Post natal injuries - how to get the right help

[Cosmo89]

I had a 2nd degree tear and episiotomy during labour for DS 2 months ago. the tearing looked messy, according to the diagram, and was sort of all over the place. I have since tried pelvic floor exercises but I am still for all purposes incontinent - ie. I am frequently leaking wee and have to find toilets ASAP to avoid wetting myself completely - though my pants are always semi soaked after a few hours- more worryingly, I am not all ok in the other department, although much better/.
This is really upsetting me - for the first few weeks I thought it was all just healing etc but now I feel ive gone past that stage and that now the evidence is that I have permanently damaged my pelvic floor and I will be like this forever.

I talked about it at my 6 wk appt - the gp has referred me (but then forgot - so now it's only just got moving) to the physio. I haven't had an appointment yet - probably won't for a few weeks - but it seems to me that physio isnt' the right place - I wonder whether the damage was worse than the drs thought? I've been doing the exercises after all, and I'm still not continent.

It's putting me off the idea of another child - I would rather have contience IN MY THIRTIES thank you. Certainly pushing for a caesrarian the next time round... if there is one.

Is the physio the right route? SHould I be asking for specialist help, if so - in what area? Gynae?

You must see your physio. Both of my daughters on their 1st babies had 4th degree and 3rd degree tears. 1st daughter (4th degree) has just had 2nd baby by planned caesarean. 2nd daughter (3rd degree) 10lb 4oz baby. Just had 2nd baby, normal delivery after about 15 minutes of 2nd stage 8lb 9oz.

Yes you should see a physio. It's amazing how many of us think we're doing our pelvic floor exercises but are actually exercising completely the wrong group of muscles or exercising the PF in the wrong way. After a tear the feeling of the exercises changes too, making it even harder to get them right. A physio will give you feedback about how to get the right technique (warning - this involves internal examination, but really isn't anything to worry about) and give you a progressive programme to build up their strength. If they're still not functioning well they can do electrical stimulation of the muscles to get them going. Physio definitely the way forward for you by the sounds of it. Good luck!

Wow cosmo, hope you get the help you need and make a full recovery, sounds like you're having a rough time of it. Be pushy if you have to, you shouldn't have to put up with that.

GL :)

Do definitely go to your physio appointment. I had a bad tear ten months ago and the physio really helped me boost my pelvic floor strength especially using the electric stimulation. I found it really hard to remember to do my exercises but have set an alarm now on my phone to remind me three times a day. And it's definitely getting better.

If that doesn't do the job, then you might need to ask for further help. I've been seeing doctors in the urodynamics/perineal clinic in gynae (these were the ones who arranged the physio) and am about to be transferred to a colorectal doctors to help me improve my muscle strength in my sphincter.
Good luck!

can you ask for referral to urogynaecologist rather than just a physio?

As all the above posters have said, definitely go to physio.

Also, dont forget you are only 8 weeks (or so) post birth, the magic 6 weeks recovery does not apply to everyone. I was still incredibly bruised internally (forceps delivery with 4th degree tear) about 12 weeks after when I went for my first physio appointment.

Try doing your pelvic floor exercises every time you go to the loo (once you have finished, its not good to stop mid flow). This worked for me, as you are sat there anyway and it only takes an extra minute.

Cosmo your post is a bit unclear, but are you saying you're also getting faecal incontinence? Because if so, I think you should push a bit harder to see a consultant about it. From my limited knowledge of the subject (had a 3rd degree tear a couple of months ago), you shouldn't have problems with your anal sphincter if you "only" had a 2nd degree tear. It may not affect your treatment, but may well affect your care for future deliveries. I'm just back from my consultant check up and he told me he'd recommend a c section next time (not only because of tear, but there were other complications too, but he said he'd always recommend a c section after a 3rd degree tear with anal control symptoms). Hope that doesn't stress you out, but if you are already thinking about c section then it might help your case.