Calling all Raggedies - the THIRD Ragged Bits thread. Childbirth injuries, sphincter problems, fistulae... all welcome.

[Jacksmania]

First thread here, May 2008 to June 2009.

Second thread here, June 2009 to Oct 2012.

Welcome everyone with ragged bits due to childbirth. We're sorry you had to find us, but we promise to hold your hand and listen.

There is no TMI here and nothing is too gross, too embarrassing or too horrible.

All welcome.

Cardamomginger yep the Prof was very thorough. He thinks in another 20-30 years women will know much more about the risks of childbirth, particularly sphincter damage. Apparently all the research into pelvic floor damage and incontinence has really only gotten off the ground since the mid-late 1990s but more and more specialists are turning their attention to it. No he didn't want to see me again, but did say I could see him once pregnant again if I had any further questions or concerns. He sounded happy with the physio I was having and encouraged me to keep up with it. I will see the colorectal surgeon he mentioned but might leave it until a few months into next year. I'm a bit overrun with appointments with my GP and psychologist to get on top of my PND and need a bit of headspace to get through that. I'm keen for a second opinion though and the Dr he suggested was the Head of Colorectal Department at a top hospital with a lot of experience in pelvic floor disorders.

I'm glad you can hold wind in if you stay still, I'm yet to be able to do that but hope I continue to improve as the bulking agent doesn't sound too appealing How is it that you feel the continued physio is taking its toll, in the sense that you're not getting as far as you hoped or more the mental anguish? I initially found it very encouraging but since my progress has begun to plateau it's become more discouraging.

cravingcake urgh an epidural! I hope you get a good anesthetist. Being awake for the cesarean isn't so much my worry, more the very small risk of nerve damage. It really is the lesser of two evils though isn't it. Do you have a surgery date yet?

xxx

cravingcake, re: the epidural, I had one and honestly, it was nothing. Certainly less than nothing compared to the pain I was in from back labour. You really don't feel much. The anaesthesiologist numbs the space between the L1/L2 spinous processes in your back (the bumps on your spine) with a local anaesthetic, and that is seriously the worst of it. He or she will wait a minute to make sure the local has taken effect, and will then insert a needle cannula. It feels like being tapped with the eraser end of a pencil. You may feel a tiny pop as the needle cannula goes in, because it has the get through quite a thick ligament between the spinous processes. After that, the anaesthesiologist feeds a tiny flexible line through the cannula into the space around the bottom strands of the spinal cord, and injects anaesthetic. If you're in hellfire agony, it's the most blissful feeling in the world... like cool water running down your back. Indescribable. If you're not in any pain, you will still feel a cool sensation in your back. Then you'll lie down, and in a bit you won't be able to move or feel your legs, and they'll keep testing the effectiveness of the anaesthetic by placing ice bags on your abdomen and asking if you feel anything. At least that's the protocol here.

As far as the difference between a spinal and an epidural anaesthetic are, the mechanics of administration are the same. An epidural anaesthetic is usually hooked up to a continuous infusion machine, because you don't know (usually) how much longer a patient will be in labour, and as only a tiny amount is infused per minute, just enough to keep it effective, it can also be discontinued as needed, or dialled down when a woman is ready to push.

A spinal anaesthetic is given as a single dose, and not attached to a continuous infusion pump, and is thus used for scheduled ops when it's normally quite predictable how long the op will last. The dose is calculated to last as long as needed, but can be topped up at need.

Does that help at all? Really, the actual injection is nothing. If you've had a booster jab in your arm, I'd almost say that burns worse. The back just isn't that sensitive.

Neptuna, my prolapse is probably caused by a few issues. One is that I was allowed to push far too long, and against a baby in an unfavourable position. I'll never forget hearing the OB say "yeah, she can try pushing for a while, but only for two hours, and then come get me". Two hours morphed into four and a half, which did a massive ampunt of damage to my pelvic floor, including damage to my pudendal nerve. Sorry for TMI but I can barely feel anything coming out when I have a bowel moment. It really is a most odd feeling sometimes :o
Anyway:
Then, when DS was delivered with forceps, I had a massive tear, and if I remember correctly, I tore through the bulbovaginosus muscle. That's what my surgeon wrote in her operative report in 2009.
I've not had a pelvic floor ultrasound. I'll pursue that if the op doesn't resolve all the issues.

Jacks Yes thank you that does help. I did have an epidural during labour so recognise the feeling you describe about it being bliss if done during such pain. However, as I was in so much pain and had quite a lot of painkillers I don't remember the details of it, just the pushing sensation when they put the needle in which is what is worrying me a bit. That and while I thought it was lovely as it took a lot of the pain away for a few hours we were told later it wasn't sited very well at all. Plus they let it wear off/run low/not top it up (not quite sure the exact term) at the same time they ramped up the syntocin drip to regulate contractions, it was the most unbearable pain I've ever been in. I was given a spinal in surgery afterwards but I was so exhausted I pretty much slept during it.

Your explanation definitely helps as the consultant I saw last week was useless and while all the medical staff keep telling me things will be different this time, its not an emergency or middle of night etc they haven't gone into details about it all.

Because the consultant I saw last week was so rubbish and wouldn't refer me to physio as 'its just one of those things during pregnancy' and I've only got a few weeks left blah blah I have contacted them myself, explained my situation and have an appointment in 10 days with the same physio I saw during my recovery so hopefully she'll be able to help me.

If you have any more questions about it, ask. I know quite a bit about them. :)

Cardamomginger, thank you so much for your last post to me - that helped enormously.

Actually, thanks to all of you, for your concern and help. I'd be a mess if it weren't for the friends we've become on this thread. This is just not stuff I can talk to anyone about in RL.

Jacksmania it's bloody ridiculous that you were allowed to push for so long when all the guidelines say no more than 2 hours. Did you ever make a complaint, or was it not worth it? I'd recommend getting a pelvic ultrasound if you can, not so much to diagnose any further damage but just so they can literally show you how your pelvis looks and what all the muscles are doing. Knowing that mine wasn't too bad was a huge relief, even though I went in expecting the worst. They can scan your sphincters too externally if you're interested. It may not be something you're thinking of right now but perhaps 6 or 9 months later, if you'd like to know. They can predict future prolapses based on what they see on the ultrasound. I hope you've got a nice relaxing Christmas planned, not something overly stressful considering what's around the corner for you in January?

cravingcake don't feel bad for worrying about the epidural/spinal, I'm terrified!! The thought of being cut open while awake is distressing too but I know it's the only safe way I can have more children. I'm thinking of hiring a doula or independent midwife (I have a few friends) to be with me before the surgery and for the first few days PP as I know hubby will be as terrified and emotional as me and so not much use! I hope you've got lots of family or other help organized for the first 6 weeks after? I think recovery after a cesarean will be a doodle after a 3c tear, at least that's what I'm hoping!!!! I also think it's VERY important you push for further physio, even with only a few weeks to go. My physio said I have to do my exercises 2-3 times a week for the rest of my life....!!!

Oh and Jacksmania this is probably going to be a dumb question, but can anything be done about the pudendal nerve damage? I'm assuming you've already looked into this??

Take care all xxx

Hello ladies,
I have 2nd stage anterior prolapse, weakness in posterior wall, damaged perineum, complete labia tear and sensitivity issues on one side. I am seeing gyanae next week but contemplating on reconstructive surgery privately. I am interested to find the best surgeon for this job. I am in London area (north but will travel), could someone make recommendations please.

Hi babynelly2010. I'm not in the UK so am afraid I can't be of any help but hopefully some of the other ladies will pop by soon to offer some advice xxx

sorry I missed the last few posts - am away with patchy internet.

I have a gynae recommendation in London. Vik Khullar who is at Devonshire Street and the lindo wing. he is very senior and experienced and is a very competent and careful surgeon. he is extremely caring and kind. he's sorted me out for multiple birth injuries. his secretary's number is 07500334000. pm me if you have any questions, it I might not be able to answer until the weekend.

XXX to everyone

Hi baby nelly / firstly I'm so sorry that you have to have this surgery. I really feel for you. I have recently had posterior perineum repair by mr stergios (stellios) Doumouchtsis at Parkside hospital in Wimbledon. He also practises in Chelsea at the lister hospital but is based in st George's tooting for his nhs work. He was excellent. Very careful and very good in particular when I had some complications and needed to be rushed back into hospital. I do recommend him
Although suspect he's a bit far south for you. His details are on the Parkside website. Wish you the very best of luck. X

Hello ladies, I read about vik khullar. I think he will be my first stop. Does he have a long wait if private?
I will look into doumouchis, never read about him yet. Yeah it is a reall bummer but hoping things can be put back together. Vik khullar sounds great, just hoping I can afford him. Any ideas what I should be looking to spend?

Hmm costs-wise you are paying for all of your appointments (mine are £150 a time I think) then you also pay for the hospital stay (one night was £1800 at Parkside) then you also pay the surgeon for the surgery (£1500?) plus the anaesthetist (£500?) plus all your medication to take home. I don't know if I got any change from £5000. I don't know how this compares to the lindo wing. X

Vik will be able to see you and fit you in for surgery really quickly. I have insurance, so haven't bothered to think about the cost, and self pay tends to be at a cheaper rate than insured, I think. I saw other surgeons for 2nd and 3rd opinions and vik's rates were comparable or cheaper.

that's great thank you for your response.
this is great info.

Just wanted to get in a few days early and wish everyone a safe, happy and relaxing Christmas!!

Wishing all the fellow Raggedies a very merry Christmas.

Merry Christmas Raggedies!!

belated merry xmas everyone! hope we all had a nice day! xx

Season's Greetings!
I was just told about this thread recently. I haven't read through too many of the posts but am already reassured. I had a 4th degree tear in August. Feel traumatised and a bit haunted by the birth (more so than in the early stages) not to mention the issues form the tear.
Has anyone gone on to have a normal delivery after a severe tear first time?

Bumping for you - can't answer that because I only have DS, but I am fairly certain that others on the thread have.
Welcome! :)

Hi sksk!

Saw your post earlier today, but have been rushing around with DD all day and didn't have a chance to post before now.
Like jacks, I have no experience of this, as I only have DD and won't be having any more (but I think that with a 4th degree tear you would have an exceedingly strong case for ELCS, if this is what you wanted). But if I can offer any other support and hand holding I am here for you.

I read what you wrote about how as time goes on, the trauma seems to get worse, not better. I can completely relate to that. Whilst I was 'traumatised' in the early stages after DD's birth, it was only as time went on that the full horror of what had happened, the injuries I was left with and the treatment I would need hit me and I began to realise how messed up I was psychologically about it all. You haven't posted the circumstances that led to the 4th degree tear nor what happened in the delivery room, but even if the birth process had been relatively OK, just the very fact of such a major injury during what is supposed to be a pretty much every day event that we are led to believe our bodies are designed to achieve (and to achieve repeatedly) is enough to result in trauma.

I've found trauma therapy very helpful. I still have some way to go, but I am so much better than I was. Might this be something you could consider?

You don't mention how you are now physically. How are things? Have you been left with pain or other symptoms? Do you need to have any further treatment?

There are no 'forbidden' or taboo topics on this thread. Between us we've seen, and are doing our very best, to survive it all. I'm sorry you had to find us, but welcome. We're here for you. XXX

I'm not sure if I should be on this thread but I shall explain and see what you (who know way more than me) come up with.

1st child, I had a 2nd degree tear, no problems I can recall after.
2nd child had an episiostomy (sp) and ventouse. I know it was damned painful as 3 days after the birth I spent most of the day on my hands and knees in tears at the agony as it healed.

Anyway, jump a few years forward and where I was sewn up, I have like a lump of excess skin. It has been like this since day 1, not evolved to this. I liken it to the inner seam of sewn garment iyswim.
Now to the crunch part. Poo. It is either a case of it is sat at the opening and just doesn't want to make an appearance or I get very little notice that I need to go.
If my stools are particularly hard, the scar does become sore but I haven't known it to bleed.
On the urine side of things, no problem, all is normal.

Is my scar as it should be?
Am what I am experiencing due to childbirth or due to my repair?
Apologies if this has been answered up thread, I haven't read them all.

Thank you in advance.

Hi sksk i'm glad you found the thread.

Hi KaFay also glad you have found us but sorry you need to. Sounds like your scar is causing an issue but i'm no expert. All i can suggest is that you try lactulose to soften stools which may make it easier & less painful. And see your gp, there are creams you can use (i think) to soften scar tissue which again may help, or they may e able to suggest something else (no idea what though). Others on here will have better advice i'm sure.

Just so you know we are a fairly slow moving thread but a friendly bunch who understand how hard it can be and are always happy to offer a hand to hold, an ear to listen or a or as required.

Hi KaFay, I had a scar revision on my episiotomy, for what was not quite a lump but a sort of rucked-up scar if that makes sense. I'm wondering if you should be assessed for a rectocoele - it's a slight outpouching in the bottom of the rectum where poo can become lodged, and can be difficult to push out. I've found that my episiotomy scar, even having been beautifully revised, can still become quite tender if I get constipated at all.

Thank you both for replying.
Jack - what you say sounds about right. I'm not sure I would be keen to have it operated on. It was so painful at the time I didn't/wouldn't let the midwife touch/see it.The thought of having it prodded and poked leaves me nauseated.

I can live with it how it is I guess, I just wonder if it is likely to deteriorate. If it did, I think I would be incontinent at times.