Anal incontinence and piles - or is it a fissure?

[gingernut]

Having read anto's account of her anal incontinence on another thread, I have plucked up courage to post about this rather unpleasant problem.

I had a very difficult ventouse delivery with my ds. I must have had a large episiotomy because they were stitching me for ages. Afterwards, the stitches didn't give me too much trouble but I had a lot of discomfort around my anus. I was told that I was very badly bruised and also had a pile. The doctor prescribed lactulose to ensure that I didn't get constipated and the pile and bruising seemed to sort themselves out quite quickly (within a week or 2). However, I have suffered with slight anal incontinence ever since. I thought at first it would just sort itself out but after 15 months I have come to the conclusion that it won't. To add to my discomfort, the pile has reared its ugly head again. I suffer a lot of pain on going to the loo, but apart from that it's just a bit itchy at times. However, despite using various creams and making sure I don't get at all constipated, it isn't getting better (and it started playing me up well before Christmas ).

I have concluded that I really need to visit the docs, to see if anything can be done about the incontinence and to confirm whether or not I have a pile or something else (I am worried it might be a fissure, which my Mum has suffered from and I know these problems can be heritable.). But of course I have been putting it off because I don't like the idea of the inevitable examination!

Really, I'd like to know if there's anything I can do to help myself, both with the incontinence and the pile, as ideally I'd like to avoid a visit to the docs. And has anyone had an anal fissure? Could it be that rather than a pile?

Thanks!

I haven't read anto's thread but it sounds like you received a third degree (or possibly fourth) tear (or cut) which involved the muscle of the anal sphincter. Or the nerves to the sphincter may have been damaged. You should definitely talk to your doctor who can refer you for tests to investigate to what extent you may have lost function of the sphincter, which would cause the incontinence. I think they can try and repair the sphincter to improve the continence. Anal fissures are little cuts in the anal passage which then cause discomfort (and can bleed) when going to the loo, they can heal by themselves, but the problem often perpetuates because the pain of going to the loo means you get constipated and then next time you go its worse. Piles are enlarged blood vessels that can protrude outside of the anus, they can itch, bleed and be sore. You sound like you are having a horrible time, I know its embarrassing but asking your doctor might help out the incontinence problem, its is more common than you think after childbirth.

gingernut - are you anywhere near Harrow, London? St Marks Hospital is the authority on "bums" and the physiology unit would be able to help. There are a series of exercises they recommend for this sort of thing - the only problem is trying to remember to do them.

I think it unlikely that you would have suffered a 3rd or 4th degree tear - simply because you should have been informed of such a serious injury at the time and t here are certain protocols for repairing these injuries that should have been followed to the letter.

...(sorry, got jumped by ds)...
so, if you have suffered a 3rd/4th degree tear and weren't told about it at the time, you need to investigate whether or not the tear was repaired properly.

Also, there is not a huge amount that can be done to a damaged sphincter. The internal sphincter is an involuntary muscle so cannot be surgically repaired. The external sphincter can be operated on but, as I understand it, there is a risk that such an operation can cause more damage than good. As such it is best to wait until the problem becomes unsustainable before proceeding - particularly as the effects of surgery tend to only last a decade or so.

Sorry not to offer any golden ray of hope. Mums' bums eh? Now there's something they didn't mention at the NCT classes.

Thanks for the replies so far. Willow2, I am in the South East so St Mark's would not be out of reach. The incontinence is only slight (I would have sought help before now if it was intolerable) so I wouldn't have thought there is major damage to the sphincter. Also, since I was in discomfort immediately after the birth I asked for help at the time and was checked out by at least 2 doctors and numerous midwives, none of whom mentioned anything about a 3rd or 4th degree tear (or any tear at all in fact).

I have decided to ring the surgery on Monday to make an appointment to see my GP.

Mumsnet is great, isn't it. I couldn't possibly discuss all this face to face with non-cyber friends!

if it's what's called "urge incontinence" - basically you don't get a lot of warning and can't hang on for long - exercises can help.

No, it's not that, just a bit of leakage throughout the day.

gingernut, I have had haemmoroids (still don't know how to spell them) for almost 20 years. Since getting pregnant twice and giving birth, they have become even worse. The worst part of the examination is the anticipation of the first one. After that you realize that it's not really so bad and your gp has probably seen grosser bums than yours. Piles are not fun, but if they aren't too bad, there are a few different creams that they can give you that help quite a bit. I have found that if they are itchy use witch hazel (liquid that comes in a bottle - dab a bit on with a cotton ball) and if they are painful use Proctofoam (your gp can give it to you on prescription). good luck.

willow2, respect to you (not meant to sound so alig - ugh!) and good luck to you gingernut.

gingernut - again, exercises can help. See if you can get referred on NHS to St Marks - you will have to wait bloody ages but they are the best.

There is a homeopathic pile cream that you can get from Boots (made by Nelson's I think) that worked wonders with mine. It has an applicator for inserting the cream inside, and I found it helped after only 24 hours. As a devout sceptic of homeopathy, i was impressed!

It's amazing isn't it? I didn't realise how many mums had bad bums until I did. I only have to mention it and I get so many replies of "oh god and me!"

I was severely constipated in late pregnancy and after dd was born developed a few piles, mostly internal but some external ones from time to time. Because I was having a few more problems recently (sorry about this!): a bit of bleeding, lots of itching and also passing a bit of mucus, my GP referred me and I went to have a colonoscopy (camera where the sun don't shine!) Although it wasn't the comfiest 15 mins of my life, it was ok and at least I know there's nothing seriously wrong, having had the pleasure of watching my insides on the TV screen as they did it!

Gingernut - DO ask your GP for advice and s/he may refer you. I don't know about you, but since having a baby, I find I've hardly any embarrassment as regards my fanny or bum anymore! Good luck!

gingernut, glad to read that you've decided to see your GP.
Just to answer your original question I was told soon after my first birth that I had three fissures and a little pile, hmmm lovely! The itching was unbearable and the bleeding, at times constant.
I sufferred the indignity of being 'put under' and being given an anal stretch - literally that, apparentlly fingers are inserted you know where and the sphinctus is stretched. Whatever, there was no improvement and after my experience (as I was wheeled into the aneasthetic room I was introduced to the ODP, who would be assissting in theatre, only to discover it was an old friend of mine!) I was reluctant to trot back to my GP's.
I became a healthy diet freak, lots of fibre and Guiness does the trick, no problems now, only, I still live in fear of constipation!
Good luck.

I had an ultrasound scanning probe stuck up mine following the original 3rd degree tear. This was to check how it had healed 10 weeks after the birth and was told all was fine and that I could have a normal delivery with my next baby.

They didn't offer me any pictures to take home though

Thanks again for all the replies. It's a relief to know I'm not the only the with a problem bum!!

Soupdragon -

gingernut - I have a terrific book about bums - not all anal fissures, but a kind of everything you ever wanted to know..., (I'm a medical journalist, not a complete weirdo ) called simply The Bowel Book by Michael Levitt ISBN 019 8508581 (OUP - don't know how much it costs but it's a small paperback) which is full of absolutely fascinating information about bums, but obviously no one ever talks about. get your library to order it for you.

Well, I saw my GP this morning and the bad news is that I've got an anal fissure . My GP is referring me to a consultant.

The good news is that I'm covered by dh's private healthcare from work, so I shouldn't have to wait too long for an appointment .

I'm off to eat another piece of fruit now!

good luck gingernut, keep us posted.

Gingernut - are you planning on having more children. I'm asking ot of curiousity because although I have 2 year old DS I have recurrent piles (but not the incontinence problem) but was under the impression that there was no point in doing anything about it until I had completed my family. Anyone any views on this?

Bozza, I was wondering about this too. Will discuss with the consultant because I would like to have another child at some point. I have been doing some surfing to see what options there are, and I think treatment for a fissure is initially with creams which ease the pain. This helps to reduce the muscle spasm and aids healing in many cases, so I might not need an op anyway (and the operations are not always successful, as smartie said).

I don't know what the situation would be with piles.

Would be interested if you could report back after seeing the consultant gingernut. And I am sure there must be some "lurkers" with the same problem!

bozza, I'll have a look in the bowel book for you & report back

the bowel book says: "a patient approach to your haemorrhoids is preferred. If your haemorrhoids continue to bleed and prolapse three months after delivery then you may reconsider the sorts of treatments already outlined in Chapter 5" (roughly: banding, injections or surgery)

Hi, I had a third degree tear after DS1's ventouse birth and it was repaired under epidural. I suffer from similar problems, of a passive nature. My consultant decided to deliver DS2 by c/section, as he said the problems would only be made worse. He said there was nothing to be done, as willow has pointed out. I just hope that pelvic floor excercises might stop it worsening as I get older.

Quick update - I saw the consultant this week. He is going to get my GP to prescribe a cream which I have to apply for a month, and he reckons there is an 85% chance of the fissure healing within that time. If it doesn't work I could have botox injections in my bottom (!) or the dreaded op. He said he couldn't see any sign of any other problems caused by the birth. I asked about having more children and he said I should discuss it with my obsterician if I got pregnant again (which I roughly translated as `I don't know' ). However, he says if I need an op for the fissure then I should delay having it until after we've completed our family.

Oh - and apparently I have `good muscle tone' in my bottom