Does anyone have any experience of missed third/fourth degree tears?

[bubblejet]

Hi
I've never used the talk boards much but was wondering if any of you lovely mumsnet mums out there have any experience of a missed 3rd/4th degree tear? My second daughter is 2.5 now and its taken me this long to go the GP and ask about some fairly embarrasing problems. After being referred to a colorectal specialist I was told last week my anus and muscle inside is damaged from a 3rd degree tear that was not spotted. I was stiched for a second degree tear in a midwife only unit and do have memories of 3 midwives with a torch debating something but to be honest was so strung out on gas and air didn't pay much attention.

I have very mixed feelings about it - doesn't seem to be much they can do now - some exercises to try and strengthen the muscles and then using laxatives and immodium to try and manage the incontinence.
I have no idea how common this is - am blaming myself for not asking more questions at the time and shouting louder when I realised things weren't right (did mention at my 8wk check but it was blamed on hormones). But also telling myself there are much worse things in life, you only have to have a quick flick through these discussions to realise I am very lucky and have a healthy little girl..

Has anyone else experienced this? many thanksx

Do not put up with this!! Yes you are lucky to have a wonderful daughter, but you deserve to have a fully functioning fango and back passage without constant management. Fecal incontinence is awful and don't suffer it. Go to your GP and ask stridently to be referred for it. You can have surgery to fix the problem. (Have a look at the Channel 4 website Embarrassing Illnesses a woman there was fecally incontinent and had put up with it for years- you don't have to!!) Let me know when you've booked your appointment!! If they brush you off, get another opinion.

Thanks so much for your reply. I don't know if I'm as bad as that woman I have a couple of accidents a week? had a quick look at the site but can't see the specifics any chance you could post a link?
The consultant I saw said they wouldn't do surgery as it only has a 50% success rate and a high risk of infection.. My husband is keen for me to go private and see if they say anything different but we can't really afford it. Hes quite shocked as I've hidden it from him from all this time too! Do you think its common to miss it? He thinks we should get legal advice but I'm not sure..
thanks again for your reply

Bubble, ask for a 2nd opinion. I think it is disgraceful your 3rd/4th degree tear was not spotted (and I am an ex mw).

You are only a young woman, you deserve better. Please go back to your GP and ask to be referred to another consultant.

Hi I've also got a dd 2 1/2.Sorry very long post.

I had a 4th degree tear which was thought to be a 3rd.The birth itself was pretty mismanaged by the student delivering me.
Mine wasn't missed but certainly wasn't well managed initially.

I wasn't told the degree of tear just midwives (student delivering and her supervisor) saying ooh we better get someone to look at that.I was stiched by the SHO in a separate room with several other people wandering in on out for bits some having a quick look at my tear.Great hey.I have since found out I should have been stiched by a consultant/senior registrar level.

Back on the ward I was handed a bowl for a quick wash down below which I was about to use then realised the woman across had just used it and it certainly hadn't been cleaned inbetween.I asked for my sheets to be changed as my blood had soaked through to be told they were only changed in the morning.

First I knew about the degree of tear was when a women's health physio came to give me some leaflets and booked me in at the consultant's perenium clinic for a few months time.

I found I had constipation from the worry of tearing the stiches after birth then got leakage around this which really scared me.Luckily as I was due to see the gynae. he picked up on this.No-one warns you so I'm not surprised you did not get picked up.It is not the sort of thing you mention at your post natal group although I now have talked in RL to friends I have found others in a similar situation with various degrees of damage.

The gynae. then referred me on to colo rectal consultant who kept saying to his students this lady who has had an episiotomy
so obviously not paying alot of attention to my notes.He was fairly dismissive but told me to follow a low fibre diet - which as I am prone to constipation and IBS wasn't the best idea.

I asked for a rectal scan as I did want to know the extent of the damage and colo-rectal guy was suddenly more serious.I was told it was actually very severe 4th degree inner/outer sphincter totally gone at the front.Colo rectal consultant then said I could have surgery but he wouldn't recommend it as I am young still and the surgery success rate isn't great.He said he has seen women with minor damage whose symptoms are severe and others (like me) who should be more severe from the amount of damage but manage OK. He referred me for colo-rectal physio like pelvic floor exercises but concentrating on the rectum.

I feel upset about the whole process and it was the women's health physio who my GP referred me too who restored my faith in the NHS.

So in answer to your question I considered going privately but didn't really see what anyone would do.They can only suggest surgery or exercises.Gynae said for underneath generally (as I still get quite alot of ache/pain from the scar) restiching generally hit and miss as often creates more scar tissue.
Also considered a hospital complaint but again didn't see what it would achieve.

My most worthwhile bit was women's health physio who gave me an ear for my problems and lots of exercises and I can get by with this.I'm still not right down below and expect I'll need some sort of surgery at some point (also have a partial prolase - rectocele) but I am much much better with a combination of the pelvic floor exercises and also time.

If I was you I'd push for lots of physio with follow up - not just printed sheet exercises.If you have rectal problems you usually get to see the top women's health physio so push for this via your GP.

I feel angry at what was an uncomplicated 2nd birth I tore so badly but like you say I know I'm not alone.I have been told I would not be able to deliver except by c-section again.

I may see a gynae who has been recommended to me in the future to see what was actually done/if anything needs to be put right but will only seek further colo-rectal advice if my problems worsen as I understand from their point of view this would entail surgery.

My advice also would be not to be embarrased as it is likely someone you know has similar problems of some degree.There is a long thread on here for women who have similar issues.

I think that you should ask to see another consultant.
Dont blame yourself for not saying more at the time, you werent to know, and were entitled to expect the midwives to recognise what they were dealing with.

Have a look at this thread.

Again thank you all so much for your posts. LittleRed I will def ask to see physio it sounds like we have a very similar situation so very encouraging to know that has helped. The GP gave me an internal (vag) and said the words partial prolapse. She initially referred me to gynae but they passed it to colorectal without even seeing me so I don't know if I should follow that up too. Yet again I went into submissive mode and didn't ask any questions.
The other thread has been very useful thanks. I have only read some of it but will work my way through, I can't believe there are so many of us suffering in silence. It is explaining so many other symptoms I have ignored (painful scar tissue and aches)

I am seriously considering taking action against the hospital. One of the things I have read that has really scared me is about future births. Thankfully this has not been relevant for me but if it had I would have opted for a natural birth again at a midwife only unit (30mins to nearest hospital). And the consequencs could have been serious. If they had just written question 3rd degree on my notes the midwife who saw me at home a week later or the GP I saw at 8 wks check might have made the link when I mentioned a couple of things..

I am swaying between anger and hope at the mo! Thanks again so much x

I had a misdiagnosed tear and told it was 2nd degree and repaired as such. Finally got referred to a colorectal surgeon and had a sphincter repair op 11 months post birth. I lived on immodium, couldn't work full time and had to change my job. If you wish to take legal action against the hospital, you have 3 years from the date of injury to do so or in some cases the date when the injury was discovered. On the bright side the surgery has changed my life. The Colorectal surgeon will probably refer you for an ultrasound and physiology tests which will give them a fuller picture of what treatment is required. Please don't put up with this any longer and don't be fobbed off.

I had a fourth degree tear and it wasn't picked up until 4 years after - during delivery of baby 2!!

I did have lots of symptoms but these were dismissed on return trips to the doctor and I was reassured all was well!

I have just had surgery to repair the damage and am currently sitting here in pain writing this with a 6 month old and a 4 1/2 year old in bed.

I am considering legal action but don't qualify for legal aid and don't have enough to fund this privately (I was told about £20000). I am making a claim through the legal protection on my home insurance but I wanted to let you know that if you want to do this you have to let them know you have a potential claim WITHIN 6 MONTHS or they won't cover you.

Also, please don't leave things - I was told if I didn't have the surgery, I would almost definately be incontinent by the age of 40! My surgery was filmed for educational purposes because it is so rare - I am lucky that my local hospital has a professor in perineal trauma and it was not even suggested that I leave things to get worse. She also told me that she had another lady referred from another city because her local hospital didn't know how to deal with her. If you don't get the chance to put things right at your own hospital - ask to be referred elsewhere.
Good luck x