Anal Fissure

[Longfufu]

Hi, sorry bit of a grim subject!

I am currently PG with DC2, I would like to have a ELCS this time. First labour did not go to plan and resulted in EMCS.

Anyway, I'm meeting with Consultant soon to discuss my pregnancy and birthing options and I would like to know if a Anal Fissure can cause any problems during vaginal births? The fissure has been a life long on and off problem and it's just occurred to me that I probably should tell he about this...

Advise please, thanks xxx

NICE says you should have a choice of c/s if you have had a previous EMCS. Moreover, having an elective caesarean is usually safer unless you are planning a large family. www.bbc.co.uk/news/health-1735380

Some of what RCOG say at the bottom of that article is a bit misleading. Recovery from caesarean is longer than an uncomplicated vaginal birth but a complicated vaginal birth generally takes longer to recover from than a caesarean. Multiple caesareans do increase risks for future pregnancies, but if this is your last pregnancy, that is irrelevant.

Good luck with the battle. So much for choice in the NHS

I think it depends on the severity of the problem to be honest. I think a normal delivery is manageable with a very superficial fissure but anything involving muscle may well be better off with a c-section. A good friend often had an anal fissure which had been a problem for around two years before she got pregnant. She was strongly advised to have a caesarian and was told that pregnancy itself could cause problems with her fissure. My understanding was that while the fissure was unlikely to cause problems with birthing her baby, the resultant stress may do permanent damage to the whole area. I would definitely mention it to your consultant and stress that it has been a lifelong problem if you'd like a Caesarian. One problem my friend had was that the obstetric consultants didn't seem to know much about fissures and how they were affected by childbirth and she had to go to her colorectal consultant through her GP to get any real answers about which way to go (normal delivery or ELCS)

By the way, I want to point out I am not a Dr. I am a nurse though, so have some background knowledge of this stuff.

Hi - well, a lot of fissures are caused by childbirth! But tbh, it isn't really taken that seriously as a problem. So unless you were talking about a severe fissure, that you have had anorectal surgery for previously, or were already suffering some anal incontinence, and is really a huge problem, they won't take it into account when discussing a cs.

Sorry to be a wet blanket - I've had a few fissures including a non healing chronic biggie, and they are hell. Luckily I had an elcs with my 1st so it wasn't made any worse. People just don't realise how bad they can be, or that sometimes they just don't heal properly.