Forceps delivery - will recovery get any better?

[oad2017]

Hi

I'm new to all of this but am essentially looking to talk to anyone who has been in the same situation as me.

I gave birth 7 weeks ago and ended up having an episiotomy & forcep delivery after only one contraction of pushing, as baby's heartrate dropped. He was a relatively big baby at 8lbs6ozs and my third stage of labour was only 5 minutes in total, so he was yanked out very quickly.

I've been left with urge incontinence both urinary & fecal, an anterior prolapse and what I can only describe as a gaping entrance to my vagina that collects air (sorry if this is all TMI!). l don't get much warning that I need to go so I really have to rush to the bathroom. Running water is my trigger that makes me feel like I'm going to pee myself - I manage to make it to the toilet the majority of the time but on the odd occasion where pee has started coming out then I just can't stop it. I can hold in normal stools for a very short period of time until I reach the toilet but have had a couple of episodes of loose stools where I haven't made it to the toilet, and once it starts coming, again I can't stop it. I also sometimes pass wind with no control. I feel mortified and so embarrassed. Every day I worry about going out if I haven't been to the toilet yet, in case I need to go when I'm out, or if I were to have a loose bowl movement surrounded by people who would hear.

I can mentally deal with the peeing issues and feel confident about it getting better with pelvic floor exercises, however my confidence with my back passage has been completely shattered and I'm feeling so down about it. I'm worrying that it will never get better and that I will never resume a normal life. I used to be very active, playing lots of sport and I'm even thinking about when I go back to work in 6 months and the thought is terrifying.

I am seeing a physio about my pelvic floor, and doing my exercises, but just wondered if anyone was in the same situation and can offer some reassurance that all of my issues should return to normal?

If there's anyone who's been through this and dared to have another baby, did the incontinence issues come back when you were pregnant again? I'd love to have two children but at the moment feel like there's no possible way I could go through all of this again, or risk causing more permanent damage.

Thanks in advance for any help!

I should also say that I'm breastfeeding - will any of it get better after I stop due to the relaxin that's still in my body?

My delivery was less traumatic than yours op, induction but no forceps and no episiotomy but two second degree tears front and back.

I had similar problems to you regarding the air collecting and incontinence, the whole 'six weeks and you'll be fine' thing is the most heinous lie I've ever heard.

That being said, it stopped being painful around two months after birth and I've regained most of the control over my bowels and bladder that I lost (though they're still not quite what they used to be)

Keep up with the physio, it does take a while but it will help.

What was done for the prolapse?

Good to know someone else was in a similar situation. Nothing done about the prolapse as it's not major and apparently should get better with pelvic floor exercises. It's not nice feeling like something is inbetween your legs though! How long after birth did you regain control of incontinence issues? 2 months as well?

Aw you poor thing OP!

Everyone's circumstances are different but mine sound similar minus the prolapse. Induced, went 2cm-delivery in 40 mins, forceps with no pain relief due to heartrate dropping. Episiotomy and 3c tear. 8lb 10 baby. Fecal urgency and urinary stress incontinence etc. I had a year of pelvic floor physio before being signed off. Physio really helped and the physiotherapist was the nicest and most undertsanding HCP I've ever come across. Also had a bum scan to classify my tear and investigate fecal incontinence and she was lovely too.

That happened in May 2015 and nowadays I'm pretty much OK. I had a cold last week and did wee myself a bit with every sneeze/cough - just a drop. Fecal urgency has pretty much gone and I'm actually more regular than I ever was so in a way that's good! I have massively slipped with my kegels these days but you should deffo keep doing them forever and ever OP.

We moved house (different county) at 7 weeks post partum so I never got the 12 week tear check up you're meant to get, so recovery might have been better but never mind.

I'm pregnant with DC2 now and definitely having a section - I'll take a 6 week recovery over a year of physio, thanks! They say subsequent labours are half as long as the first, so I'm not really up for finding out

Also your last sentence of OP - definitely. Part of me so wants to have another vaginal birth as I felt like superwoman for a good 6 months after, but I will kick myself if I end up with further permanent damage & incontinence. So a section it is!

And congratulations on your baby

Yes! I went through this 16 years ago. There are some things you must do.

You will heal. It's very early days yet to be expecting your body to function anywhere near normally with the amount of damage suffered. It took me 6 months to realise the full extent of the damage.

You need to seek out a colorectal nurse and not a physio. They deal with the same things from very different perspectives. The colorectal nurse is experienced in all things 'behind' and will have good links to surgeons should this be needed (hopefully not). Her intervention will automatically strengthen all the muscles for urinary incontinence too. So don't worry, that bit is covered.

Mine has prescribed an programmed (adapted to my needs) internal electronic toning machine. I still have nerve damage but now it's so much more managed. I have to do 30 mins a day, everyday.

There is a chance that your nerve and muscles have been stretched or damaged so seeing the CR nurse will be essential. 70% of severely affected women will be able to prevent surgery with her early intervention.

Your body has been through major trauma. My advice to you is pad up to alleviate anxiety in these early months.
You may wish to use a decent skin protector too.

Make sure you give your body time to heal and do seek out the CR nurse. Insist your GP makes a referral but stress the colorectal nature as this is important to see the right person. She can guide you through the next year of recovery.

You will recover.

Congratulations on your new baby!

Oh OP I remember how utterly mortifying the fecal incontinence was! No one warns you about it then when you google it you find nothing but horror stories.

I had a similar delivery and although I don't think my issues were quite as bad as yours they were very similar and they all resolved - mostly within a few months (i.e. it wasn't impacting my day to day life any longer) and certainly two years later apart from the fact I might lose a couple of drops of wee if I sneeze with a full bladder I have no lasting impacts at all.

Definitely get the right help as PP said but for the vast majority of people things will resolve.

Hi oad2017 and congratulations.

It isn't unusual to get some transient urinary problems or even a few bowel symptoms but what you're describing sounds a little beyond that and I'd be slightly concerned that you had a 3rd degree tear which wasn't picked up. I definitely think you need to ask your GP for a referral - 3rd degree tears get followed up by gynaecologists at 8-10 weeks so by the time you see someone you'll be well into this time frame.

They'll probably recommend a gynae referral first, but if possible and it's not too far away, try to be referred to a tertiary care centre with a dedicated pelvic floor MDT (multi-disciplinary team). This will mean your situation can easily be discussed and managed by urogynaecologists and uro-gynae nurses as well as CR nurses and surgeons.

I think at the very least I'd want a trans-rectal ultrasound and possibly even some ano-rectal manometry (pressure) tests. These can be requested by gynaecologists although if abnormal, will warrant a referral to the surgeons.

Thanks for your replies everyone, it's so nice to have people to talk to who understand.

BendydickCuminsnatch - have you had any incontenace problems come back since you've been pregnant again?

DoctorMonty - I have been referred to a pelvic floor physio at the hospital. I was given a full examination (vaginal & rectal) by a doctor before leaving the hospital to ensure no damage was missed, as well as an examination at my 6 week checkup. I have a physio appointment next week where she is going to do a full examination (couldn't do one at my last appt as I was pre-6 weeks pp), so I'm hoping between all of that that nothing will be missed!

P.s. I don't know why on earth no one tells you about this kind of stuff before having a baby - we had a full nct session for women only, covering the recovery period, and pelvic floor disorders were not even mentioned!

oad I agree it's a gaping hole in the antenatal classes isnt it!

I'm still in the first tri of pregnancy 2 so no real issues as yet aside from when I had that cold, but I'm thinking I probably won't cope with the big belly as well as before.

"ano-rectal manometry (pressure) tests" - yes, that's what I had! Can't remember these terms. I didn't have that til about 8 months post partum though as none of my transfers came through properly after we moved area so I was lost in the system and it took a long time to get things sorted.

I had no continence issues during my 2nd pregnancy. I had an ELCS this time round (entirely unrelated reasons) so escaped finding out what the impact of a 2nd vaginal delivery would be.

I'm about 12 months on from you. I was referee to gynae at my six week check but took until 5 months then another 4 months until I was seen by physio.

I've had 5 months of physio, and things are better but its still something that impacts my day to day life. I get serious anxiety going somewhere new when I don't know whether there'll be a toilet and it's impacting on work too. I'll never have another child as the risk of it getting g worse or being permanent is one I'm not Willi g to take.

Thanks for your honest answer froofroo - does it still impact your life because you're having accidents or because of the anxiety, or both? Sorry to hear it took so long for you to even get help in the first place

I am four years on from you and YES it can get lots and lots better, hurrah! but there are many things you can do to help yourself.

Firstly - be patient but in the long term do not feel shy about being very assertive about getting gp referrals on to specialists and getting retested anally etc. I was lucky enough (failed to heal episiotomy, slight prolapse, not so much incontinence but the farts for sure! And a sense that all was wrong down there! ) to have health insurance so after my abysmal aftercare and contracting mrsa and multiple infections someone gave me a referral to a uro gynae and it turned out they ran the nhs birth trauma clinic in my birth hospital and were HORRIFIED i hadn't been transferred up to them as I should have been - the junior staff and midwives had been too enthusiastic gatekeepers. I felt there was a sense in my busy london birth hospital that I should be stoic and carry on, mustn't grumble about women's troubles etc, but other cultures take weakened pelvis VERY seriously and I was lucky to be surrounded by people encouraging me to take care of myself. I had my episiotomy redone in the end.

All my French friends with similar issues recommended a pelvic floor exerciser

I got it, it was amazing, I couldn't believe it was never recommended to me in the U.K. even by pelvic team, the uro gynae or even the fancy obstetrician I saw for second child. Get it and use it!

Both uro gynae and obstetrician said second time round that I should have a section, to prevent any more damage. I did, it was fab.

Also: running is not good for pelvic floor. Pilates and yoga are fantastic. There are great gentle post natal Pilates DVDs and a programme called MuTu Mamas available online which is specifically for pelvic floor. It will really help.

Plus I promise you, time does a lot (as long as you help yourself!) - both times at a year after the birth I noticed that I felt so much more back to normal!

You are still so close to the birth - read lots and lots about pelvic floor (French children can't throw food is where I heard about the French approach then confirmed this with friends!) and there's lots of info online.

for you, it is a rough ride.

Oh OP, I'm so sorry. I had no idea the damage childbirth could do to you either. I had a textbook waterbirth and have a grade 2 bladder prolapse and suspected muscle avulsion, but won't have that confirmed until August when I see my urogynacologist. You will need a team behind you. I have a pelvic floor physio, an OBGYN, a Pilates instructor, and excellent GP, a psychologist, a psychiatrist, and will also have my urogynacologist in August. I'm super lucky that I don't have any incontinance issues, but it does take me a long time to empty my bowels properly unless everything is quite soft as I'm too scared to push at all.
I can't tell you bout recovery as I've only been doing proper physio for 6 weeks (an 5 months PP), but I'm only just starting to feel a difference now. I still can't really 'lift' my pelvic floor say, when I pick my daughter up, but I'm finally able to feel the tiniest flicker now. I'm also using a tens machine (the Pericalm) but have only done so for 2 weeks so will report back on that front. Ask your physio for guidance on using a stimulator, they shouldn't be used without medical guidance. And talk to your physio/gynaecologist about getting fitted for a pessary. I am getting one in a few weeks. My symptoms are improving on the whole (only occasionally feel the air bubble thing, whereas at 5 weeks PP there was a definite bulging sensation) so I may not need to use it long term, but for now I like the idea of having some extra support while my muscles recover. I wasn't on board originally but my physio said it's like damaging your ACL- you'd wear a knee brace for that while you strengthened everything up and a pessary is just to support everything while you're recovering.
On a more practical note, do you have family around? If so, get them to come over and do some batch cooking of nutritious food. Get your groceries delivered. Can you afford to hire a cleaner for a while?
Lift nothing heavier than your baby. Are you breastfeeding? If so, try and learn to feed lying down so all those hours spent feeding are resting your pelvic floor. Get onto some vitamins- a general multi, and high dose vitamin C, D, magnesium, and zinc. All of those are really important for muscle health. Make sure you're eating enough protein so your pelvic floor exercises can be effective.

It is so shit. I am still so angry there seems to be this huge conspiracy to keep women in the dark about pelvic floor dysfunction until it happens to them.

Hi OP,
Faecal incontinence is horrid. I feel for you. You display more severe symptoms than I had and think you need a rectal scan to rule out an undetected/unrepaired severe tear. Mine took place at 3 months. At 6 months I had a strength test (manometry).

I thought I'd give you some time pointers.
The pelvic floor takes 3 months of diligent exercises to strengthen and then another 3 before you feel another improvement. Everyone is different so you might hit these marks slightly earlier or later. Here's how it went for me (scan said 3b tear, colorectal surgeon thought only 2d degree so who knows). I did 5/6 repetitions of pelvic floor exercises a day for the first 6 months. 3 times a day after that (for life now).
Faecal incontinence
For 5 days after the initial constipation days. After that I was very urgent for about a month (I didn't leave the house much). Then I had milder urgency. At 9 months I was still mildly urgent. 3 years on I'm OK. It's a conscious process. I can hold my stools until I reach the toilet.
Walking
Unable to walk further than 500 yards for 3 months. It started easing up at 10 weeks. After 6 months it felt a lot more normal.
Air in the vagina
This got much better after 6 months.
Coccyx pain
Excruciating for 7 months. Very painful for another 8. In total, unable to drive for 15 months (now have coccyx cushion at home and to drive). This I think is quite relevant because it shows that more than a year on, there was still improvement happening.
Dyspeneuria
Scarring made the entrance of my vagina too tight and I bled after penetrative sex. I had surgery 18 months after birth to correct that.
I was fully discharged 2 years after giving birth.

I agree with another poster that you need solid support for the next year (definitely the first 6 months). People around you need to understand you have not had a normal delivery and need to rally around you (take you to hospital appointments and baby clinics, bring food, listen to you). From my experience you'll get people who get it straight away and people who will deny the seriousness of your situation (saying either it's all normal (it's not) or well you've given birth what did you expect?) and anything in between.
I hope this helps.
I send you and froofroomcgoo a big hug.

Thank you all so much for taking the time to respond, it's so nice to know that other people have been through similar things. I can't believe that pelvic floor issues are kept so hush hush given the day and age we are in, it means that when it does happen to you you feel like a freak for not bouncing back from labour in the space of a few weeks. My sister in law is due next week and I've told her everything because I think it's much better if you don't go into recovery setting your expectations too high otherwise it just leads to frustration.

eyespy - which London hospital were you given treatment at? I gave birth at c&w and have been referred to St. George's. Also what was the name of the pelvic floor trainer you bought?

Elderberries - thanks for sharing your story and all your tips. I am able to feel and lift my pelvic floor now (I couldn't a few weeks ago) so thankfully I am able to do my pelvic floor exercises. I have a wonderful family around me and my husband is so supportive, I'm very lucky. I also take other measures to make things as easy as possible - I have a cleaner, get groceries delivered, have a freezer full of home cooked food, and have also been breastfeeding lying down since the beginning as I wasn't able to sit down!

Pinguina - this is really helpful thank you. poor you it sounds like you've been through such a rough ride. My coccyx is nowhere near as bad as yours as thankfully I am able to sit to drive already. I am going to see an osteo though to see if they can stop it hurting. With the faecal incontinrnce I feel relatively confident with solid stools but if they are loose or my tummy is a bit upset then I can't hold it in, so I need to get to a point where that isn't happening so I don't get caught off guard

OP I had a very similar birth in 2014 (my baby was 8lb 6oz too) although I had forceps as he was stuck and I had pushed for literally HOURS.

The recovery was so tough, but it will get better. Be kind to yourself and accept all help offered, don't do what I did and expect that you would feel 'normal' by a certain point.

I'm currently 17 weeks pregnant with my second and there are absolutely no issues. I am classed as high risk and more carefully monitored but the birth has caused no issues in my pregnancy so far.

I have also been referred to a hospital post natal exercise class to try and restore core & pelvic floor strength

Thanks rockandroll. Does that mean you never felt normal again? Or you just don't think I should put a timeline on it? Did you suffer similar issues to me post birth?

Congrats on the pregnancy I hope it continues to be lovely and straightforward - are you opting for a section?

Sympathies op, I had a back to back labour and after very prolonged pushing had epsiostimy and forceps and the whole thing was brutal.

I also had your issues to deal with afterwards and was offered plastic surgery as I was left a little lopsided

The incontinence was checked by a consultant and deemed to be a result of back to back and forceps and took a few months but did improve and now I am almost the same as before.

I had a second child but had a section so can't comment on a repeat performance.

I really hope you get the help you need and you are gentle on yourself, you have been through alot

Thought I'd pop back as I had my booking appt yesterday - midwife said I'd have no problem getting a c section and she advised against a vaginal birth. I was only discharged from physio this time last year though so I'm sure that's a factor. Dunno, thought that might be useful to you.

Oh I did feel normal, just not as quickly as I had hoped. Within a year everything was back to how it had been before.

Not sure about the section, depends on the consultant when I see him at 33 weeks. I need to do some thinking as I'm not even sure what I want myself.

I think my issues were mainly the result of almost 4 hours of pushing before forceps. I'm hoping I'll see a bit of an improvement when I stop breastfeeding.