Continued support for SPHINCTER INJURIES, FISTULAE and other CHILDBIRTH INJURIES - the Ragged Bits Thread

[Jacksmama]

Hi all,
old thread here.

Cyee started this thread in May 2008 after her op, and it's been a haven of support for so many of us who have injuries to our bits from childbirth. Especially with respect to sphincter injuries, fistulae and incontinence after childbirth, there seems to be such a lack of support for women, and the entire subject seems to be taboo. It's as if most MD's think that "a certain amount of damage is to be expected after birth and you just have to live with it". Well, that is simply not the case - and this attitude is unacceptable.

There are all kinds of Ragged Bits stories on this thread. Be aware that THERE IS NO "TMI" HERE - this is the one place where you can spill it all. If you read through the old thread, which is nearly full, you'll see that someone, somewhere, has probably experienced it - whatever it is! So don't be embarrassed or ashamed... we'll tell our poo stories if you'll tell yours.

And also - there are success stories here. Several of us who have been through the medical mill have been successfully "repaired" and are "fully functional", so to speak or even expecting again. In those cases, please join us for Pervwatch - the "after action" report for anyone who is once again venturing into marital relations!

Welcome everyone. We're sorry you had to find us, but we're glad you're here.

Really interested to see this thread as I had a fissure leading to peri anal abscess then a fistula two months after having ds1. Had 3 surgeries. But all the doctors I saw told me that it was bad luck and not to do with childbirth. I kept saying I felt it must be related. Was I right perhaps?

I'm pretty sure you're right and that it was related. I think there are many more complications that can be traced back to childbirth than the medical system is aware of. How sad, really. I think it's because so many of us suffer in silence and/or are too embarrassed to spell out our problems, or are brushed off by GP's and are unwilling to stand up to them and pursue a solution. Makes me feel quite militant, on occasion .

Thank you - it really helps to hear that as I always felt sort of unacknowledged if that makes sense! When I first went to the gp with the pain from the abscess (I didn't know what it was at that point) I was in so much pain I was sobbing. The doctor (female) said "you're crying an awful lot for someone with a sore bottom - are you sure you're coping with your baby?" I actually ended up agreeing with her and went home feeling like I must be making a fuss about nothing. Three days later I was on hospital, with a temperature of 40 and having surgery under general anaesthetic to drain 50 mls of fluid from an abscess. Wish she'd listened to me!

Hello - may I join you? I actually posted this in childbirth, before seeing this thread - but I think its far more likely that some of you have been in the same situation - any advice gratefully received!

I have a wonderful 8 month old DS, but his birth and the subsequent recovery were quite traumatic. I have suffered with some incontinence and have been having physio for the last 5 months which is helping. I saw the continence specialist yesterday who (without examining me) gave the opinion that most of the damage was probably already done, and if I delivered another baby it most likely wouldn't get much worse. I was completely horrified, and I don't think realised until that point quite how terrified I was about the thought of giving birth again - I would love another baby, but would have to seriously consider whether to have one if I thought I would have to deliver again.

To give a bit of background I had a high forceps delivery and episiotomy in theatre (which I know isn't that unusual) within a couple of days it was infected. The midwife checked after a week and said that it was the worst episiotomy breakdown she'd ever seen and I had a gaping hole (sorry if tmi!) I went back in to hospital and spent two days on a drip not being able to eat while waiting for a spot in surgery. Because I wasn't eating my week old DS had to go home with DH as my milk supply obviously dropped a lot and he was frantic

The surgery was successful although some of the surrounding tissue was dead and had to be removed. However I have been left with a lot of scar tissue and have lost quite a bit of sensitivity and also have some continence issues although these are improving.

Basically I'm really scared that because this consultant doesn't think I would suffer much more damage that I would not be eligible for a ELCS.

I'm wondering how hard it is to get one agreed?

Has anyone managed to get an agreement in principle before getting pregnant again?

Has anyone failed to get an ELCS agreed and gone private? (approximately how much is this?)

Would also love to hear from anyone who has had a repair following episiotomy breakdown and how you recoved, as I'm yet to meet anyone else who has had this kind of repair done.

Thanks for reading

Washngo - that sounds awful. Your story about the GP really resonates with me, as I remember sobbing with pain and having the same conversation about coping with the baby, hormones etc - and yet I had a gaping wound - was that not enough reason to cry? :(

Wow - how glad am I that I stumbled across this!

I am a 23 year old mum and my DD is 2. Over the last 2 years since her birth I have been through alot in regards to my downstairs!

I like many of you had a forceps delivery and episiotomy. This got infected and (if a little dramatic) led to me feeling deformed down there!

After a year of batting my bf off with a stick I had to succumb to the terrifying realisation that I was desperately un happy with myself and would have to do something about it!

Long story short - I had to have a preocedure to reconstruct my perineum and have now been referred for physiotherapy. I had my first appointment today and it has been the first time someone has sat me down and explained I have a slight prolapse of which I had no idea what it was!

Needless to say I am utterly fed up! Not only do I feel I have lost 2 years of my life as a normal healthy young woman I feel totally alone in all of it.

My partner is my best friend and whilst I can tell him anything, sometimes he just cannot understand what it has been like!

I wonder if any of you can give me some background info on what a prolapse is? whether it effects childbirth for the future? and generally to know I am not alone!

Rufous- absolutely that was reason enough to cry. Your experience sounds really awful and I hope that you are now able to recover and enjoy your time with your ds. Since my experiences post birth of my ds (now 2.6) I have gone on to have dd and the symptoms I had (slight continence issues regarding wind) have worsened a little but more due to the pregnancy than birth. Had a fantastic and enjoyable labour with dd, however I did speak to a consultant beforehand who said that, although he didn't think a c section was necessary, he would have been happy to perform one due to my continence worries. So if you did want an elcs I think you'd be more than justified and would hope your request would be listened to.

Hi ladies..glad to have found this thread and looking for advice. I gave birth to my son eleven weeks ago he was back to back and so I had numerous hands 'up there' trying to manually turn him. The birth went on for hours and eventually I was given an episiotomy and he was delivered ventouse. I couldnt walk for two weeks and my stiches became infected and 'undone' but they were left and I was given antibiotics.

The first month after birth I was unable to hold in any poo and it would literally fall out! Now its not as bad but I still have a LOT of urgency and have to go quickly if I feel the urge. In addition to this the last part of the bowel movement wont come out and I would have to use my hand to push it out via my vagina (sorry this really is TMI).

The doctor suggested I need to see a consultant so I am now waiting for my appointment. During my examination she said the muscles in my anus were very weak. She mentioned neurological damage..which could be possible and this has really confused me. Does anyone have any idea what the problem could be and if I will ever be able to have another baby vaginally or would I be best to have a c section? Would they even give me one? I dont want to end up incontinent at 30.

Any advice or suggestions would be so welcome.

Kitten - you sound just like me! I was going around saying exactly the same 'I don't want to end up incontinent at 30' Very similar story to you too - no-one mentions that urgency can be a result of an epiosiotomy do they? - but when I looked on the internet afterwards it does come up as a complication. My DS is now 8 months and I have had physio, and I have to say I have gone from being in the same situation as you to it being a lot more manageable. The consultant I saw said the pelvic floor can improve for up to a year after birth - so there is hope!

I'm not sure about the c-section Vs delivering again thing, that's my question too - although I have to say if I thought I had to deliver again DS would be an only child! :(

Hi all, welcome to anyone who's new, I always say this (Cyee would :) but it's true) sorry you had to find us but we're glad you did.

Regarding continence (or rather, incontinence issues) - they do get better with time. I, too, had the "poo falling out" problem. Oh god. It was awful. For some reason, I had a lot of diarrhea after having JB. It was dreadful, I lived on Imodium for several months. It does get better.

BUT.

It is utter bullshit and completely irresponsible, IMNSVHO (in my not so very humble opinion) for a consultant to say that any damage done and present currently would not likely get worse. They are criminally unaware of the cumulative nature of nerve damage. Nerves take offence very quickly, and they hold grudges. A subsequent pregnancy is in itself a lot of strain on a previously damaged pelvic floor. A further vaginal birth, even a zippy straight-forward one, isn't going to improve matters.

(I'm trying to address all the points everyone's made since my last post, if I miss anything, please slap me upside the head let me know. It's just that I have my first evening to myself in I-don't-know-how-long, and I have actual work I need to get to, even though I would love to piss the entire night away drinking and MNing.)

I had an internal repair done February 2009. JB's birth was a complete nightmare, 4 1/2 hours of pushing followed by episiotomy and forceps delivery. Massive 3rd degree tear (possibly 4th, no-one seems to be sure) and PPH. It was just utter shit :(
My wonderful surgeon did what is called a wedge resection of the right side of my vagina. It involved, essentially, cutting out the horrid ropy thick scar tissue that developed as a result of an utterly incompetent stitch-job immediately after I'd delivered JB, and suturing things back together properly. She found that I'd actually torn through a pelvic floor muscle, and it hadn't been repaired at the time of JB's birth :( - but she fixed it a year later. The recovery wasn't bad at all. I was very achy, and needed to rest and not lift JB anything over 15 pounds for two weeks, but compared to recovering from JB's birth, it was a breeze.

I had a second repair this past November, for all the external damage. The cut through my labia (for the episiotomy) wasn't repaired, either after JB's birth or when I had the internal repair, and my labia was in two pieces and tended to roll up and get caught. I went private for that one. Well worth it, although I have to be truthful and say the recovery was tougher than I expected. Being external, the surgical site was a lot more painful. But after 4 weeks I found I was well on my way to feeling normal again.

I encourage anyone who is having problems to speak plainly to your GP/ consultant. Yes, it is embarrassing to admit you suffer from incontinence, regardless whether it is of urine, stool or wind. But keeping quiet serves no-one, least of all you. You need to push until you get to see someone who knows what they're doing.

If I can be allowed a small moan, my fissure is giving me grief. I had a couple of days of hard poos, and it opened up again and I am back to square one. I've been taking more and more Lactulose (does anyone know if you can become tolerant to it??) to keep my poo soft, as well as the supplements my naturopath friend gave me. But things aren't so happy right now. :(:(:(
The last time I saw the surgeon I'd been referred to (because my GP thought the problem was haemorrhoids) he said that if the cream he prescribed didn't help, I should consider having surgery to incise the anal sphincter to help it relax so fissures don't form. He said if a fissure doesn't heal in about a month, that's usually necessary. I am so terrified that it will come down to that. I have control of my bowels but not of wind if it's really bad (I should NEVER have curried chickpeas!!!) but sometimes the control feels precarious. I can't give up what control I have, and I'm so worried that incising the sphincter will mean that I'll lose even more control.

Gah. This is all so shit. Sorry to be a drag, but one of my patients was telling me today that she delivered at the same hospital that I did - and she got to the same "we can see the baby but it's not coming out" stage that I did, and they did a C-section for her. For me, it was forceps. They might as well have shoved a bomb up my foo. Same result. It brought up all the anger and :( I felt after JB's birth, and I'm feeling a lot bit crap tonight.

Hi Ladies. I was just reading through and thought Id answer a couple of questions. Hope this helps .

Islabear - It is worth asking your GP,Consultant or Physio for more info about your specific proplapse. Common prolapses after childbirth are : Rectocele - prolapse of the rectum, Cystocele - proplapse of the bladder; and a prolapsed uterus (womb). All of which can occur following, damage, stretching or weakening of the pelvic floor muscles.

RufousBartleby - after suffering a third degree tear with my DC1, and subsequently having pain on going to the toilet ever since, I was adamant I wasn't going to risk delivering vaginally again. I asked for an elective C-section for DC2 right from the start. I voiced my concerns to the midwives and consultants, but they all seemed reluctant to agree my request, initially. I was given lots of info and reassurance that a vaginal birth was a perfectly viable option, but I stuck to my guns. They referred me for counselling to talk through my specific concerns re: a vaginal delivery. Then at my 36week check with the consultant - he suddenly confirmed my elective C-section, and said that the reason it took so long to agree to it, was that he wanted to make sure I was fully informed and had explored all my options, before going down the c-section route. It was the best decision I ever made, and compared to the trauma of my first delivery and recovery, the c-section was a walk in the park. If you want to elect for a c-section they will let you on the NHS, but just may not confirm this until around 36 weeks.

On posting previously I said I'd update when I know more, regarding the repair of my rectocele. I am just waiting for an ano-rectal ultrasound to determine if my sphincter muscles are damaged, or rather, the extent of any damage to let me know the risks of incontinence following a rectocele repair. I have now had loads of investigations: a flexible sigmoidoscopy, a rigid sigmoidoscopy, a defecating proctogram (an embarrassing but brilliantly informative test, which used a dye and x-rays to show exactly what happens/ where everything goes when I go to the loo) and an MRI scan. Hopefully, the results will be good and I will then set a date for the repair. Fingers crossed.

Hello all, it's been ages since I posted, but I'm still waiting for my physio referral - I saw my GP in Sept, consultant at the beginning of December, and since then nothing. Every time I call the hospital, they say they have to put me through to physio, which is always an answer message, and they've never called me back

I don't know what to do now. My problems are getting worse not better. I'm sure I've got a rectocele - I can't hold in when I need a poo, luckily we have 3 loos in our house and my office is right next to the staff toilets. I still feel the consultant didn't really take me seriously - although he acknowledged there was some damage, he didn't really examine me properly, and said he wanted to refer me to physio first. I don't know whether I should leave him a message via his secretary and ask him to see me again, or go back to my GP. Arghh. I just want this all fixed. As for perv watch - I can count on one hand the number of times I've had sex since DS was born, and he's 3 in July. I just feel all horrid and broken, and I hate it all.

Sigh.

I hope everyone else is getting on ok. It's good to come on here and be able to be totally honest about it all - I can't talk to anyone in RL about it.

I killed the thread

I've got my physio appointment at last, next Friday. I eventually rang the complaints line, turned out my referral from the consultant was 'lost' and physio have a different number and never check the messages on their old number.

Anyone else got any news?

The B of S- I'm sure you didn't kill anyone.They will be back soon I expect.(am a long term lurker!)I hope your physio goes well.I had some real success with a lovely lady physio after 2 kids,but then I had 2 more!

Annamolly-can I ask,who do you see for your problems?

I am currently trying to decide to go NHS or private for my Cystocele and rectocele repairs with possible TVT and looking for possible enterocele while they are there.
I was told by a gyne that a urogynecologist is the department I need as the bladder prolapse is the most severe but it is the inability to open my bowels that causes the most problems.So do I need a bum doctor too?

Thanks l4k.

Good evening everyone,
I somehow fell off MN for a while there. How are you all doing?
Bugger - you didn't kill the thread! How did your physio appt go. Do you think they want to rule out the impact of physio before further investigatrions? Seems like quite a lazy approach?
l4k - any closer to establishing your plans for the repairs?
Best wishes to all of you :-)

Thanks cyee, yes,I've been refered to prof Linda Cardozo at Kings who is a urgyne and( I've been told by a private urogyne) a very good surgeon.Have gone NHS cos cant stand the stress of trying to get our private healthcare to pay and also,because of other health problems I have I'm likely to be in ICU after op and GP recommends being in good NHS hospital with all the resourses.
I'll just have to wait now and I have no idea how long that will take.I suppose it could be anywhere from 2 months to 6,7or8? I haven't a clue.I know there is never a good time-ds1 is doing gcse's this summer,dd2 is doing her 11+ in sept and ds2 is starting school too.DH says we'll cross those bridges later but I like to plan and find it hard not knowing.I can't believe after avoiding the op for so long ,now I just want to get on with it.
thanks for asking.
And where has Bugger gone?

Hi, I'm here - so glad someone else is too, l4k and Cyee! Physio appt was as ok as these things can be, I did end up blubbing, but because physio was nice, and actually listened - I felt like she was the first person who has. I had to do a urine monitoring test for a day and keep a bowel diary - delightful, eh? I'm going back tomorrow for second appointment and full examination, which I'm dreading. But at least I feel I'm eventually getting somewhere.

l4k, I'm in Scotland, so it's a different NHS system here, with max waiting times - I don't know if you can find out somehow what yours would be online?

Yes Bugger,I find if anyone is actually understanding and nice to me when I see them about my 'problems' I end up crying however much I try not to.
Now off to look on kings college hospitals web site for waiting times,thanks.

Another blubberer here :) It was times like that when I realised how much I was holding in. Nothing like a joke about needing loads of KY!
Bugger, how was the follow up? Was it as bad as you expected? hopefully not.
l4k - I went NHS in the north west and I think it was about 7 months total from my first consultant referral to having the op. I actually found it really frustrating not being able to plan, or not knowing what to expect. This culminated with a real anti climax when after a series of quick appointments, I had to wait about 5 months for the actual op. I was gutted, since I'd just about faced into everything and was ready to move forward. I hope things keep moving for you.
Take care all!

Hi everyone (Jacksmama here) - I fell off this thread for a while too... how is everyone? I'm still struggling with my bum - the fissure was well on its way to healing and then I had a bad few days and took a backwards turn. It's not as bad as it was... but it's also not as good as it was for two glorious weeks.
The thing is that the changes I'd need to make in my diet are very hard to keep up - very restrictive and very limiting.

Hey Jacksmama - sorry to hear about your btm. What changes did you make that seemed to make the difference? It didn't involve cutting wine out, did it?
I am ok - working hard and trying to get control of home back.. argh! Hope you are ok otherwise? :-)

Ha ha ha - cutting out wine... are you insane, woman??

You know what, I have no idea what I did wrong. Currently, things are fantastic and I am not particularly doing anything right or wrong. I'm just going to enjoy while it lasts :)

Hello all,
tried phoning kings hospital to find out hoe long I'm likely to wait and the lady said if my GP does "chose and book" I'll get a reference number and a pass word and be able to book an appointment to suit me in approx 2-4 weeks.
Rang GP's sec who said not sure about that and she'd look into it.Not heard back yet but with some more chasing it looks more hopeful.
Problem is,I'll still have to have whatever tests they feel necessary before we book an op.Uro-dynamics will be one but one gyne said I needed a cystoscopy too.He also said that I have a mild womb prolapse too but it would be best to leave it alone atm which I'm happy about.I'm trying to avoid a premature menopause for as long as poss but my periods have been irregular again of late, the last three appearing after 7 1/2 weeks ,then 5 ,then 3 1/2.
sorry,seem to be writing a book!
Jacksmama- I had a fissure for about 18 months after dd1 and cried every time I opened my bowels,it was agony.I have no idea why it healed when it did but if I feel a tiny one developing again ,I have to alter my position on the toilet,leaning oneway or another,so the worse of the "crowning"(what a gross mental picture! sorry)pressure was on a different part of my bum hole(don't think I've ever written bum hole before,at 38 you'd think I'd be beyond finding that amusing ,but no.)
God knows if that helps you but I hope so.