3rd / 4th Degree tear recovery

[IfonlyIcouldgobackintime]

Four months ago I sustained a grade C third (borderline fourth) degree tear extended from an episiotomy as a result of a forceps birth. Baby was my first baby, 8lb 7 and in back to back position and got stuck.

Visually everything seems to have healed ok but four months on I am still suffering as a result of this. I am unable to walk for more than 15 minutes without everything starting to ache and feel very bruised.

My main problem however is still with bowl movements. Some days I suffer from urgency, when I know I have to go I have approximately 30 seconds to get to the bathroom. Other days I have the opposite problem, when I start to go i am then unable to finish and sort of get stuck halfway through iyswim.

Stool softeners are not an option as they obviously make the urgency days much worse. I am being so careful with my diet and drinking pints of water every day but nothing seems to really help.

The hospital have said everything looks healed, physio have given me exercises to do which I sometimes think are helping and sometimes not.

This is really starting to affect my quality of life as I feel unable to leave the house some days and constantly worry when I am out and about. Just simple things that I thought I would enjoy with my new baby like a walk to the park have become an ordeal and something I simply can't enjoy.

I'm really hoping to hear from anyone who has had a similar experience, please tell me it gets better with time and continuing physio??

I had a 4th Deg tear following back to back forceps delivery with no episiotomy performed in time. Originally it was classed as a 3rd Deg but later reclassified as 4th after an anal probe at 9 months post partum. In my local NHS authority it is standard for 3rd and 4th degree tears to have a follow up physio, a consultant appointment a few months after delivery and an anal probe at 9 months to check repair/recovery. This is where my tear was reclassified. It is very common to feel sore/bruised for at least a year but if you are experiencing bowel issues you need to get this addressed ASAP. I would push back to the GP or hospital for a consultant referral to be fully checked out. It's really important you heal properly to avoid in continence problems later in life.

The consultant who did the probe at 9 months post delivery said that it showed a small unhealed internal tear at an awkward angle wouldn't have been picked up on otherwise. Either it was missed in surgery when I had stitching after birth or it was stitched but didn't heal correctly. I had a lot of stitches in surgery, took over two hours so who knows! He said as long as I wasn't in pain or experiencing bowel issues then it would be ok to leave and not worth repairing, so it has been left. However I am not allowed to give birth naturally again as it is too risky because of the position of the year. This is not common though, he said over 90% of women with 3rd degree+ tears are physically able to go on to deliver naturally again as follow up care is now much more of a focus these days.

Oh I feel for you, I had a 3c tear as well eight months ago.
I still have some issues with needing to go quickly but it definitely has got better. I used stool softeners for a while but not the full amount. Some people are more sensitive than others.
Definitely keep doing the exercises but I would go back if it is effecting you so you cant leave the house, have you seen any improvement? The physio told me there are things they can do to check the muscle tone which might be better than the doctor just looking at the stitches. Its difficult I know but I keep telling myself its still early days...

Hm, had no mention of a probe at nine months though.

Could you have levator avulsion? This is where part of the pelvic floor muscle has become detached from the pelvis and can cause a heavy, painful feeling and bowl problems. It's often seen with posterior babies, forceps, large heads, and very long (but also very quick) second stages.

You would need to be checked by a gynaecologist to find out. I'd push for a referral and scans to get this looked at. It's unlikely to get better on its own.

More info on tear treatment and endo rectal ultra sound:

www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Pregnancyandbirth/Thirdorfourthdegreeperinealtear-patientinformation.pdf

I think it depends on the type of tear. 3b,3c and 4th degree are more serious than a 2nd degree or 3a degree tear and require a higher level of aftercare

Please go back to your physio or ask to be referred again by your GP. You should be able to go to the park without worrying about being near a toilet.

I was thought to have an unrepaired third degree tear (2x ventouse, episiotomy, forceps, severe PPH, anal incontinent 6 days after birth).

Was referred to urogyneacology clinic at 4 weeks. Started intensive physio (5/6 series of exercises a day-back to back took one hour every day-intensive for around six months then three times a day for life).
Had a rectal scan at four months. Sonographer said third b tear. Was referred to colorectal department.
Colorectal consultant looked at rectal scan and said that in his opinion my tear was "only" second degree (still unrepaired but perhaps the only luck in my case). He did a strength test at 6 months. At that point my symptoms were better than what you describe but I still had urgency (minutes rather than seconds to get to the loo). Surgeon said I was within normal range. That brought home to me that a lot of people must suffer from urgency because it really did not feel like prebirth.

18 months on. Things have still improved. I do not leak stools and I can control 95% of my wind. The only red flag is when I'm ill with diarrhea. I don't leak but clearly I need to hold tight (tighter than before giving birth).

I really think you should ask to see a colorectal surgeon. Either ask your physio as they may work in collaboration with the colorectal department or go to your GP and ask to be referred.

I sustained a bladder and uterus prolapse. I could not walk further than half a mile for three months. It took until month 7 to feel I was walking normally. Now I can trot but I can't run anymore (and definitely no trampoline).
I'm not a physio so I don't know exactly what the consequences of your injuries are but you should be assessed. I was first assessed by the physio (questions and physical examination) and then I had a long questionnaire to fill in with the colorectal department (warning: some of the questions are horrid but be as honest as you can as it will help the surgeon see what the problems are and therefore what can be done about them).

I feel incredibly sad for you. I vividly remember my postpartum.
One issue on top of everything else was that a majority of healthcare professionals were talking to me as if my birth was just like everyone else's. No one ever said "You are seriously injured" or seemed to show the compassion that I would have deserved at that time. This left me in a no woman's land because I couldn't understand how I could be just like everyone else with the symptoms and pain (horrendous coccyx pain) I had.
So I am saying it to you: You are seriously injured.
You gave birth, yes but you also sustained serious injuries. This means that you are mother to a new born as well as a seriously injured woman trying to recover. You are not simply recovering from birth. You are trying to recover from serious injuries.
I hope understanding this will help people around you help you. If you had been seriously injured in a car crash, people would have rallied around you straight away. Unfortunately because your car crash had the disguise of birth, people might be thinking that every is fine (including you). Your postpartum is vastly different from most women. I have the same regrets about not having had the moments I had imagined with my baby (I was in too much pain and couldn't sit nor squat for months so couldn't bathe my child on my own for example). I wish healthcare professionals were more open about births such as ours. Unfortunately they're not and this forum is trying to fill the gap.

I hope this is helpful and I hope you can get the referrals you need.

pinguina I don't know whether your words are helpful to OP but they touched me (I'm crying right now and my birth injuries happened 3 years ago).

You are absolutely right that these are injuries that are masked by birth and are not always fully acknowledged, and that hcp can be a bit too matter of fact about it, as though it's all normal. It's not normal.

My family know what happened to me during my birth and, to a lesser extent, the after effects of my injuries but everyone now and again will say something like 'well ds1 was born healthy. That's the main thing.' As though that undoes what I went through. Of course I'm glad he came out alive and he recovered from his birth injuries (he had erbs palsy due to his nerves being stretched in getting him out with shoulder dystocia) but he has made a 100% recovery. I have not. And my injuries and consequences are not a limp, a weak arm, a scar on my abdomen. They are embarrassing, personal, not for polite conversation, therefore hidden, not talked about, glossed over.

The all's well that ends well attitude (though only in regards to my ds, not me) I find a bit hurtful, then I feel guilty for making the birth about me.

Last week I went for a growth scan to check I'm not about to have another massive baby (ds1 was well over 10lbs, head circumference at 99.6th centre, back to back labour for over 70 hours and absolutely no warning signs he'd be big - normal bump size, no gd, I'm a normal weight, did not gain much weight during pregnancy (in fact weighed less after the birth than pre pregnancy) - and I spoke to the woman doing the scan about what happened. She blanched, especially when I described what post partum was like (zero bladder control, unable to stand longer than 15 minutes for months, unable to walk quarter mile to shop for months, having to leave the hospital in adult nappies, prolapses I had to diagnose myself as no one bothered to check or care (until a routine smear test where someone actually confirmed it to me).

Finally someone who made me feel that it was ok to be upset about this. It's not just the normal price for having for having children. That I was very unlucky and its understandable that I'm not just over it.

I still live with the consequences of that birth but the emotional trauma feels worse. Or maybe it's the daily physical reminders that stop me moving past this.

Thank you pinguina for starting so clearly that it's not normal and that the hidden aspect of it makes it harder for others to understand.

Hi ladies, I would just like to say that you are so lucky how many resources you have now. I suffered a 4th degree tear in 2003. There was no online help or people to talk to. I was not told how bad it was until my 6 week follow up when I was incontenent. A 4th degree tear was explained to me at that time. I didn't know that the pain I was in after child birth was any different than anyone elses as it was my first child.

I went through the trauma of repair surgery when my baby was 9 mths old. I got a staph infection and the surgery was undone. I then had a c-section birth in 2005 and went through the excruciating pain of a 2nd repair surgery when that baby was 9 mths old. First repair is the best chance so i was in trouble from the start. To date it appears to still be intact but has small tears in the muscle. I had another c-section birth in 2007.

Too date my son is now 13 yrs old and I'm still fecal incontenent. I've been in hell for 13 years. Daily life is hard. Its hard to be far from a bathroom. I'm gaining weight because its hard to exercise because it causes accidents. I'm now possibly looking at another surgery in the near future but not sure yet. Sorry i'm being so long but i want you all to know you aren't alone with your suffering. I've been suffering in silence feeling all alone for 13 years. It is just so hard and I'm hoping to find someone else who can understand.

Tears are so difficult. Definitely ask to see a colorectal surgeon but the referral needs to include your obstetric history so you see the right surgeon. Intense physio also. I had a fourth degree tear 3 years ago (might have been a 3c but I'm pretty sure endoanal scans etc confirmed 4th degree, i.e. Into rectum. There were certainly stitches in my rectum. I really sympathise and truly hope you get some help and answers. It's just awful that after a year they just treat you like you've had a normal uncomplicated delivery.

Hi 3Kidsnomore2002,

There's a Facebook group called "3rd & 4th Degree (or severe/episiotomy) Tear Support".
You might also find other victims of serious obstetric trauma through the Birth Trauma association. The bladder and bowel foundation might also be able to help.

You are very brave. Despite your injuries you are raising three children. What a woman! I hope you get to find like-minded people.