Mode of delivery for 2nd after faecal incontinence first time?

[tiredpooky]

Hello, I have looked back at old posts but would like my 'go' with this.
It seems the stuff i have been told and read conflicts.

Basically with DC1, in 3rd trimester i developed symptoms of anal sphincter weakness (messy to wipe, bit of poo can fall out when i stand up from toilet after bowels open and land on seat and i cant feel it coming away). I didnt know what it was at the time, but womens physio told me after. After ventouse delivery low birth weight baby, minor internal tear, was incredibly numb in back passage. Had 3 episodes where i thought i was passing wind and actually passed small bit stool. Also had prolonged time (2y) where in the morning if i was 'windy' wasnt safe to go other than on toilet. Got diagnosed lactose intolerant, thats better now, still not sure how much nerve damage to back passage was a part in that.
Things a lot better now, but i am not the same.

Saw womens physio who said i could have another vaginal delivery but should have endoanal ultrasound to check for missed 3rd degree tear. She took my notes to multidisciplinary team meeting and they said ,. no, c section, no scan. Physio said after to me, she thought they were being defensive.

Anyway, am now 25w, hopefully get to speak to consultant in 3w about his advice. Anal sphincter weakness symptoms have started again. I dont want to have a c section, but I really dont want a lifetime of continence issues, in fact, I'd rather not have any more 'accidents'. I keep oscillating between the options. What i need is more advice.

To compound the issue, I have terrible groin, pubic and vulval varices and the registrar thought they would have to cut through them for a c section, so bleeding risk ++, but i also need to discuss this with consultant.

Thank you for your time any one who replies. I am grateful.

You poor thing it really sounds awful.

I had quite a horrific time after my second child which involved an episiotomy which unfortunately then tore pretty much from front to back. (2 hours stitching)

There was slight nerve damage, not on your scale as didn't have an accident but not knowing when I was fully finished was an issue. Did have urinary incontinence probs for a bit though. 2 years later it's pretty much resolved except for the awful scars.

I have worked very hard with pelvic floor exercises etc to get things a lot better.

I know myself I would not have a vaginal birth again, I will not risk further damage.

Consultant agreed that I could have a section next time.

Have you seen physio?

Sorry saw you are under physio care, couldn't look back @ your post as on phone.

At the end of the day it's going to be your ultimate decision so getting a few people stories might help, I won't risk it again.

Good luck.

Its very unusual to develop sphincter weakness BEFORE the birth of first child. This suggests some congenital vulnerability involving nerves, muscle tone, anatomy maybe. This is not a typical picture which is usually only AFTER a complicated delivery eg very prolonged 2nd stage or instrumental, huge baby etc.

I have been a mw for many years and I have never seen this. i doubt if many of your obs team have. I think you need to speak to someone with a specialism that might lie outside of your unit, that might be a colorectal surgeon but some gynaes might have the expertise. The ultrasound mentioned would be part of a specialist assessment. It might be that vaginal birth might not make it worse but you need an expert to discuss it with.