Anal Fissure, Short height- C-section better?

[php2731]

I am presently 38 week pregnant. I have a history of anal fissure and had
the operation Lateral Internal Spinchterotomy (LIS) done 2 years ago
which is done on Anal spincture muscle. Now I donot suffer from anal
bleeding but often get burning sensation or itching when
constipated etc. I have to take sitz baths occasionally and constantly
have to watch my diet, making sure I take enough fibre and drink enough
water.

So my question is do you think it is reasonable for me to have an elective
c-section to avoid more trauma from labor pushing, tearing etc. to my anal
area? Some women develop anal fissures for the first time during vaginal
childbirth but if I agreed to have a normal delivery, I would be going
into it with a pre-existing injury so to speak. Anyone with fissure problem before delivery and what delivery option did doctor suggest? what was the outcome.

Another concern I have is my short stature of 143 cm. From sonography at
week 36 the weight of my baby was 2796 gm. Doctor said that my pelvic
measurement is ok and i can try for vaginal, but I am not sure if that is
the minimum pelvic measurement. Should this be a concern for me? Anyone with this experience?

sorry can't help but thought I'd bump for you.

I have an anal fissure which I am fairly sure was caused by my first vaginal delivery (ventouse). Second pg and labour did not worsen it at all. However I am short (153 cm) and have a small rather flat pelvis and I did have 2 very difficult labours due to that. Was offered an elective section 2nd time but decided to try for another vaginal delivery which I did manage: however, if I had another I would opt for a section! (am not planning on having another though).

I had problems after birth of ds1 and was offered an elective by consultant 2nd time around. I also read that they should have sent me for examination earlier in pg to see how friable the tissue was but they left it too late on.

Also the reading said if you've ever had fecal incontinence then an ec should be the option. There's not just the immediate impact of the delivery to consider but future continence into middle and old age to which childbirth trauma is linked.

I sound very much in favour of an elective, but I actually have a vb with my 2nd. However, if I was pg again I would give serious thought to an ec.

PHP2731 I had anal fissure after I had my DD. Was very bad and for a year doctors treated it as piles but then when I was loosing so much blood that started fainting they referred me to the hospital and done Botox injection. Fissure didn't go away but I was able to get away using Regtogestic Glyceril Trinitrate cream on daily basis.

Was absolutely terrified when got pregnant second time. Strangely during pregnancy my fissure didn't bother me at all and haven't used my cream for 9 !!! months. Had an appointment with the sergeant as needed advice re going for vb or section. Had opinion of 2 consultants and both of them agreed on me going to have vb.

So I had my DS 8 weeks ago. Fissure didn't bother me for a week after birth and then I was in agony again. Now in pain every day and seriously considering Lateral Internal Spinchterotomy as can't keep going like this. Read so many scary stories on the internet about not able to control your bowls etc. Can you please explain to me what exactly they do and if there is a chance you still will be in control of your bowls. Just don't fancy an idea to wear diaper for the rest of my days.

As regarding birth and fissure, don't think it make it any worse. Apparently mine didn't bother my during pregnancy as blood supply increases during pregnancy so I guess it took my body a week to get back to normal.

Have you not seen a bum specialist during this pregnancy, to determine what the risks are to you? I am a bit shocked TBH. Can you speak to your MW/GP and demand an urgent appointment? It is not as though you have much time on your hands and you need proper information to make your decision.

To jellycat, could u please let me know the following:

Do you still have the anal fissure problem that developed after first child birth? In between ur 1st and 2nd birth was the fissure bothering u, i mean bleeding, burning etc.

Also how did u come to know about ur small flat pelvis, from sonography? Did doctor mention anything before ur labour in relation to baby's head diameter and ur pelvis, that would cause long labour?

How long was ur labour, was the pushing phase also long?

Sorry to ask soo.. many questions just feeling so panicky now and hard to decide. Thankyou so much

Hi Heated

It ok with u could u let know a little more what problem u had after birth of DS1. Also why did u not go for an CS the 2nd time then?

HI TC08

LIS is a pretty simple operation they perform on the spinchter muscle, recovery very fast, and very less pain. I recovered from my fissure almost fully, no bleeding while bowel movement after the operation.

Was ur fissure cured by Glyceril Trinitrate cream before u got pregnant the second time, i mean did u have any bleeding itching etc when got pregnat the 2nd time. How long was ur labour and pushing, any episiotomy etc?

Hi TheProvincialLady, what is bum specialist. I am regularly having prenatal visits to my Gyno specialist, and he says considering my fissure and short height I may opt for C-section if i want, but also tells me i can try for vaginal... basically thus it is hard for me to take a decision now

PHP2731 glyceril didnt heal it i guess cos needed to use cream every day instead of advised course of 6 weeks. Didnt have any bleeding, itching, constipation during pregnancy. Labour was quick: contractions all day but managed them absolutely and they started coming every 5 minutes only at about 8pm. Got to the hospital with contractions 2 min apart and was 7cm dilated. DS was born less then 2 hours later with just gas and air. Had my bowel movement on second day and was fine.

RE: LIS is there any sideaffects? Did it hurt after operation?

Sorry, I can't remember the proper word but I saw one after I had my DS as I had a haematoma in my bottom. Basically it is someone who specialises in problems of the back passage.

tc08

LIS sometimes have the side effect of incontinence, but it did not happen to me. After the operation it only hurts little after the effect of pain killers lessen a bit, but they also give pain medication for few days. I even passed bowel the next of my operation and it hurt only a little.

Did u start bleeding again after ur 2nd delivery? I understand glyceril did not stop ur bleeding.. so it is better u go for the operation. How long was ur pushing.. as sometimes long pushing phase results in fissure..What is gas and air that u r referring here?

As for LIS it cures, but still u need to take care of ur diet, constipation problem to avoid recurrence of fissure.

Meant that labour was quick and I only used gas and air during pushing stage. So was very in control (which is probably better with fissure, know that sometimes during epidural you can end up with worse fissures cos you are not aware how hard you are pushing, not sure if it makes sence).

Ya I am bleeding heavily at the moment and in agony :-( Use cream 5-6 times a day and only feel better by tea time and in the morning it starts all over again. Very hard going with toddler and 8 weeks old baby in the house.

Had my appointment with sergeant after delivery and he looked at my fissure and told me that it birth didn't affect it at all. Unfortunately still in pain so will probably consider operation. Strangely enough sergeant just gave me an option of going for Botox again, never mentioned about LIS. They talked to me about it before but said cos of my young age (guess not that young, I am 26) they wouldn't advice operation cos of sideaffects.

to tc08.. added to my previous post.. do u think the fissure got worse after the 2nd delivery. Also did u improve from the cream u applied, how long did u continue using the cream before getting pregnant again?
Soory ... for all questions.. Thanks a lot.

Don't think it got worse, guess just the same. Hard to compare cos like I said it did disapper for 9 months of pregnancy (fissure was still there but it didn't bother me cos of increased blood flow) so you do tend to forget how sore/bad it was before.

In my case creams did not work: they give you a quick relief but do not fix the problem. So I was using cream for over 2 years before I got pregnant second time.

Sorry for asking too, but before you had operation did they warn you about sideaffects? Thanks

My consultant said I should have been referred to a proctologist (bum specialist I think) earlier in my pg to look at how friable the tissue was but it was too late at 36 wks - gee thanks!

Php, with my 1st delivery which was pretty horrendous all round, I had a 3rd degree tear high up, above the sphincter, leaving the wall between back passage and vagina very weak. I was sewn up after delivery but then I tore further just from getting up from the sofa when at home. Muscle tone there was pretty bad for a while & I had fecal urge incontinence which meant a rapid dash to the loo as I couldn't feel the sensation of needing to go until the last minute.

My consultant suggested an elective with my 2nd pg to protect the area, she had got twitchy after recently having given colostomy bags to 2 vb women with fecal incontinence problems. However, although during pg I felt the muscles become less effective I was never incontinent. I was also getting conflicting messages from the mws, so I did tonnes of reading on the subject just to be better informed.

In the end I chose to have an epidural which slowed the labour down and I pushed in a very controlled way, without the pain ruling my actions, and I had an excellent delivery with no complications.

However, what I didn't give enough weight to was future continence in years to come, which childbirth has a major factor on. If I had another child an elective would be a definite consideration.

Sorry I only just got back to this. To answer your questions:

The fissure did cause me problems between the pregnancies. I always felt there was something wrong after the 1st delivery but it didn't get really bad until several months later, when I had pain, bleeding and itching. The fissure was treated with diltiazem cream but although this improved things greatly it didn't clear up completely and I have always had to be careful not to get constipated. It was fine during the second pg. I took lactulose if I was at all constipated but didn't have much trouble.

I was told about my pelvis after the first internal during first labour. They said I may not be able to deliver vaginally but that they couldn't be sure till I got further along. I was subsequently told by my community midwife, who did a smear test on me when ds1 was 18 months or so, that she was `amazed' I hadn't had to have a c/s due to the shape of my pelvis.

First labour was over 2 days long although established labour was 36 hours. Tried to stay mobile but eventually got tired and had an epidural which slowed dilation. After 4.5 hours fully dilated the head had not descended at all and I was taken to theatre for ventouse, prepped up for c/s because they weren't sure they would succeed. Ventouse was successful however. Second labour was 10 hours established although this was preceeded by 3 days of relentless and extremely painful pre-labour contractions as ds2's head was being squeezed into my pelvis. Pushing stage was 1.5 hours. They wouldn't give me an epidural 2nd time. Bum was fine afterwards though!

Sorry for the essay. I don't know if it will help you decide.

To jellycat Sorry for all the questions but did your fissure return after second birth? Did you have to use any creams during pregnancy and did you use Glyceril Trinitrate? Just trying to get my head around it before considering operation as i tried all of them except diltiazem, the last resort is surgery. Many thanks

My experience was of developing a fissure even though I had an elective section! It's under control now but I have to be careful with diet and water intake etc. So be warned that a section isn't a guarantee as far as your bum's concerned. And also be aware that having a section really slows down your digestive system (it was 8 days after my section before I could open my bowels, in spite of drinking gallons and moving around as much as possible). The scar makes pushing painful and so constipation is inevitable - not fun if you have a pre-existing fissure. Sorry to be doom and gloom but these are things to consider too.

TCO8

When doctor told me about the operation after examining me the first time, I was surprised. I asked him is there any other remedy i.e any oinment etc that would help me but he said my fissure situation was bad and opt is the only option.
I was really suffering bad, bleeding etc on and off for almost 2.5 yrs.

No The doctor didnot mention me about any side effects..i guess its coz no other choice for me.

I just visited doctor today and he says labour may put a lot of stress in the anal area and may worsen it, but I may give a try. It is so hard to decide.
How was ur tear, i mean big/small after delivery.. u must have also received stiches for that right? how long did it take for the area to heal up completely, i.e u could sit, pass bowel etc comfortably.

My fissure has never healed completely, but most of the time it doesn't really hurt - I get a bit of a twinge when I go to the loo sometimes that is all. If I get a bit constipated it hurts but after a day or 2 settles down again. But most of the time it doesn't trouble me so I haven't bothered to go back to try anything else, have just had 1 course of the diltiazem. So it was there during the second pg but because I didn't get constipated it was OK. It didn't hurt after the second birth, despite the long pushing stage (or at least I didn't notice anything, although I did have piles).

I haven't suffered from these problems, but I will say that my recovery from an emergency c-section was better than from the ventouse and episiotomy birth first time round.
Just making the point that a c-section isn't necessarily a bad thing, I was pleasantly surprised.

Just read this thread and cannot comment on the underlying problem. I'm sorry for you, that you've had so much pain and are worrying right now.

Whatever the outcome, if you want an EL CS you'd be in hospital week 38, 39. An EL CS would be performed 1-2 weeks in advance of your due date to ensure you don't go into labour.

Jellycat, i thought piles and fissures are different..do u mean that you developed fissure after few months of 1st delivery and piles after ur 2nd delivery?

shubiedo, good to know that u had a positive c-section experience. what was the reason of ur emergency c-section?

I have a few questions about c-section, if u could let me know:

Regarding recovery, how long did it take for the pain(i mean abdomen ect pain due to surgery) to go away? How long were u stuck to IV etc and what pain medications did u take?
How long after your section were you allowed to get up and move around? How long did they leave catheter in?
How long before you were allowed to eat? (i heard they allow food only after passing gas, is it so? sorry timid).
How long before u had 1st bowel movement? is it painful
Were you able to nurse right away?

I am a litttle nervous about it all. Thanks for your help!