Anal Fissure - Second Pregnancy - C-Section or VB, any experiences?

[Bobsmyaunty]

Hello,

Hoping there's some mums out there that have been here before and can offer their experiences to one confused petrified mama...

I developed a chronic anal fissure shortly after my the birth of my DD (long second stage, back to back, ventouse) - which got much worse postpartum as I thought it was just piles. Took about a year to clear it completely after much consuming of Laxido and Apricots (used to like then, don't now..).

I'm pregnant with my second now and my midwife has referred me to a consultant to discuss the option of a c section. She said to consider long term health implications e.g. at 60 + the bowel is a bit more feeble anyway.

I'm staying on top of my diet during pregnancy but am already getting the odd fissure twinge and I have a very slow digestive system anyway. And am a bit petrified of pushing tbh as I don't even strain on the loo - even minutely - out of fear of tearing.

However, I've also heard about lots of mums developing anal fissures after a c-seciton due to the strong painkillers and lack of movement.

So, basically I is confused!

Anyone out there with any experience to share?

I understand your dilemma. I have a very sluggish system and am set on a c-section for my second child due to previous third degree tear. I'm especially worried about the long term implications if I did further damage to my pelvic floor/sphincter.

Post op constipation is a worry though, although that can be well managed with the right meds. I know, for example, that Fibogel and Lactulose (which I was given postnatally in hospital) just aren't adequate for me, and Movicol is much better.

So if I were you I would favour ELCS with a plan in place to keep your bowels moving afterwards.

Movicol and Laxido are the same thing btw.

Thanks Diving, pretty much what I'm leaning towards. The risk of further fissure tearing us just too high.

I found Laxido good too and fybogel/lactulose rubbish. I guess at least we have the experience to know what works!

When's your elcs due and did you have much trouble getting an OK from the consultant?

i had a little constipation after section but nothing to write home about, took syprup of figs, plenty of fibre and bananas and water.

I am however so much better down below after a section, I had minor issues nothing even doc could write down after however enough for me one if the best side bonus from section was i was left in tact below, its a no brainer, have the section, all your below should be OK. sorry under presure tyrping with rodder

had minor issues from normal labour, and nothing from section,

another labour and i belive i would have had things for doc to wtrite about

BTW altough as we are always told its major surgery its not as major as labour, its much calmer and more pleasant, its a great way to have a baby enjou

Thanks Knitted - good to know.

I have a toddler too. Out of interest, when were you able to lift something of that weight? (she's very heavy - about 2.5 stone)

I've had nothing OKed yet, I'm only 7+5. But it's fair to say I won't be taking no for an answer

I had a fissure in my 20s - unrelated to pregnancy though. Horrible experience and the Nhs really let me down. Ended up with a top doc in Harley st looking after me. It took a yr to clear.

10 years later i am now 38 weeks pregnant and went back to the doc who immediately advised a section. Also, have been so careful with my fibre intake but have developed a pile just from the weight of carrying. It's continually bleeding because the skin can't cope.

Think you need specialist opinion especially as the Nhs are so pro vb. Constipation post section can be managed. Cuts and tears are completely different.

Hi MissyBear. I'm really sorry to hear the NHS let you down. An Anal Fissure is a truly horrible thing to endure, I had no idea they could be so painful, the throbbing - Argh! And in yours 20's it must have felt overwhelming.

I think you are right re specialist opinion, and as you say, esp since the NHS are very pro VB.

All my instincts say go c-section. I can feel how sensitive that area is, I'm only 16 weeks and already I've had a couple of early occurrences which I've nipped in the bud. The idea of straining/pushing feels counterintuitive...when it comes to it I'm not sure I could do it for fear of making myself incontinent. It is such a real risk.

It was horrible but a while ago now.

I did a lot of research and although I might have managed a vb I just wasn't prepared to risk it. Once the skin/muscle is weakened your odds of being damaged in vb go up. Not just in terms of the immediate impact after the birth but also as you get older and pass through menopause. The odds are obviously individual and it's what you're prepared to risk.

But finding out that an elc was as risky as vb helped. Different risks but the same level. And there is evidence to show elc is better for the baby post 39 weeks.

Hope this helps.

Diving - not many people mess with a determined pregnant woman! I hope you get what you want :).

Missy - apparently at my appt with the consultant in Dec, they check the skin and tell you how vulnerable you are. Even pregnancy is giving me the odd fissure, but I'm on it and straight away go on Laxido until it clears.

So presumably you are scheduled in for your c-section next week if you are 38 weeks this week?

Yes - am booked for thurs next week and I'm terrified. Never been in hospital. Never had an op. Hence why I'm watching the mumsnet info - checking for info/reassurance on sections.

I'm going to admit that I've gone privately. My faith in the Nhs was so severely impacted in my 20s that I couldn't face the system again. It has meant I can pick nearly everything. I feel very fortunate to be able to do this.

It's a consultant proctologist you're after and I'd demand a report, although you probably know that. Plus I'd do lots of research first. So if you're going down the section path you've got the groundwork alread covered. I don't think you'll have any problems with vb as so many of my friends seem to be pushed for that option.

Hoping this helps again.

Good luck Missy. I don't think anyone would blame you going private - you need to feel safe when undergoing something like an op.

I'm thinking if I don't find my appt with the consultant in Dec of any use, I'll look for a private proctologist to give me a second opinion. Health is too important to risk. And I didn't know to demand a report! I thought they would just take a look and give me their opinion. The only person I saw about my fissure was my GP who was brilliant and made sure that every subsequent appt to discuss the fissure was with her so she could track progress. She had kids and I got the feeling she was fed up with women having to endure such horrible after effects from birth.

If you have time and remember afterwards I would love to hear how everything went. It sounds like you will be in safe hands.

Hi OP. I had a 3rd degree tear with my first birth, and MW referred me to a consultant during my second pregnancy.

I was surprised to find that the consultant was very open and willing to go with whatever I wanted. In my case, I wanted another vb, which he signed off on. But he said that the choice was entirely mine if I felt I wanted a c-sec.

Hopefully you will be supported with whatever you decide. Good luck.

Hi Elsbethy, thanks for your reply.

Have you had your second birth yet? I hope if you have it went well!

Can I ask you how you weighed up the decision and came to decide upon a vb?

Sorry for the delay, will pm you.

My goodness I am glad to see this tread! I'm the only person I know that had an anal fissure after the birth of my DS. Aren't they awful?

Reading the above posts, I think I was lucky as it was identified pretty quickly and so then I had everything to make it heal as quickly as possible (sitz bath with salts, medicated pads/wipes, stool softeners etc.) so it cleared up after a couple of months, but I did have to be pretty vigilant about looking after it. It does sound like you had a really rough time of it, and maybe a particularly bad fissure, so I can completely understand your fear.

My next is due in Feb and I'm going for a VB as I'm really hoping it doesn't happen again. I think I know why it happened, as with the OP I had a very long second stage which ending in me pushing sooner and harder than I wanted to, felt ready to, in order to get him out before they started intervening. This time I'm going to do far more work on my hypnobirthing and I'm going to (well, I plan to) have a home birth so that I'm more relaxed and so (hopefully!) have a shorter and easier second stage. As you had some complications last time maybe a home birth isn't for you but I really recommend the whole hypnobrithing thing. Anything for a calm, controlled second stage rather than frantic pushing, right? I'm also going with the idea that second labours tend to be shorted and easier, especially the second stage.

Best of luck whatever you decide and here's hoping for intact botty holes all round!

I had a 3rd degree tear with my first & was set on having a section this time...was referred to a consultant who in a nutshell explained that my nhs trust don't do elcs- i would have had to have gone to another county.what she did though was amazing- put a plan in place for me to be induced so that i would be in hospital when labour started (my first labour was vv quick & i was terrified of labouring on my own & tearing again). So i had a 1 hour vb after induction & no stitches required at all this time- no tearing. So i guess wgat i mean is that

Oops bloody phone- as long as you have the right support & plan in place there is a chance you could have an amazing problem free vb the second time around- i'm glad now that i wasn't able to choose a section. My midwife said that the chances of tearing so badly again weren't increased the second time around, just not reduced like they would be if the first time had been tear free...

I am gobsmacked they told you the Trust didn't carry out ELCS. Surely there are always scenarios where ELCS is essential? Like a woman who's had 2+ previous sections? Not to mention that they are treading on shaky ethical ground to outright refuse all requests for ELCS...

I'm glad you had a good outcome cookie, but I'm sure this was a lie to get you to agree to VB. Would you mind naming the Trust/area?

Kind of in the same boat here, but not exactly. For starters I have fistulas as opposed to fissures, and its due to crohns disease, not previous pregnancy.

At 16w, I saw the consultant and he told me he advised a section due to having 5 fistulas (4 rectovaginal, 1 bowel to bladder). My surgeon has also told me under no circumstances am I to even attempt to push a baby out, as I will (in his words) burst wide open. So he and my consultant would back me up if needs be.

Have you asked whoever has been dealing with your fissures for their advice, or to back you up on your decision? Might help if you need it.

Just to let you know, I had my elc. The procedure was brilliant - so easy - but the anaesthetic side was horrible and that was with a top consultant.

The recovery has been ok as well. But I have my husband staying and a team of midwives who have time.

I achieved my objective of protecting my behind which would be strongly advised in the risk adverse private system!

On reflection I wasn't prepared to risk any incontinence issues now or later at all. But that isn't for everyone as you exchange no risk for a pretty big op which is scary.

Hoping this helps Bob.

Wow I'm so pleased (but not pleased) to know there's lots of us out there.

Fistula's sound v painful Gudgxv. Do they give you dad to day pain? I think that's a good idea of yours to go back to the person that treated my fissure. It was an excellent female GP so I guess whatever her input is, it's bound to be helpful and she can let me know where I was on the scale of fissures (close to needing the op or manageable). God they are awful. I bet fistula's are way up there.

Missy Bear thank you for sharing about your elc. I hear a lot about how 'it's major surgery' but not about whether that actually matters if you see what I mean? There are lots of risks in VB that never seemed to be outlined in advance! I don't think I'd even heard of fissures or prolapses before I gave birth... but I knew all about the c section risks.

Somebody advised me today the best thing to do is understand all the risks on both sides of the argument. I guess it's also the impact of the risk not just the probability. Maybe there's a small chance that my fissure might erupt again into ridiculous proportions, and it might be a small risk but if the result is incontinence then I am counting myself out...

I so wish there was more credible information out there on this stuff rather than having to hunt and scrounge around for it...

Thank you all so much for your posts!

I agree OP that you have to consider the impacts of risks, not just their statistical likelihood. I had a 3c tear in my first labour. On the basis of endoanal scanning during my second pregnancy my consultant was happy to recommend me for a VB as I'd recovered well, but only I knew what a long haul that recovery had been (still do my pelvic floor exercises religiously ). I didn't want to go through that again, nor did I want to increase my risk of problems after menopause (something that is often not mentioned by midwives keen on VB). I asked for an ELCS and got one without difficulty.

Only you know what level of risk and what type of risk is acceptable to you. I'd also add that a major factor in my decision was my psychological state - I just didn't feel that I could get my "game face" on for labour after the first time round, I was simply too frightened. My ELCS was lovely and calm, DD and I were fine, and I actually found it quite a healing experience, which I wasn't expecting at all. Good luck with whatever you decide.