Tearing and pelvic floor consequences. When will I know?!

[Superslinger]

I tore pretty badly, they thought it was third degree, but after calling four different people to look and 'i'm just going to insert a finger into your anus' x4 (boak/ cry/ more gas and air consumed than in labour), they decided just 2nd degree. I tore in lots of directions other than the perineum though, some labia tears that also needed lots of stitching - the whole stitching phase of horror went on for THREE HOURS after labour!

Anyway, my HV has since asked 'is your pelvic floor your own?' Well, I assume she means am I continent? And yes, i seem so, in that i haven't noticed otherwise... But my question is WOULD i have noticed? i'm 3 weeks post-birth and still bleeding so using heavy duty pads - is it possible i'm no t in control of my wee, but don't notice because of the pads?!

Any experiences/ advice much appreciated!

Hi,
Congratulations on your DC, but I am so sorry that you tore this badly. I sustained serious birth injuries when I had DC1 almost 2 years ago, that included a very bad 2nd degree tear. Like you, as far as the tearing was concerned, it went in several directions, including through the urethra. Do you know if this happened to you? I think it is far too early for you to tell what your continence is going to be like - it takes a long time for muscle to heal and it will take a long time for the swelling to go down. To be honest, I think it will still be too early at your 6 week check. Even if you are advised to start pelvic floor exercises, I'd let everything rest and heal for another month - I say this as someone who has had serious reconstructive surgery on my pelvic floor and vagina and was advised to let things settle down for 8 weeks before starting any pelvic floor exercises.

I think there are several things that could effect your continence:

1. How well the muscle heals
2. Whether you have any nerve damage as well
3. Whether you tore through your urethra
4. Whether you have any additional damage, such as prolapse that hasn't shown up yet.

1. If you have been stitched well, you should heal. But if things don't feel right in about a month or so, then get yourself checked.
2. Nerves do regrow! So even if you have some damage, things should improve over time. It just might be a bit trickier in the short term for you, and it might also be hard to know if you are doing your pelvic floor exercises or not. A hint of nerve damage is if things feel numb in your vagina (but again, 3 weeks is far too early to tell).
3. If you have torn through your urethra, this may effect the thickness of the urethral sphincter and the competency of the pelvic floor round the urethra. And this could effect continence. Once you are properly healed and and are able to do pelvic floor exercises, strengthening this part of the pelvic floor should help. If it doesn't, get yourself checked out.
4. You might be absolutely fine! But if you do start to feel things sagging or dragging or notice any bulges, get yourself checked out. Much too early to tell - there'll be all sorts of swelling and things and it can take a LONG time for things to settle down.

If you have had this amount of damage, I would press for a referral to a specialist uro-gynae surgeon for a check up at about 3 months, just to make sure everything is OK and where it should be. But you might find that you really do feel OK and not need to bother with this.

Have read this back and I really don't mean for it to sound like a message of doom - just trying to be thorough!

So - let's put a positive slant on it:
Even if you are leaking wee now, it's not necessarily any indication of how things will be like when it all settles down and heals. If you have been stitched well, you should heal well and your pelvic floor should work well. It takes a LONG time for thing to heal and settle and 3 weeks is really early! Pelvic floor exercises should really help if there are any problems, but just rest and heal for now. If you are worried get yourself checked out by a uro-gynae surgeon and/or a specialist gynae physio.