c-section after an anal fissure? Or vb?

[heavenlyharry]

(first time poster!!!)

Hi there

I have one DS who is 2.5years and Im 32 weeks pregnant. I am currently under a consultant, with the idea of having a c-section.
I had a fairly bad birth with my son who was eventually a forceps delivery. After the birth I suffered for nearly two years with an anal fissure so it was like pooing razor blades with lots of tears and creams and laxatives. Finally it seems to be cured and although I am scared to go to the loo, I do not have pain anymore.

I am really confused and cant decide what to do. I know that constipation comes with vb or cs. But Im worried about the strain on my bottom, yet I know that c-sections are major surgery and not ideal.

Does anyone have any experience or knowledge they can share.

Im seeing the consultant in two weeks time when a decision will be made. The midwife hasnt been able to shed any light and I just dont know what to do for the best.

Thank you for reading
x

In my completely lay opinion I think it is just down to luck. I know that anecdote isn't evidence but for what it is worth three of us suffered with this in my NCT group. One had a CS, one forceps and one normal delivery without even a stitch.

We didn't suffer for as long as you but all three of us were in pain for about 4 months with many tears being shed.

All things being equal I would go for VB and get straight on the fybogel, dried fruits and prune juice (this is my plan anyway). I entirely blame my fissure on constipation from codeine based pain killers which I would have thought you may take more of following a CS?

Thank you Pastabee for your advice.

This is what Im unsure about, on whether the fissure was caused by the birth or the constipation after.
I was definately planning on taking Movicol straight away or leading up to. But that really makes sense to get some fruit, nuts and bran in the house.

I found my fissure only really healed when I started drinking prune juice. It was absolutely disgusting and I used to knock it back like a shot reminiscent of uni days. I definitely plan to use it again but hopefully as a preventative.

I would ask your consultant whether it was most likely to have been caused by the birth or constipation but with mine I know it was the constipation. That didn't start until a week after birth when my stitches got infected and I needed codeine and up until then I'd been fine.

I've had an fissure in the past, before I got pregnant and had DS - it was awful, you have my sympathy! It got pretty bad before I even knew what it was, and took ages to heal - it was basically there for 2 years and I have had several others, much smaller, since then so I guess I am prone to them...

FWIW - you are very unlikely to be offered a CS to avoid another fissure, unless you happen to get a very sympathetic consultant. It just isn't seen as a bad enough complication. Not saying I agree with that, at all' but that's how it is.

i had a planned CS for my 1st DC and that meant I escaped any perineal trauma and I was very grateful I didn't get a worse/new fissure. (I did have to warn the nurse who was giving me a painkiller suppository to go easy, and she was very sympathetic, luckily).

I didn't have any constipation post CS, but then I ate sensibly with plenty of fruit and stayed well hydrated. I didn't actually get my initial fissure via constipation, btw, I got it through the opposite, diarrhea after food poisoning. So over doing the laxatives can make the problem worse, not solve it. what fissure sufferers need is stool softeners, not laxatives - there's a difference.

So really, unless you are adamant that you want a CS and are very determined to fight your corner, you are very unlikely to be offered one purely on the grounds of a fissure. personally I think you are much MUCH likely to get one if you have a planned CS than an instrumental VB, but of course there are many other factors to take into consideration. the gp I'ce seen about my fissures said that it was damn lucky I had had a CS not a vb, but that was just in respect of not getting any more fissures.

Good luck - and if you haven't tried it, Xyloproct is a wonderful bum anaesthetic! Need it on prescription though.

Sorry - clearly I meant 'Much much less likely to get one after a CS than an instrumental VB' , not the other way round.

I guess the one thing you can be reasonably assured of is the chances of a second instrumental delivery are very low and your pushing stage will probably be quicker. You could try re posting to see if anyone knows the stats?

Thank you for the replies

Wheresmespecs - I have already been offered a c-section. I actually work for an obstetrician who has advised me that I should have a section, although he is not my consultant so I need to discuss this with them who Im seeing in two weeks. As far as Ive been told you can also request a c-section now, even for non medical reasons, and although they will try and talk you out of it, they cannot refuse.
Thank you for your advice, its nice to hear that others have experienced similar problems.

Pastabee - I guess my chances are low of another instrumental delivery. Im still non the wiser of what to do. Getting myself all in a worry!

Great that you already have a C section agreed if you want it OP- although I appreciate that it doesn't make your choice any easier as such.

To be accurate, and for anyone else reading the thread - it isn't true that you will be given a C section for maternal request. The NICE guidelines have been changed recently and they say that if a consultant refuses your request, you can basically ask to see another consultant until you get one that agrees with you.

However, these are only guidelines. Individual hospitals and PCTs don't HAVE to follow them. So you can sort of use them as leverage in an argument... but there is no legal obligation for anyone to give you a CS.

A lot of misreporting went on when the NICE guidelines were issued. According the the Daily Mail, any woman can have one just by asking. Not true at all.

Heavenly Harry - I had an emcs and didn't suffer from constipation. Although being immobilised and having an anaesthetic will increase the likliehood of constipation.

I didn't even have any trouble with the first post birth poo (sorry, tmi!) but then I was so paranoid about it that I was stuffing myself with dried apricots, prune juice and lots of water.

Iirc you had to do three wees after your catherter was removed before they would discharge you from the ward and so I was necking water like there was no tomorrow in order to get home.