medically, but questions I would be asking might well include:

How confident are we that the key problem is the granulation material?
(The we is very important IMO, it firstly puts you on an equal footing, and also indicates you see yourself as being a part of the team. In my experience medics are willing to make far more effort for patients who take responsibilty themselves)

How successfully is further surgery likely to be on the basis the other attempts have not rectified the problem?

What would you plan to do differently on the basis prior attempts have not succeeded? (I'd be wary of anyone who just offers to do the same again without a convincing reason as to why this time it would be different)

What are the risks of further surgery?

What other options are available?

If relevant 'I've heard about this scenario and this really frightens me, what do you think?'

It might also be useful, both for yourself and the gynae to be able to say 'My main concern is .....' and think what it is. I'd probably be tempted by 'full recovery in the long term', (even if that mean more discomfort in the short term), but you may feel, and its your feelings that matter, that 'I need pain relief now as I can't cope' is most important. Or maybe both.

I know with my pelvis I'm pretty much prepared to do anything in the short term if it helps the long term, IYSWIM, BUT, I'm not in massive pain, just severely limited in what I can do.

Hope this helps

Katy

Hello. I was about to plough in and offer advice but then I read katy's post and she's really covered everything. The only thing I'd add is to write a list. I've gone for appointments with consultants feeling organised and ready and once in there my brain has disintegrated and I've forgotten to ask the crucial questions or got sidetracked. If you have the list you can tick through all of them and make sure all your concerns and questions are answered.

You sound informed about what has happened to you and you are well within your rights to be wary about a fourth operation unless they can guarantee that they will do something different to make this work. Either that, or your consultant has to admit that it's just a case of repeating the operation until the healing 'takes' which of course opens up the question of increased scar tissue. As Katy suggests, ask what he would do in your situation (and why). You can also mention the advice from your sister's friend. It may be anecdotal but it's still evidence of how in one instance repeat surgery didn't work and your consultant should be able to address your concerns about that.

On the issue of your consultant I think you are right to hold out until the senior chap is back from holiday. As you say, he'll know your history. If you were seeing someone junior then I'd say jump ship and push for consultant care but you're already there. Just bear in mind that if at the end of this appointment you're none the wiser as to what to do and you don't feel your concerns have been addressed then ask to see someone ele. He won't be the only senior gynae consultant out there.

Good luck. My mother in law took me to A&E when my scar split open and I always remember her saying to me as I inched along the walls, clutching my stomach and feeling as if the world was falling on my head, "childbirth is not for the faint hearted". It's very true but you do heal and you will heal.

Just remembered something else that I meant to add...

It's really difficult with a newborn as you're the bottom of the heap when it comes to being looked after, but make sure you're looking after yourself and eating well, etc. Also, make sure you aren't anaemic as this can affect healing (my blood transfusion was missed due to a cock up over my notes on the day of my daughters' birth and so I left hospital with haemaglobin levels through the floor which made my healing issues even worse). The best thing to take is Floradix iron tonic which comes in a bottle and tastes like a fruity, herbal (strong) tea concoction and doesn't bung you up like standard iron tablets. You can buy it from health food shops and good chemists and it's good stuff.

thank you so much both of you for your advice. i read it this morning and was so grateful to you for helping and i just didn't know what to say.

Katy the idea of writing up my questions is brilliant, im definitely going to do this. i did something similar for my first appointment, i wrote down my whole history and it helped so much. i don't know why i didn't think of doing it this time around, feel really silly now... i think i was just thinking of this next appointment as 'more of the same' but i actually need to look at it as a real opportunity to move forward (even if, as i'm increasingly thinking, that means no surgery for now) and make the best of it.

kitstwins i was anaemic when i first gave birth, i lost 800mls in the birth which i'm amazed wasn't enough to trigger a transfusion. anyway i had to take very strong iron tablets for 6 weeks and then had my iron levels checked again and they were fine. i do wonder sometimes if this contributed to my stitches not healing properly as i guess there would be less white blood cells in my body. but i don't know the science of it all...

what does amaze me though is that i actually saw a gynaecologist on day 16 post birth for my open stitches (this time it was someone more junior, a registrar). she ruptured some granulation tissue (I don't count that in my 3 surgical interventions, or it would make the no so much worse...). what amazes me is that at no point did she say to me this is serious it's not going to heal by itself we need to keep a close eye on this. i had to go back at week 8 for a gynae referral.

i wonder if maybe some of the granulation could have been similarly ruptured before it became solid tissue as it is now were the wound to have been monitore. anyway i don't believe in winding myself up about what should or could have been, i just want to move forward.

and i'm totally with you katy on the whole 'ill do whatever it takes in the short term to get better long term' attitude.

oh and kitstwins you made me smile about childbirth not being the faint hearted i know someone senior in health policy who i used to work with and i suggested to them recently that i should be hired as a government teenage pregnancy tsar! just 10 minutes with me would convince any teenager that being a mum is not about having a trophy baby and pushing it around in a nice lovely pram for all to admire!! i absolutely love my DS to bits and am so grateful to have him- but no, childbirth is defiitely not for the faint hearted....

Hi Muslimah,

Any update on how you are doing?

Katy

Muslimah, do you know why it happens in the first place? I saw the mw today who confirmed to me that my epi wound is open. She sent me to the hospital where the registrar checked and said there was possibly a small infection( They took a swab as he wasn't sure- I've been on antibiotics for 8 days and I am scrupulously clean. ) anyway, he said wait ten days, take ten days more antibiotics and see. I asked him why and he also said it had opened up due to infection. And that was the only reason. Now I feel confused and have to just wait and see. Sorry for the sideways hijack.

Katy ive had quite a few good days in the last two weeks which has been lovely. i still take painkillers every day but its been so lovely to be able to get out a little bit even if just a short walk.

we had our eid celebration yesterday, its the celebration after ramadan (don't worry, i wasn't fasting in ramadan, i was exempt on so many different grounds). i was worried about how id manage it because it being my son's first Eid, everyone would want to see him. but i got round it by going to my mum's 2 days before so i could break up the journey, and i managed to get 2 lie-downs in the day which helped. i was shattered by the end of the day but this morning i was ok.

i still need to write my list of questions, i've been mulling it over in my mind to work out what i want to ask, and am going to put something down tomorrow. i'mincreasingly thinking i want to wait before more surgery, but then again, i don't know what the options are until the appointment. my health visitor reassured me that if i don't want more cauterisation i can still ask to not be discharged just yet so they can keep an eye on me. she also suggested that physio might help.

how are you doing?

margherita76 i dont know why episiotomies open up, my midwives kept telling me that somtimes this just happens.... i wonder if its more common in an episiotomy than a natural tear because the skin falls together more naturally if the tear is natural. but this is my own thinking.

do you know how much the wound has opened?

they key thing for you now is to promote natural healing as much as you can. the antibiotics will kill the infection- but you now have a wound that needs to heal and it doesn't have stithes to hold it together.

i would recommend taking daily salt baths- but some coarse sea salt the kind you cook with, put a handful in the bath and sit and 'sloosh' the water into the area (as my reflexologist said!) with your hands for 5-10 minutes. you will be amazed at the difference this makes and it shouldn't hurt- though i find washing it off afterwards helps becuase if i leave the salt there then it can sting aftera while.

i know you say you're very clean, but just to check, are you washing yourself with water after every loo? this is very important. you can still get an infection anyway, but this helps avoid it. also its recommended to keep the area dry so after washing, you could use a clean hairdryer or desk fan to dry yourself. (if your dryer has dust in it, you might wanna buy a cheap one for this purpose).

another very important thing for you to do is to air the wound as much as possible. sit with a towel under you, no undies or anything and air the wound. do this for as long as you can as many times each day as you can. tbh i was in so much pain i was practically bed bound so i didn'twear undies for about 3 months believe it or not!

there's more i could say, i'm an expert on this! but i'll leave it to that for now.

actually i feel like such an expert that i'm considering suggesting to NICE that they include postnatal wound care in their next update of postnatal care guidance. i really feel that more could be done by health professionals. and though i've been lucky with the medics ive seen, many other MNers andothers on other forums have not.

Muslimah I am glad you have had some good days and been out and about. Before the birth I was already housebound due to PGP so I feel a bit like a prisoner myself!

I think the wound opened all the way ( as far as I could tell ) And thank you SO much for all your advice - I will do the salt slooshing thing if you say it helps. I do shower after every loo - or use a sports bottle with a bit of tea tree oil. I have been lying down and airing when poss but that gets a bit stingy at times. One more thing - how salty should the salt bath be?!

Thanks again for all your brilliant advice ( my mum said something similar about the fact that tears are jagged and so fuse together more easily - not that she is an expert but it makes sense).

no worries,i feel for you i really do.

for the salt baths, my reflexologist said a handful of sea salt in a bath which is just a few inches full of water. she said it's not a relaxing bath it's about healing! i have to do it slightly differently now to get the salt to go internally, so i use more salt and more water, but for you for the external wound this should be ok for now.

and i was so reluctant to do salt baths as i'd heard so much about them stinging- but it didn't as i said above. anyway, my reflexologist checked with a senior midwife becuase of my concerns, who said it's brilliant, do it,and she said its the iodine in salt that makes it help healing.it'salso anti bacterial, so i'm washing with salt water whenever i can too. i left teh tea tree oil over this because salt had the antibacterialproperties of the tea tree plus the extra healing properties. anyway do whatever you think is best in that regard.

sounds like you're keeping it really clean that's great.

you should also consider getting a tissue viability nurse. i only found out about this type of nurse when it was too late but another mumsnetter who went through exactly what i did had one and said it was really helpful. you may need to insist. but do persevere. make sure the medics take you seriously as the earlier you get treatment the better.

you may still get to the point i'min battling with granulation tissue as detailed above, and that's why i say persevere with getting medical help.

btw did you say there's no OH around? i ask because my DH checked my wound daily to see how it was healing and it saved me doing it.

please don't hesitate to ask any more questions i'll help as much as i can cos i've been where you are and it's not nice.

just think of it this way, for me, i'd rather be the one with the birth defect/child birth related illness rather than my DS. and enjoy your DD as much as you can, it'll be a good distraction.

Hey,

Good days, bad days but at least it now feels like its being taken seriously. Its hard both accepting that I'm not going to just get better, but also trying not to feel like I'm a failure as I haven't just got better.

I'd be inclined to go into the consultation with an open mind and see what the options are, what they sugggest and how you feel about it. Your HV is completly right that you shouldn't be discharged until you are better.

I don't know enough to know if physio would be helpful, but beware that sometimes people are prepared to suggest things just to say something. In my experience this is much more prevalent at the lower end of the medical scale (i.e. where HV sit IMO).

I had a pelvic floor physio appointment last week, mainly to ensure there weren't problems there that were hindering my recovery. It was pretty intrusive, but the lady was so nice and sensitive it was absolutly fine (and I can have a problem with these things). She had that rare ability to be completly professional, whilst making you feel like she was your new best friend!

Keep in touch

Katy

It's always worth asking about the option of doing nothing.

If you are concerned that each intervention causes more granulation, but you are healing, then it may be worth considering letting the healing complete itself and looking at the granulations again in 6m or more. The healthier the tissue, the better able it will be to withstand further trauma and to heal well afterwards.

As for 'nerve pain' (all pain is nerves, but I guess here they're labeling a pain with no apparent cause) again, wait-and-see might be reasonable. Scarring can hurt for a long time - it's not uncommon for a fully healed C-scar to still hurt 6-12m after the birth. I have a friend who says that her scar was numb from the outside, yet hurted from the inside for over a year! But duering that time the pain did improve and eventually went completely.

You have a lot on your plate, physically and emotionally. Constant pain is draining. But it may be possible to mentally put it to one side for a while: "I'll deal with it later", IYSWIM. Pain can be much worse if you focus on it. If you can manage to live with it, enjoy life despite the pain, while other things get sorted out, you may find, when you decide it's time to address the pain issue again, that it has actually improved a lot.

You know that I have been in a similar situation to you. I am not in any way belittling the pain, nor the distress and humiliation of the investigations and treatments. I conceived dc2 despite living with a degree of pain, and after dc2 I had no more pain there. What is more, despite all the scar-tissue, I gave birth to my 5kg dc3 without even tearing! You can heal completely.

well overall the good days are continuing and i'm managing my pain much better. i'm learning to rest once the pain kicks in and understanding that that helps me do more rather than overexerting myself. but in the last week, the pain has lessened considerably. its still there,i'm still on painkillers, but its nowhere near like before and i'm starting to get some semblance of my life back

i had my gynae appointment on tuesday and overall i think it went well. i did as Katy suggested go in with an open mind,and much as I had before been thinking that further cauterisation wouldn't help me, i ended up having it done.

the thing that reassured me was i had a long discussion with the consultant before he examined me,and i asked him whether cauterisation increases the risk of granulation tissue growing as my friend had said, and he said this isn't true. as a medic i'm inclined to go with his opinion so when he examined me and saw the new granulation i went with his recommendation to cauterise.

i also asked him whether it could be nerve pain, he said he didn't think it was, he thinks its from the wound healing. also my husband later said something which made a lot of sense, that if it was nerve pain it have few/no triggers.

we discussed so many other things too, and he put my mind at ease on a lot of things.
the main message was to rest lots and not expect too much from my body, and also to not associate all pains with the episiotomy pains as some pain may be normal postnatal pain. i think this perspective will really help me.

i did ask to not be discharged,but apparently as i was at a private hospital on the NHS, there are only a certain no of follow ups you can have under this scheme. that was a bit frustrating to be honest. but the

consultant did say that he actually told the secretaries to give me one more appointment than i was supposed to have already (very nice of him ) and he told me the way to get around this silly rule should i need further treatment- which is basically to get another referral so i'm effectively a new patient!

but for now i'm going to keep on trying to get some structure into my life, get back into things as PrettyCandles suggests, and see what happens.

Katy I know what you mean about health professionals bedside manner! i had so many internals as i was induced, and there was only one nasty midwife, but all the others were so nice and really put me at ease that along with my breathing exercises really made the whole horrible experience much more manageable!i hope your physio continues to help and you keep getting better.butremember, the myth of 'you will just get better' is evil! sometimes we need proper medical help and we shouldn't be made to feel bad about it!

Margherita if you're still following this thread, do let us know how you are, i hope all is well.

Muslimah,

That sounds fantastic, I am really so pleased for you. It sounds like you got a consultant that really knew what he was talking about.

My back has a gain been really sore, and I'm feeling really fed up with things, but I'm back at the physio tomorrow for pure massage which he thinks may relieve things a bit.

I am starting to feel really angry that this wasn't done months ago, but maybe thats a part of what I have to work through.

Hope everything continues to go well for you.

Katy