Moving on from a 4th degree tear (tmi potential)

[jammic]

I had a hospital appointment today to check how I've healed since our son was born 10 months ago. Some parts of my sphincter have healed fine, other parts have not done so good. My pelvic floor is loads better than it was but still isn't good. I can get to the toilet in time (it's very rare that I have a sudden urge) but sometimes I have a very small amount of leakage when I walk (bowel rather than bladder). I've had physio and the electrical stimulation and whilst this helped my pelvic floor, it hasn't made any difference to the leaks.

They're referring me to a colorectal specialist. There's a small chance I may need surgery but she said they'd try other things first. She wasn't very specific about what these were, although she did mention medication.

She strongly recommended that if we have another child, it should be delivered by elcs. Which is fine. Labour and delivery were pretty traumatic (DS was back to back, delivered by forceps and wasn't keen on the whole breathing thing but is fine now). I don't really think I would want a vaginal birth again anyway and it's far from certain that I could be pregnant again (DS was the result of our third IVF cycle).

I have no questions and am not really sure why I'm posting. I am just sharing I guess.

Hey dear...though i am a c-sec mum with no personal experience of what you are referring to, but i just felt like replying. I do know one of my colleague who needed a small surgery because of the tear. I am not sure what exactly they fixed. Further on she had no complications.

I guess you should go with whatever the doc suggests but try reading up a bit on this problem. I am sure you must have done that already. Maybe that way you are better prepared and can actively discuss the issue with your doc.

Hope you recover 100% very soon dear.

You have my sympathy. I too had a 4th degree tear 10 months ago with my DS (boys eh!)

I am in a very similar situation, where I've given myself time to heal and feel as though I am now at my 'new' normal but it is hard to get used to. I still have a lot of discomfort around my scars (episiotomy tore also), especially if I've been sat on a too hard surface for a bit too long. I havent had to be referred to a colorectal specialist but did see ladies physio for about 6 months which definitely helped me make sure I did my pelvic floor exercises properly. No idea what your next treatments are or what they may involve.

This isnt really any help but just wanted you to know you are not alone. Also, I too have been told (and have it in writing from gynae consultant) that any future babies are recommended to be ELCS.

My daughter had a 4th degree tear with her 1st baby. Saw a physio for a number of months and a colecteral specialist. All ok but was recommended to have a cs for future babies. Had her 2nd baby 4 months ago by planned cs. All well

Before I got pregnant, I didn't even really know it was a risk and once I was pregnant, I skipped that section of the book praying it wouldn't happen to me. I did all the exercises, looked after myself as much as I could and hoped, I guess, that the rest would follow.

It's just one of those things really isn't it? No one really talks about it, it's happened to plenty of people, it will happen to plenty of people... It can be pretty rubbish but it can get better with time and with help.

I just wish the toilet was a bit closer at work!

Hey there. I feel for for you I really do. "Only" a 3rd degree here - have had some bowel symptoms, but thank god these seem to have cleared up with physio. I also saw my consultant yesterday and with the tear and large blood loss (also had an atonic uterus and lost 2.5L blood) and emotional trauma, he said I'd qualify for a ELCS next time. I feel stupid to feel relieved by this as a c section is major surgery and it seems crazy to want that over a natural delivery, but I'm petrified of delivering vaginally again. DH also scared to go through it again!

Not sure why I told you that, but felt the need to share and wish you luck for the future!

I had a 3c tear and suffer from a bit of faecal leakage still 3 years on. Just about to have another baby and I am having an ELCS this time. I'm terrified of the idea of surgery, but right now my symptoms are just about manageable. Any worse would really affect my quality of life. It's such a taboo subject, which makes it worse I think.

I'm having an ELCS with my first baby in a couple of weeks to avoid this very problem - I had minor surgery on my bowel years ago which puts me at increased risk of problems of this sort. Not much practical help here but sending you sympathy and . I was fortunate enough to find a consultant who was very understanding about my desire to avoid any problems - first consultant I saw said I could go for VB but they would 'cut me rather than let me tear' (In fairness to her she hadn't received letters from previous surgeons at that stage, including colorectal specialist, both of whom recommended CS.)

A CS is surgery but to me it is a well managed risk - I definitely prefer that to the unknown / potential risk of a VB going wrong. In my particular circumstances I will take the CS every time. Ironically have developed late borderline GD so probably would have ended up with CS anyway due to gigantic baby!

If you continue to have problems don't be afraid to ask for referral to colorectal specialist. They will see a lot of ladies in your situation and be able to talk you through the options. Worth paying for a private consultation just to get a speedy admission into the system.

I don't know if I'll get pregnant again - our son was the result of our third IVF cycle. But I definitely couldn't risk it getting worse. I can cope with the leakage I have now but it's minor, it's easily dealt with but if it was worse, or if I couldn't hold it in... Oh god, that would be horrible. We're moving house next year so if we do get pregnant again, it will be with another hospital. But I checked with the doctor that any new doctor wouldn't veto her advice. She was very reassuring that it would be ok.

I guess it's just wait and see now, see what happens with the new colorectal doctor that I've been referred to. She didn't think it would take too long.

Good luck everyone, hope the cs's go well.

2.3 years ago I had my dd, "only" had a 3a tear but I required a full restitch some months later. Touch wood I've never pooed myself but when I need to go I need to go. 2 consultants at two different hospitals have promised me in writing an elcs at 38+3 next time to avoid natural labour.

Just had an appointment with the specialist to discuss my bowel leaks. Feeling depressed. I've got to try suppositories first off. I'll need to get up 20 minutes earlier in the morning to sit on the loo for 20 mins whilst the suppositories start working. I already get up at 6.20. Another thing to fit into the day. If this doesn't work (and to be honest, i'm praying that it doesn't), they'll look at other things.

Do you know what the doctor said...? I still can't get over it. 'Blame your son.' I said its hardly his fault! WTF? Yeah I'll go home shall I and make him apologise

Oh jammic, thats not good. Can you ask to see someone else? They shouldnt say that to you, its very unprofessional no matter in what context they said it (ie if it was meant to 'lighten the mood')

I'm off to see gynae consultant tomorrow and if they say to me to 'blame my son' i will absolutely hit the roof. Yes my injuries are a result of his birth but in no way are they his fault.

What a stupid thing to say, I'm sorry the appointment wasn't more reassuring for you.

"Only" a 3rd degree tear here (3b). Definitely will request an elcs next time.

He did say it kind of in jest but as you say, it doesn't really make it any better. An ill-advised comment, really, to someone trying to move on from a traumatic experience.

I wish I could swap but that wasn't even the consultant. Just a lackey of some description! My next few appointments are with the nurse though. She seemed a bit more human!

After he'd left, the nurse said to me our bodies just simply weren't always designed to give birth. I don't know if that's reassuring or not!

Glad your next appointments are with the nice nurse, that makes such a difference to have someone understanding.

Try not to worry about the comment made, but you could make a complaint to the hospital if you feel strongly about it.

How are you feeling now?

Slightly off topic but have you considered counselling to help with the emotional side of what happened during the birth, i've done one lot of counsellig back in summer (over 8 weeks) which really helped but i'm still highly emotional so am considering going back. It helped me by having someone who will just listen, and also gave me a safe space to open up about everythig. Might be worth considering for you.

Better. Did my first suppository this morning (which wasn't as bad as i'd feared but did take a lot of time out of my morning) and so far no leaks, which feels completely weird! No definitely agree re counsellor, always useful to chat these things through.

So I take it the suppositories are supposed to clean out your bowel each morning so you don't get any leaks? Is this supposed to be a long term thing or an interim measure before surgery?

Yes that's right. It's so that they can tell whether the leaks are because not everything is coming out when I go to the toilet or whether it's just because of general leakage.

It is helping (helping not solving) but I can't have this being my actual solution, it's taking too long in the morning. I go back on tues to discuss options. They said there were other things they could do, but they needed to know what was causing the leaks first.

I had a 3c 7 months ago, so far everything seems to be going ok.

I found physio pretty useless until u did bio feedback which definitely made a difference.
I found the whole experience really traumatic and very few people feel comfortable talking about it .

3c here after DD (DC3 - she was face first and 9,8.5 and in a hurry). So I sympathise.
Luckily I had the chance for a GA & repair work the next day and everything healed fine.

I really hope you get to a solution.

Feeling depressed today. Last time I went to the hospital, the suppositories seemed to be working and she'd given me a load of other things to try (using a footstool to get me in a better position, cutting down on fibre - I'm eating too much, trying not to get stressed - haha..., eating as soon as possible to help get things going). I felt quite positive but desperately wanted to find something other than the suppositories.

One month later, I'm back in again for my next appointment. We've only just got back from being with relatives over Christmas, I've struggled to get ten minutes to do the suppositories whilst we were away. I've been rushing it and it hasn't worked. I've failed miserably to buy the footstool or organise any cereal bars to munch on first thing (just been so busy, I've barely stopped). I haven't managed to cut back on fibre because we were in other people's houses and it just seemed so tricky. Stress levels are way up for a hundred and one reasons.

She started off by giving me a right bollocking, saying what was the point of the session if I hadn't done anything in the interim. I burst into tears - I'm balancing so many things at the moment, finding extra time to do something is just so hard right now. It's not that I haven't had the will to do something about it, I just haven't been able to over Christmas. Anyway, she was a bit nicer after that.

But pretty much, it looks like the suppositories are my only solution now along with the other stuff above. I thought they were just for assessing what was going on but they're not, they're for keeps, and that's really hard to take in at the moment. I am just so struggling to find the time to do them as I have to do it before I leave for work, and I'm already out the door by 7.30.

So the sessions have kind of been put on hold for now, until I'm in a better position to commit to doing what I am supposed to be doing. I've still got more tests though, I don't really understand why. She said there was nothing else they could do, whatever the tests showed. Only surgery and that might make things worse.

I just feel completely harrassed and blackmailed almost. Which is stupid. She's banging on about needing to find time for myself to sit on the loo, it being for my own good. The only way I can do it is by getting up even earlier. And then she's saying, don't do that, cos you're already getting up early and you don't want to make yourself ill. Go into work later she says, but then I go into work early so I can come back and spend time with my son. I don't want to not see him or see him for less time. That was never the point.

So I'm pissed off with it all. It's not f'ing fair. Ooopsie quite a long post. I think I needed to vent.

jammic I just read your thread and can I say how pissed off for you I am, and the attitude of some of your doctors, it really is unacceptable . I had my DD 5 mo ago and just had a 2nd degree tear that in the scheme of things has been fine so I can only imagine the ongoing trauma you and some of the other ladies on here have been through.

Do you have someone you take with you to these appts? You sound quite vulnerable and could do with an advocate. Frankly some of the comments made to you are downright unprofessional imo. You had a baby and what happened to you was v unfortunate but you shouldn't have to put up with this, it's obviously affecting you and of course it would. I would start getting v assertive with them, talk to you GP, ask to see another specialist, complain to the hospital "blame your son" hardly sympathetic.

Sorry, probably not helpful :(. Just wanted to say I hope you get it all sorted :).

Do you mind me asking, was your son a big baby or difficult birthing position?

I am very sorry to read what you are going through. Have you ever visited the Birth trauma Association website? They have some info that might be of help to you or might lead you to find better solutions.

www.birthtraumaassociation.org.uk/bladder_bowel.htm

I'm not an expert or medically qualified - I was just wondering why you had to use the suppositories in the morning. Could you use them at night when your ds is asleep? I was just thinking you would be more relaxed. Are they used once a day? I understand that you empty your bowel to avoid leakage during the day - but could it work the other way round?

Sorry if I'm missing the point about the morning routine.

Thanks guys for your support. It's really kind of you. Day-to-day, I'm ok with it all. I deal with it and just get on with things. But I seem to turn into a nervous wreck at these appointments. I always seem to struggle a bit with doctors and end up in tears. And I think these ones just tip me over the edge. I keep going thinking that I can manage it on my own, and then for some reason I seem to fall to pieces. I think I am pretty much discharged though from the nurse appointments. I just have to go back for these (potentially pointless) tests in a couple of weeks.

Lois, he wasn't big (6, 13) but he was 'unexpected' spine to spine and a forceps delivery. (They didn't spot that he was spine to spine until he came out the wrong way up.)

Goodygumdrops, thanks for the link. I've been on there before a few times but this time have noticed that on the newsletters they're asking for submissions of birth stories. So I've submitted mine. It was quite therapeutic writing it.

Granite, when they first gave me the suppositories, they said I had to use them after my normal natural bowel movement. I always go to the toilet first thing in the morning, so they wanted me to use it straight after that. And then be leak free for the rest of the day. But I spoke to the nurse about this at my last appointment, and I am going to try switching it to the evening and see how that goes.