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?

Fay, you have just described exactly how I feel about (not wanting) a vaginal birth after third degree tear, particularly the psychological reasons. I'm really glad you got a ELCS and you found it such a positive experience.

I've had fissures in the past and had a CS 4 months ago. I am not a CS fan for other reasons but bum-wise it was fine. I refused all morphine based drugs after theatre, made sure I drank lots and ate "loosening" foods and had no problems at all in that department.

I'm sorry to hijack. My fissure is not vb related: I've had 2 CS and it appeared months after my first. Anyone had Botox for theirs? Been booked in to have it done in January.

My first birth sounds very similar to yours. I had chronic fissures that healed 2 years later and with the help of a procedure. I was very scared about the possibility of their reappearance during my second birth. Thankfully all was fine. Don't worry too much.

Have just read the rest of the thread. I didn't realise I was risking incontinence in later years by giving birth twice more after chronic fissures and a 3rd degree tear during my first birth. Nobody mentioned it to me. I'm quite worried now.

jimmy, I've no experience of fissures but in general, I think the hormonal changes during menopause can cause a reduction in muscle tone in the pelvic floor. Any woman can get this regardless of whether or not she's had kids, but obviously if you've already had a pelvic floor injury then it's something to keep an eye out for. There's a brilliant poster on here called gussiegrips, she's a women's physio and its worth searching for her posts about what you can do to protect your pelvic floor.

I had a chronic fissure for 2.5years after dc1 was born (vb with episiotomy), it didn't start until 2weeks after giving birth, I assumed it was piles &was caused by getting dehydrated while bf'ing, eventually I got so fed up I overcame my embarrassment, saw dr &fissure was diagnosed. It only seemed to go away when I stopped pelvic floor exercises.

I told my midwife about it when preg with dc2 (1year after fissure had healed) & no-one ever mentioned that a VB might be inadvisable/cause problems in later life due to fissure.
It did flare up a couple of times during 2nd preg, but I managed it with fibogel &staying well hydrated, also did bare minimum amount of pelvic floor exercises.
Gave birth to dc2 8weeks ago in birthing pool. Fissure &epi scar both fine during birth, had a small tear which was stitched up. Was more prepared this time, ate lots of fibre & took fibogel every day when fissure appeared at 2weeks & it stopped quite quickly. Still taking fibogel & not being over zealous with pelvic floor exercises, hoping that keeps fissure at bay, no idea what long term implications will be though as my Dr never mentioned it .

I had third degree tear with first. After second, I developed a prolapse and a fissure. Ahhhhh the pain of a fissure - like giving birth every morning :(

NHS also totally let me down. Mine took 6 months to heal.

I'm pregnant again and have opted for a ELCS. Amazingly, consultant was fine with this (and I didn't mention the fissure - it was due to prolapse).

I am going to ask for movicol post delivery after reading this thread (is it ok during breastfeeding?)

I will post back if it would help anyone?! Due in 3 weeks :)

Reading with interest. 3rd degree tear 6 months ago and fissures for 5 months. No plans for second baby yet but will at some point...

Hi, I had an ELCS a few weeks ago after a nasty 3rd tear with DC1. Honestly it was the best thing for me as I was left with mild faecal incontinence, a wrecked pelvic floor and the inability to hold wind in. Not having to worry about these issues has been a godsend, not least for my self confidence. The CS recovery was sore, but was right for me (and I think it might have been less sore than the remedial repairs done to my poor undercarriage!) Good luck with what you decide b

I got my fissure several weeks after my second vb. For me, something about breast feeding and hormones/thyroid issues slow things down to such an extent that it becomes a problem. I was lucky an got great treatment from my gp. After dc3 (another straightforward vb) I'm carefully managing things (diet, fybogel, softeners) and seem to have avoided a repeat although had piles from pregnancy. Unfortunately for me it's always been pregnancy related issues that have been the problem.

Incidentally I have a friend who developed problems after getting constipated from pain killers post cs - things are never straightforward

Hi everyone, am new here and I need ur advice urgently and am really scared. May 2014 I had my baby at 20 weeks for my water just broke and delivered after 2days but the baby died before I delivered her. Now am pregnant again and am already 18weeks gone so my gynaecologist is saying that it is necessary I go for a stitch ( cerclage ) because of what happened with my first pregnancy. I am thinking I shouldn't go for the stitch because my cervical length is 4cm long and it's not that am dilating or something. Everything is fine at this stage but the doctor is saying it could be that I lost my first baby due to an incompetent cervix and that if it was cos of that that it will happen again and then it might be too late to safe the baby. Am really confused. Has any done a cerclage at 18weeks and how was the outcome. It is risky or safe? Please ur advice is needed urgently for I have 2 days to decide whether or not to do it. Thanks

Hi lovely2,
So sorry to hear about your baby being born too soon in May.
I'm afraid I have no experience of what you're asking about, maybe you'd get responses from people with experience if you start your own thread?

Fidgetywidget,
Thanks... God bless you

It seems quite 50/50 between those with fissures going to have another VB and those ELCS. And re the discussion about implications later on in life I reckon there may be a difference between those who've had fissures/issues and bounced back to normal and those that have had reduced capacity. So I don't reckon anyone needs to worry if they weren't advised of long term effects.

I know my main argument is that my capacity has been reduced after the first birth/fissure and if it's reduced by the same degree then I'm in trouble!

flossy are you better now?

My appointment is in a few weeks and I'll happily feedback on what he says?

It's so nice to hear from all of you.

lovely I'm sorry to hear of your troubles, hope you find some good advice somewhere.

rooner I have been prescribed mo icon during pregnancy do might be ok during breastfeeding but obv best to check / thinking about it I'm pretty sure I was on it when bfing too!

Hi Bob,
Have you had any luck speaking with someone yet?

The fistulas, I had surgery in January and June to insert setons in them to keep them open to drain. There was due to be more investigative surgery this year to see how theyre doing, but I got pregnant so everything has been left until baby is here. I'm used to them now so dont get much pain, but with my body stretching they are beginning to get a little stingy again. God knows what kind of state they will be in after baby is here!

14 weeks to go til my planned c sec!

bonzo just found this thread. I had fissures about 18 months ago completely non pregnancy and childbirth related. They just wouldn't heal and I ended up having surely to tidy all the scar tissue and Botox. It's been brilliant since. No real issues. Incredibly painful post op and knocked me for 6 for a couple of weeks. Thought I'd be back to work and fine within a day or so but extremely painful post op. But honestly been brilliant since. Still have to keep an eye on things and if I do feel like I'm getting constipated I act quickly to get things moving again. But am now 26+4 with first baby and had no real issues. Am also planning vb as until this thread hadn't even thought it could cause issues and it's not been mentioned at all by doctors or mw.

Sorry, I meant surgery, not surely.

Foscar thank you. And congratulations on your pregnant. That's so helpful. I'd anticipated a week off work, well it will be 11 days due tomorrow me working part time. They've not mentioned surgery per se, just a thorough examination (!) and the Botox. I seem to have one fissure which keeps re-opening. Though, touch wood, a month or so of the diltiazem cream has made a huge difference. Really no pain at all after the first week or so. I've also been pooing really easily too (tmi I know, but inevitable on this subject really).

I'd definitely speak to your gp or midwife about the risk of a VB with the previous fissure. Actually, scrap talking to your MW. I've found them pretty useless in the past when I've raised concerns about anything really. I'd go to your gp, and then ask to see a colo-rectal or obs/gynae specialist.

Grudyx glad it's manageable. A fissure and a fistula sounds like a lot to manage. My appointment is on the 10th December with a Consultant at the Hospital...no idea what his/her specialism is in but I imagine is in childbirth rather than a proctologist.

Will definitely feedback what he/she says in case it helps anyone.

I will only be a few weeks behind you if it's approved, probably about 16 weeks from now! I know for my bum, it can't be soon enough. It's struggling through pregnancy.

Seems like MW responses are mixed on this issue too. For the record, mine is in her 60's and seems pretty practical. She has two daughters who have had children too (she was the midwife for one of their homebirths). I mentioned the fissure and that I was in the second stage for 2 hours with a back to back labour. She said it was probably caused by the head banging on the bowel/rectum. She said 'they may well recommend an elcs' and that 'no-one would blame me if I went for it' and 'to consider long term impacts on my bowel not just immediate health'.

I can feel I have problems now (can't really hold in a poo if I need to go, occasionally twingy pain, very prone to fissures if I get constipated, if I try to squeeze out a fart I wee a bit) where I didn't have any before - just a sluggish digestive system. Sorry for the tmi here but as bonzo says it is inevitable on this subject!

I've heard from a friend of a friend (a direct conversation between the two of them related to her issue and mine, not a distant random chat) who had a fissure for 2 years and underwent physio treatment to deal with it - her proctologist said to her C-section, no qualms, when she fell pregnant. HOWEVER, she obviously had a chronic long standing issue, maybe with knock on effects on bowel strength as a result, like me. So I think it really must be a very individual issue as there are very individual risks here.

Lots of posters here have said they were fine with a VB. I'd be interested to know if they were fine post-fissure or had any further issues like mine as I'm starting to think this is the defining factor!

Is anyone still on this thread? I had my consultation yesterday and it was rubbish!

Consultant didn't seem to see that a fissure was of any relevance to anything and she didn't seem to know much about them e.g. said that she didn't think people had surgery for them, they just heal on their own. If you've had a chronic one then you know it takes a lot of work to get them to heal!

I mentioned my reduced capacity and that after a year of having one I felt borderline whether I'd need to go on to have surgery. That I had NO issues before childbirth and now get one really really easily and have to manage it immediately.

She just mentioned that she'd published a paper talking about how women who have had 3rd degree tears can still go on to have vaginal births so...

I'd like to get anther opinion but don't know where to go. Has anyone got any ideas? Like a women's health physio? I'm happy to pay - I'd just like someone with knowledge of a fissure to talk me through it. I'm not happy to go in blind...

Any pointers much appreciated!!

What about a colo-rectal specialist bob? See if you can google one close to you and call their secretary, ask for an appointment?

Thats the tricky thing about these bum subjects, no one really knows exactly what theyre talking about except the specialists. What area are you in? I can recommend mine, Mr Martin Downey, at Wishaw General, if you're in this area.

Thanks Gudgyx - that's exactly what someone else suggested! In fact it was a Women's Physio. I've left a message with my midwife this morning asking if she can book me an appointment.

Didn't realise I could book directly - think I might try that!

Thank you again :)