appointment with consultant after 4th degree tear... completey extremely scared! what questions do i need to ask

[kittenbaby]

hi im dreading my apointment with consultant on thu about my 4th degree tear in childbirth

anyone thats been though this
what questions should i ask

this is what ive thought of so far

1. why do you think this happened
2. could of it been avoided
3. how will it effect me in the future
4. future children cs or vaginal
5. when will i stop being in pain
6. when will i stop having nightmares over this ?[could be difficult to answer ,i know]

can you think of any others

Epithelium tissue is skin kittenbaby, or surface tissue cna be internal or external

thanks noname

wonder if i should take some diazepam or ask gp if ok for me 2 take some

Mmmm Diazepam?

Do you feel you need to take something?

How about a herbal remedy?

Me, I have to admit I am not one for taking pills apart from the very occasional paracetamol.

But I also admit to a glass of wine.

Chat it over with your GP

i dont really want to take anything
as id like to be able to be focused enough to ask questions etc

but im terrified to be honest

Is there someone who can come with you for support, kitten?

Hello again, both children in bed and glass of wine in hand (lord,it's not even 7pm but it's been one of THOSE days!).

OK, I have more time now. Definitely take someone with you, to hold your hand but also to be an extra pair of ears. I find I listen really well and attentively during medical appointments, but forget to ask any questions. And often about half of what has been said to me goes out of my head the minute I'm out of the room. Plus, I realise I haven't understood it properly when I come to explain it to someone else. Someone else will be less stressed and emotional and can really help you listen and ask the right questions.

Do talk to your GP but to be honest the exam isn't so bad. I would be wary of any medication which might relax your muscles. The consultant will want to assess your anal muscle tone, and so you you should avoid anything which could affect that.

Hmmm....what else. Well, my tear was such that I had a colostomy performed at the same time as the tear was repaired. This was to let my sphincter rest while the repair healed. Various physiological tests showed a few months later that my sphincter hasn't healed, but the fistula (hole) between my vagina and rectum had. Since then there has been debate about whether I will be continent without my colostomy bag. The plan, last summer, was to get rid of the colostomy and then see how continent I am. But I got pregnant by mistake (!) so everything has been put back a year. I go in to hosptial 2 weeks today to have my colostomy reversed.

Don't let the above frighten you, my tear was very very very serious. One question I would add to your list is the nature of the tear and which parts of your anatomy were affected.

Which hospital is it?

A physio will assess your pelvic floor strength through a digital exam and possibly various probes. They can then work with you to teach you how to do your PFE properly, and assess your progress in strengthening the muscles. They may also use various pieces of equipment to help with this.

I'm very shocked that you have left hospital without anyone really explaining to you what has happened, and what the plan of care is going forward.

When is your appointment? x

hi

my dh is coming with me a nd dd is going to mil
how long do u think ill be at the hospital allday? or an hour or so?
what do u think will happen to me ?

nothing has really been explained to me

thanks for explaining that about the diazepam, it makes sense im glad u told me that

my appointment is thu

One question I would add to your list is the nature of the tear and which parts of your anatomy were affected.
how can i word this
the nature of the tear part ?

how long where u in hosp for?
how did u feel when u got pg with dc 2 ?
did u have cs?
are there different levels of 4th degree tears ?
why did u need the colostomy ?
was it because it was so extreme

thanks for helping me xxx
enjoy your wine xxx

Hi again, Kittenbaby. Sorry been offline for a while

The clinic in London I was talking about is The Perineal Clnic at King's. You can get your GP or your consultant to refer you. They are VERY good, I understand.

Oh, and good luck with the hosp appt

I think spudballoo really is a great source of info for you kittenbaby.

As I said earlier, she has the true knowledge of living with the problem

Much better than any 'learned from books' people

Blimey NoName, was only trying to help!

Am in no way pretending to be expert... (Am most decidedly not)

Hello again.

I would imagine you're appointment will be relatively short, perhaps 20 mins or so. But clinics often run late, sometimes very late, so I would allow 2 hours or so. It generally says on my letters how long to allow for the appointment?

I hope that they will want to talk you through what happened, examine you to see how things are going, and ask you questions about how you are doing physically. The examination is likely to be an internal, both vaginally and anally. Neither are painful or as horrendous as you might think, plus everyone I've met along my 'bum journey' has done everything they can to put me at my ease and make me feel comfortable. I find humour, deep breathing and pretending it's happening to someone else get me through it. Plus, remembering that whoever is doing the exam has done it a million times before and, to them, it's just another bum!

They may well refer to you to any or all of the people I've mentioned before as a follow up. but you won't see those people on that day, you'll get a letter with another appointment.

Don't be afraid of asking the obvious questions, and just use every day language. So, you could say, 'I don't understand what has happened to me. I know I've had a 4th degree tear, but I don't know what that means or which bit of me has been affected or what it means for the future.' If they explain and you don't understand just say, 'I still don't really understand because I'm not medical, can you draw me a diagram'. Push push push until you understand it, because then you will start to feel better about the situation. The fear of the unknown is impossible to conquer, but once you know what you're dealing with you can face it.

I was in hospital post repair/birth for 4 nights.

i was VERY shocked when I got pregnant as I was breastfeeding, hadn't had a period and only had sex once! Plus, we'd decided not to have more children given the damage that was done by the delivery of child1. I struggled for the first half of my pregnancy, but now feel very blessed with my lovely surprise child!

Yes, I had a CS on the advice of my colorectal surgeon in order to protect what is left of my pelvic floor. It was a really positive experience and I have no regrets at all.

Yes, althought 4th degree is the 'highest' degree of tear you can have there are still 'bad', 'very bad' etc within that category. I had a 10cm fistula (hole) between my rectum and vagina and my sphincter was split from top to bottom, internally and externally. It's about as serious as it gets.

The colostomy was because the tear was so serious, and was my best chance of the repair working.

Did I answer all your questions?! Hope so. xx

thankyou porpose and noname xx
thanks 4 taking the time to reply to me

spud thank you so much its great to chat to someone thats been there as
as you prob have experienced too i dont have anyone to talk to or ask advise from as i dont know anyone else thats been thorough this xx
think people think ive just had a few stiches and im making a big deal over it
i really feel like punching them !!
like my mum for example kept telling me to havee salt bath but the mw said salt baths are not reccomended these days as there too harsh
mum turns round 2 me and says well women had to be a bit tougher in my day !!!
and she also goes mmm think thats wjhat happened to me !!
[no it fucking well didnt she just a the normal stiches!!
even one of mates said when i mentioned id be at the hosp on thu she goes what u gotta go there for!!!
is it ok for me to ask any other questions if i think of any xxxx

also spud v well done on the bf xxx
not easy is it
esp after what weve been though xxx

also spud have you ever experienced flashbacks/nightmares

It's terribly hard for people to understand unless you've been through it yourself. I often read threads on here encouraging people who have had serious tears to go for a vaginal birth for subsequent deliveries which, in my opinion which is based on the advice I've been given, is utter madness in terms of protecting your future continence. A 4th degree tear is very serious, quite uncommon, and thus not readily understood by others.

Are you very sore still?

I haven't really had flashbacks, but for the most part I've just blanked it all out if I'm honest. I just want my life, and my bum, back.

Do ask lots of questions. I'm very happy to help as best I can.
xx

Hi Kittenbaby

I remember your previous posts. I think Spudballo has pretty much covered everything, just wanted to say make sure you tell them about any continence issues you may still have. I always found it helpful to write down my questions before attending, I found it easier to remember the answers that way.

Spudballo, Good luck with your reversal. I had mine 4 weeks ago.

Kittenbaby, just wanted to say, i really feel for you. What rotten luck. I had a third degree tear. Never been told the full extent of it, and was too scared to ask. Had terrible pain going to the loo for about 9 months. Just felt so underconfident/concerned about the damage for ages. But, time is a great healer.

I know what you are going through is worse, but i understand the initial emotions you must be feeling. A good birth experience has been tainted and you feel gutted and confused as to why. It just happens and takes a while for the self doubt to go.

Try to remember the actual birth - before the discovery of the tear, so it makes you feel better and less down - you did so well to deliver a healthy baby as you did. You should be proud. I used to say to myself, would i prefer not to have my little one and not go through this, and the answer was always no. Hopefully, after this confusing/worry stage you'll be able to look back on the birth and feel positive as you start to heal.

The very best of luck with your recovery Kittenbaby. Stay as positive as you can, and use Mumsnet as a support, as it saw me through the darker days when i was so underconfident with my body and couldn't really talk to anyone about it - unless you have gone through something similar, no one understands what you are going through. When your baby starts to become a cheeky toddler, and makes you laugh out loud, you'll know that it was worth it, no matter how horrid it seems now. Give that baby a big kiss, and the very, very best of luck for your recovery. xx

Porpoise,
Sorry if my post was not clear regarding the 'learned from books' people.
It wasn't meant to offend you.
The information and help from spudballoo I felt was much more relevant than anything I could offer because she has experienced the trauma and subsequent treatment.
My knowledge is learned from books and nursing experience and that is what I was referring to.
Please accept my apologies.

NoName: sorry from me, too - got a bit prickly last night!

4Jen....can I ask you somequestions about your reversal? I haven't come across anyone who has had one and would love a bit of help if you can spare the time?

Sorry to hijack your thread kittenbaby.

nonametoday, do I know you? I feel like I do but I don't know who you are! xx

Don't think so spudballoo,
Only been on mumsnet a few weeks., did post initially as papilion but changed it because someone already had a similar name.
Unless you met me in my former life as a midwife (who knows?)
I've only met one mum who needed a colostomy following a 4th degree tear.
Not my patient I hasten to add, but I know the midwives and doctors involved with the repair were all very concerned and there was a huge follow up.
But as is the case no one can really say in a lot of instances why it occurrs

thanks you so so so much for all your help and advice
not long till my appointmnt now
yes im gonna write down the qustions incase i get all upset or somthing and forget what i wanted to ask
and im not gonna take any diazepam so ive got a clear head

its so nice to talk to people that have been there xx

do you normally have a smear test when your there
im totally dreading having a smear test but in a way it would be good to get it all over and done with at once
although is this jsut wishful thinking
will i have to have several appointments

I also have a 4th degree tear. Wasn't aware of it happening, just got whisked to theatre...

This happened 9 weeks ago and I was referred to the womans health physio. She is fantastic, I have been a few times she is going to do ultrasound on the external scar next week. She is getting em to do various exercises to help with any problems. I am still bleeding so she will do internals when I have finished.

I would recommend getting your consultant to refer you to the physio if you can. My appt with the consultant was very short and sweet, and said I would be fine to have another vaginal birth as long as the baby is small. He also said I will be consultant led on any pregnancies and that I could opt for a c section if I want.

I am still in pain although my GP is still happy to prescribe painkillers and I m very careful with my diet to ensure I can poo without straining (sorry!)

Hope your appt goes well...