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.

Hi there - i've just found this thread, hope i can join.
I've got 2 children 4yo and 15mo. Both episiotomies following long labours, 4yo was 72 hours, had forceps too.
Since birth of my youngest i've had 'issues' that I thought were normal and i'd bounce back as i had previously. Stupid ignorant person that I am.
When bending to clean the showerscreen daily I'd pee myself. I ended up seeing a womens physio who said that yes my pelvic floors were useless (I couldn't hold more than 2 squeezes before my muscle was fatigued she said). After 4 months of her spending more time between my legs than my husband, whilst giving me electrostimulation I finally felt confident that I could live my life without pee'ing myself.
THEN I stopped breastfeeding at 10months and not sure if it was hormones or what but when my period returned it felt like my insides were falling out. I raised with with my GP who have an internal and said she thought I had a prolapse. If I can manage to get a tampon in it will fall out as soon as I get into a sitting position.
3 months later I finally saw a urogynaecologist who said I have grade 1-2 rectocele and cystocele and a 'gaping' vagina which if I impoved my pelvic floors it'd hold everything in and i'd not have a problem anymore.
Sounds so simple huh! But how when i've already spent months seeing a physio?
I left the office in tears and I still cry multpile times a day thinking about it. I can't live like this anymore. Its the 'gaping' that annoys me more than anything else. I have NO sensation down there at all. s*x life isn't affected...as we dont have one anymore now. I can't feel anything, husband is quite well endowed and he said it just feels lost in there ;o(
Since my appt a few weeks ago I've been paying more attention to my body than I had before. When i wipe after peeing my fingers actually go inside my body, and looking at my bits it is just open!
Its made me think perhaps my episiotomy never healed properly?

My youngest was verrrry bruised when I pushed him out. I spent an hour pushing before epi and turns out he was coming out face first not top of head. Needless to say I was very bruised too. It felt like I had a scrotum ha!

Sorry for the long winded vent above...just wondering what you all think?
Can an episiotomy heal open, hence why I have the gape?
can it be recut and stitched? I'm not having anymore children.

I shoudl have asked at the specialist but the appt felt very rushed and it was as if my problem isn't severe enough for them to worry about.
I'm 36....living the life of an elderly lady with a share in tena ;o(

Thanks in advance x

Welcome along pphello, sorry you had to find us. Wow, that sounds like either errors or things were missed along the way. Feel free to rant as required, its so frustrating when the medical staff say oh its just x y z. The good news for you is there is surgery you can have - perrenial refashion i believe is the term generally used. Its exactly as it sounds, cut and restitch of the perrenium but that will only fix the gaping part. It sounds like you need to get the prolapse fixed as well, probably at the same time. I have one too which now (11 weeks post second baby) feels worse than before. Some of the ladies have experience of this on here but there is a prolapse thread as well which you may get more info from. I'll be heading over there once i finish breastfeeding as i cant live like this forever.

I have read that episiotomy's can heal open as well so thats possible, the scar tissue of mine certainly feels very wide or that could be my big arse stretching it

Theres no TMI or stupid questions on this thread either.

Hi pphello - also extending a warm hand and so sorry you have had to find us.

Sounds like you definitely have a prolapse, definitely have a poorly and incompletely healed episiotomy, and may have some muscle damage as well (did the gynae say whether there was a gap in the muscles of the pelvic floor as well as the skin - a poorly healed episiotomy can mean that that it's not just the skin that gapes, the muscle layers are also open). ALL of this can be repaired surgically. Physio will help you to build up muscle strength before surgery, and will do a lot to help you post surgery, but I doubt it will do anything to solve the problems you have got. It's possible that the gynae has 'decided' that you will 'obviously' be wanting more children and that for this reason they prefer to wait until after you have 'definitely' completed your family before operating and that this is why they just said to go away and do physio. (BTW - it's really not true that you can't have surgical repairs if you still want more kids.)

I think you need to go back to your GP and ask for a second opinion. I'm trying to search online to see what the cut off point is for physio before they 'decide' that it hasn't worked and consider other treatment options. I can't find it, but I think it might be 6 months. So if you can hang on until then and then go back to your GP, then you can say 'look, I've been doing it for the recommended time, and it's still not doing anything'. (Not suggesting that you carry on with the exercises - just trying to get the boxes ticked, IYSWIM.) I think you need to impress upon your GP just how devastating this is for you and how intolerable it is to continue to live like this. I think they don't always 'get it'. Also stress that you have been doing the physio exercises religiously and that she also used electronic stimulation to kick start the muscles, and your symptoms are unchanged.

It's shit and it sometimes it feels like the end of the world. I'm not surprised you are crying so much . But it does get better. Surgery helps enormously and the right physio at the right time can also do wonders to build up the muscles again and to get the nerves firing properly. (Sounds you like you have a bit of nerve damage too, if you say you can't feel anything. This gets better too - nerves just take a long time to recover and sort themselves out again.)

If you are in London and are able to go privately, I can recommend my lovely lovely surgeon who will take you very seriously indeed. But I appreciate that this might not be an option.

So so sorry . XXX

pphello, your experience sounds remarkably like mine (even down to the urogynae who doesn't give a damn. seeing him was so depressing. you're not in the southeast by any chance are you? I'd hate to think there were two urogynae who made their patients feel so bad)

my incontinence was a combination of nerve damage following a difficult birth with ds1 (72hr labour, forceps and episiotomy. his head circumference was off the scale - over 100th centile - and the pain during labour was also far beyond normal contraction pain. In hindsight it was nerve damage) and pelvic floor weakness. did my exercises diligently (70-100 per day once I had sensation back) led to some improvement but not that great, still.

I have a cystocele and urethrocele they are very noticeable from the outside though urogynae with the arsey attitude wasn't even going to tell me that. I had to press him on it he was just dismissing me with 'it's your pelvic floor' (leaning back in his chair, waving me away with his hand)

sex life is screwed. I have given up on orgasms. sex is for dh only now. and it leads to me having a painful, heavy feeling for a day afterwards. I cant bear to stand or walk for too long because of the pain, which makes me unlikely to ever initiate sex.

Had Ds2 recently so after 3 months of pfe (I have a new referral to physio. I was too cowardly and embarrassed to have pf function measured last time) and then I'll have to bite the bullet and see the rude urogynae again.

I also feel I have a gaping fanjo. pfe made some difference in tightness and incontinence but second pregnancy has set me back. I sleep in adult nappies as I have a cough at the moment. even with wee shooting out with each cough, when I get up first thing I run a continuous leak all the way to the bathroom. its beyond stress incontinence. I hope physio can at least get me back to just the cough and sneezes incontinence because this is depressing.

Hello Everyone,
I am wondering if anyone else is living with no perineum (Mine is extremely paper thin). I have my first child two years ago via c-section, he was stuck. I just recently had my second child in november vaginally. Everything was going well. I was told i had a second degree tear, which was sown up. However as time went on, I would notice i had trouble with controlling my gas. When I went back to work, I notice I had incontinence of very small amount of loose stool. I was mortified and extremely depressed. I called my OB who suggested i see a Urogyn.
And there is when my nightmare began. I was very hopeful prior to this. So I was told there that i have an anal sphincter tear. I was also told that I have a paper thin perineum (my nephrologist said its non existent). the urogyn said based on my age and the severity that I should definitely get this fixed. So I went to see the colorectal surgeon. Upon exam he made me feel better and said I would not need the sphincterplasty now. We are going to do more tests to be sure. I asked him about getting my perineum fixed, which he said "Don't let anyone do anything to you down there" He believed my sphincter muscles are intact (I think), but are really thin and weak. Surgery could cause a problem. So I am happy with what the surgeon said, however, what about my perineum. My anus has literally moved towards my vagina.
Does anyone have this problem. For how long, does it affect you sex life. I am soo freaked out by how i looked. I am getting so depressed.... I don't want to be defective my whole life...... But i prefer to be continent (Although now i shart and have diff with gas).
Any words or suggestions would greatly help!
Thanks
Sofia

Hello newbies. Am at work, will return and read as soon as I can.
You're among friends here :)

and or as required for all.

So sorry to all of you. and . Am on my nexus, so can't look back and see who posted what, so can't direct my comments to individual posters. But hopefully you can work it out!

It makes me so angry that you have both had such dismissive attitudes from your gynaes. There is no reason at all why you should have to live with these severe symptoms. PFEs are not going to solve such dramatic urinary incontinence - surgery is the only thing that is going work. Can you get a second opinion?

I also had a paper thin perineum because my tear only healed (incompletely) at the skin level. I had no muscle underneath, as I had a 3cm gap. It was fixed and now it is OK. I had sphincter damage, although no tears, and this meant I had faecal incontinence and couldn't hold wind. The hincter was stretched and weakened during burth. What tests have you had? They need to do a endoanal ultrasound and anal manometry. the first will show if the sphicter is intact (and will also show if you have a gap in your pelvic floor muscle). the latter will show what the muscle strength is. Since having my prolapses repaired (cystocele, rectocele, entwrocele, uterine prolapse) and my pelvic floor muscles repaired, things are much better and I've been able to do physio much more effectively to build up my strength.

on holiday with patchy internet, but will do my best to keep up with this thread! xxx

Cardamomginger, thank you for your comments. My appointments for my analrectal physiology tests have been cancelled until next month so now i have to wait. So you too had no muscle between your rectum and your vagina? how was the repair surgery? And with your sphincter muscle was that surgically fixed as well or did you get better with therapy. I am doing biofeedback, which seems to help I can walk and hold my wind sometimes now.
How is your continence now? And now with the surgery you have a perineum again? is sex painful? Thanks for all the answers in advance.
Im so happy i found this site!

I somehow needed to create another account so I was catia108 now i'm CSRHP, just in case anyone is confused. Again thank you so much, it helps to know there are other women like me out there!

the repair of the muscle under the oerinuem skin was done through the vagina at the same time as a whole load of other prolapse repair surgery. I won't lie - it was bloody painful. pulling together 2 ends of a muscle to close a 3cm gap hurts!! my surgeon injected the muscle with a long acting local to try and help with the pain and with botox to try and stop it going into spasm - this can happen when you close a large gap. the muscle is fully functioning now - strength is symmetrical and I score almost 4 out of 5 for strength. continence is much much better. no accidents. wind is still a bit hit as miss, but it's getting better as strength improves.

I didn't have anything done to the sphincters. I think they prefer not to unless they really gave to and as I didn't have any actual tears there was no need. biofeedback was suggested for me too. at the moment I just can't face it. after 3 major ops, 2 minor, masses of gynae physio, severe PTSD, etc, sticking something up my bum is so not what I want to do right now! I might revisit this, but I want to see how far I can get without it.

sex is not on the agenda right now. lots of reasons. some physical, some PTSD related, some because my relationship with dh is shot to bits. I'm not the best person to ask, and in any case I'm an extreme case so my experience is not the norm. the perineum rebuild, however, hasn't impacted on the no sex situation. that's been fine.

xxx

I just ran into my colorectal at the hospital yesturday. I asked him about my sphincter muscles which he finally said he does have clinical suspicion that there is a tear and weakness. Now i'm all broken again. I just don't know what to do. I want my perineum fixed, but i wonder if i should leave it for when I need sphincterplasty? So lost, hurt and sad.....

.Wait until you have had the scans and you know the extent of the damage. Are you seeing a gynae surgeon too? I think rebuilding your pelvic floor muscles is easier and less risky than trying to rebuild sphincter muscles, so that might be something to do first. That plus physio and biofeedback might help you. I'm sorry. I know what it's like when the problem just gets bigger and more complicated. xx.

CSRHP this is much easier said than done but try not to worry, any new information can be hard to take (good or bad) so dont panic yet. Take time to cry, be angry, frustrated, or ignore it for as long as possible - whatever you need to do to cope. Everyone on this thread has been through or is going through the roller coaster of emotions and physical problems that make us Raggedy.

I cant offer any practical advice but do extend a hand to you, and all the other Raggedies that have recently joined us.

Xx

Yes i am see a urogyn, he was the one who made me aware of my structural (significant defects) ..... Biofeedback def is helping a little. Do you know anyone who has had a ruptured/torn sphincter and still manage to be continent when they are older in life? I'm only 29, and the reality of this is more than i can handle...

sweetheart . I know. all of us here know. the shock and devastation of being broken so horrifically, in such an intimate place, through doing something 'normal' can be unbearable. it's even harder when you look at other women who just breeze through it. can you get some support through counselling? no, it doesn' t solve the reality, but it can help you find strength to get through it. I've found emdr trauma therapy very helpful.

I don't know of anyone who's had the repair. when you know what the surgical options are, talk it through with your surgeon. maybe with the urogynae as well. ask for a second opinion if you want it. ask them about the risks, failure rates, success rates, long term data for the procedures.

xxx

Had my EUA friday. Colorectal have said they can.t see a fistula but my perineum is thin. And also mentioned a lot of scar tissue in the front as was examined botg front and back. Still no explanation for vaginal gas and rectal bleeding during menstration so I.m to go back to see colorectal in 6wks time. I can.t say I.m not worried about the perinium part and don.t understand how this is the case after 3 2nd degree tears the last being sutured bya midwife.

so sorry you didn't get the answers you were hoping for. to be told 'we don't know' is horrible. what's the plan going forward? as for the perineum, it can be fixed. have they scanned to see what muscles may be torn? as for why - what often happens is that they use a suture that doesn't last long enough for muscle to heal, so it opens up, even though the skin (which doesn't take as long to heal) does close (more or less).

I'm sorry . xxx

Thank you for your support cardamomginger and cravingcake! I will keep you up to date. Hopefully with good news

Thanks for ur advise Cardoman - My stitches did come out afger a day but I was told I was healing naturally. I also have been realky struggling to inprove muscle tone so will mention this ti physuo on nxt visit.

Hi everyone. I had a 3C tear 12 months ago, I think I've been pretty lucky and healed okay physically. But I'm still very anxious about it, I'm finding the mental aspect tough.

My current worry is that I think I'm about to get my periods back. I used non applicator tampons before, but it is making me feel sick the thought of using them again. I'm not sure why but I'm squeamish so I think it's the thought of feeling the scarring. I was planning on using a mooncup but I can't imagine being able to do it now. Can anyone offer any advice please?

Hi Caker, welcome along. I'm assuming you have recently finished breastfeeding and thats why your periods are about to return? For the short term i would suggest using pads, not great but until you build up the confidence to try tampons or the mooncup. I cant use tampons now and have recently had DC2 so just have to use pads. I dont like it but thankfully my periods are not too heavy or long. I dont have experience of using a mooncup but am tempted to try one but i'm nervous about it (not being comfortable, leaking or falling out etc).

Have you been able to have sex? Did it feel 'normal'? If so then you may be fine and could try applicator tampons as they can be easier. Do try when you know you will be home all day so can quickly remove it if required.

Or you could speak to your gp about going onto a Pill which you dont get periods on, it will only prolong the process but could give you some more time to get your head around it.

Also, get a mirror and have a good look, you may be surprised by how normal things look, that could ease your squeamish feeling.

Thanks Cravingcake. I'm still breastfeeding every 3 hours day and night (DD is not a good eater) so I'm not sure why but it definitely is my period unfortunately. I haven't had sex since trying at 6 weeks (so I could tell my GP if there was anything wrong at my check up) - I must have been mad, that attempt was quickly abandoned! I got DH to have a look and he said things look normal but I haven't been brave enough to look. I suppose that is the first hurdle. I had a check up with a gynae physio at 4 months and they said everything is okay. I have some urgency issues and can't squat down or kneel on one knee as it is too painful but I'm hoping that will eventually subside.
I'm using leftover maternity pads for now!

Hi, I wondered if anyone here could give me some advice on my childbirth wounds saga, since so far the doctors seem unable to fix me.

I gave birth at the end of November, I had to have an episiotomy and forceps. My stitches were not right from day one, I complained about it in hospital and they checked them but they made out that I was making a fuss over nothing and that things would settle down. 3 days after the birth, when I was discharged I could barely walk. I went to the out of hours dr in the night because the pain was unbearable and I had a raging infection, I was given antibiotics but the stitches had all dissolved on the outside.
I was told by my midwife the next day that things would heal by themselves despite the lack of stitches and that I would see a real difference in 6 weeks.
It didn't heal and I expressed concerns at my 6 week stitches check at the hospital, they told me that granulated tissue had overgrown in the gap and I needed a minor op to cut it away, I also had a small infection. I took antibiotics again and then had an op in January where they cut out the tissue and restitched.
The stitches got infected again, despite all of the salt water etc, not bathing, hair dryering my bits. I took more antibiotics and eventually most of it healed apart from where the stitches were poking through, then a small hole formed, like a deep black hole. Back to the drs I went and they said that the wound was very clean and I didn't need antibiotics, but it had opened because although the skin had healed over but there was no tissue underneath and it needed to grow up, I was told that it would slowly heal and to come back in 3 weeks if it didn't heal. That was about 4 weeks ago. It had seemed like it was healing well and a few days ago when i checked it, it had completely healed and was just a scar.
Yesterday I felt it sting and looked and there is a hole again. I am off to the drs again today but I have a feeling they will say it's clean and will heal by itself.

I am worried there is something more going on. Why does it keep opening? I haven't done anything strenuous to pull on the area, no sex, no exercise (other than walking and occasional swimming). My baby is 5 months old and I am getting really down about this. I just want to be healed. I feel like there's nothing anyone can do for me and I'm never going to be able to have sex again.

I'm so so sorry this has happened to you. On my nexus at the moment and will reply more fully when I have kicked DD off my laptop.

I think this is very fixable, but what they are doing at the moment is rubbish. They need to consider the possibility that the muscle layers underneath have not healed (likely if the stitches failed, you had infection, and they have referred to a no tissue underneath). If so this needs to be repaired. It won't close on its own and you need those muscles intact for proper pelvic floor functioning. Fixing this may be possible via the vagina, so it may not be a case of giving you another episiotomy type incision.

I've unfortunately had 2 major and 2 minor vaginal/perineum surgeries. I have always been given antibiotics after surgery, as a matter of course. It is so easy, nigh on inevitable, that infection will occur after surgery. No matter how careful you are. Once you get infection, healing is compromised. Surgeons Ned to watch for infection post-surgery and treat it promptly and aggressively.

It may also be that, for whatever reason, the sutures they are using have been giving out too quickly.

I think you need to see a different team. Can you go privately?