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.

Think my ability to be concise was torn with my perineum....apologies.

What an inspiring story, that really has brought tears to my eyes. It so helps to know there are others who know how you feel. I love my DH to bits, and he has been amazing since DD was born, but the thought of sex is just terrifying. I think it would be easier when I know I'm 'fixed', as it were, we only tried it once and it hurt far, far too much to even try. I don't think that was psychological, but that experience has added to all the fear, if that makes any sense at all!

It's all been on the backburner anyway due to my other health problems, and so it's all caught up together as being very traumatic. I've not been offered any psychological help at all, but tbh, I'm not sure I want any. The flashbacks etc have eased but it's the thought of being in hospital and internal examinations that bring everything back. Closing my eyes helped whilst in early labour so I will definitely do that again. My nice GP did write to the hospital and say "I'm sure you remember her after all the drama, please see her quickly and be nice" in more professional terms than that, and said he didn't even have to examine me if I didn't want to, which was nice. I took him up on that offer as couldn't see the point, I know I need a hospital referral anyway...

Gosh I am going on too. It really, really does help to talk though, surprised how much.

kelly thanks so much for your helpful posts. Hope you don't mind if I explain my case a bit further - just makes me feel better to have someone to talk about this with who is in a similar situation!

Had a scan today and turns out baby is breech - feet down. Unlikely to change before 38 wks. I have obstetric Cholestasis so am likely to be induced at 37-38 weeks, depending on how bad it gets. So just want to be clear that if induction is likely to be required (cholestasis linked to stillbirth if pregnancy goes beyond 38 wks) then better to just opt for an ELCS rather than induction which would very likely require epidural and delivery on my back ? (which was the case with first baby - I think I tore because I was on my back and not really in control when pushing - cdn't feel much urge and hard to focus on bearing down in the right place).

All a bit depressing. Need to re-read the link you sent as am not familiar with all terminology. I agree that most things I have read about 3 deg tears indicate that women don't seem to tear as badly again with another VB. Am just concerned about damage it will do to defects.

oldgreymare well eventually I got sorted seen the stoma nurse yesterday and she asked me was I getting therapy I said I was refused it, so the stoma nurse is sorting it out. Im getting a social worker as we are both carers my husband and I need support so all looking up atm.

I have spoken to the stoma nurses yesterday I will b off my feet for 2 months with the bag im horrified really truely scared why was I never told this could of happened in childbirth???? fellin ill today going back to bed v soon.

The 1st year of my dd life I will miss out in so much due to pain etc tbh I can never think of havin sex ever again im v serious im due a smear test and this will never happen.

How is everyone these days?? thanks for the help ladies I will keep posting wen im free

oldgreymare how r things going with u atm???
H

Hi everyone,

I'm sorry I've been away from the thread for so long. We were on holiday, and life was a bit crazy before that, and to be completely honest, I sometimes find it hard to come back to this thread because I needed it so much during a really really dark time in my life and, while that's over now and I'm as ok as I'm going to be, it does sometimes bring up memories again.

Soapy - I'm so glad the stoma nurse is sorting therapy for you. You need it, sweetie. You sound like me when I was going crazy with PTSD. I hope she finds you someone good. (((HUG)))
Also, as far as someone with experience of colostomy, I may have it wrong but I think Cyee who started the original thread had one for a while. PM her (send her a private message) and ask. Instructions for PMing are at the top of the page of this thread, or if you don't want to, I will.

Kelly - are you going to have to have a colostomy then? Temporary or permanent?

Titfer - I would never tell anyone what to do but if I were in your shoes, with a breech baby and a previous tear, I'd opt for ELCS. I do know that you could successfully birth a breech baby but if it all goes pear-shaped you might need an EMCS... and I think I'm influenced by my fear of ever giving birth vaginally again after I had Jack - so you have to take everything I say with a large barrowful of salt :)

Will be back later. (Promise!)

Sht, soapy*, I just re-read what I wrote and I didn't mean to sound so awful - I just really think you need some help after what you've been through. Sorry! Should read what I write before hitting "post".

I have sent cyee a pm is anyone else awaiting surgery?? at least im getting more support I have a lady from the colostomy assossiation comin out on Mon but im still TERRIFIED

Of course you're frightened. Why wouldn't you be - you've been terribly let down by the medical system so far and you're facing a procedure with an uncertain outcome. Anyone would be scared. I was pretty freaked out before both my repair ops (internal in Feb '09 and external Nov '10) and for both I was assured a good outcome. A lot of my fear had to do with putting myself in the hands of the medical system again, even though my repair surgeons weren't the ones who'd f*cked me up in the first place.

Hey jacksmania that is exactly how I feel gosh everyone must feel the same in my mind im gettin butchered again why does nobody understand!!!!!

Some lady from colostomy assossiation is callin on monday how delightful attending pain clinic today as nothin has worked this pain is driven me crazy!!!! will report back later ladies anyone else still in pain????

3 1/2 years on and two ops later, yeah, on a bad day I still hurt. Ok most of the time. It's baaaaaad during my period, nobody can explain why but my entire perineum aches when I have my period, like I've been kicked in the crotch. It's worst when I'm standing. Occasionally it gets so bad I have to sit or lie down. It would be nice if that went away some time!

Meant to say "I'm ok most of the time, I only hurt on bad days and the first two days of my period". It's late here, my brain is mush. Good night!

Yes, jacksmania I get perineal pain around my period. Well, I only had 3 between DD being born and getting pg with DC2 (if you exclude the MC, this is pg #3).

I also found that my perineum ached and ached - especially when standing - in the 1st tri of this pg and during the one I lost. I spoke to my MW about it but she couldn't explain it. I think it has to be hormone related but I have never looked into it really.

soapy good luck with the stoma lady, I hope you puts your mind at rest a bit - as much as someone else can.

I completely recognise the feeling of putting yourself back in the hands of a system that caused the problems in the first place. The last procedure I had was by epidural rather than general anaesthetic. I couldn't feel a thing but I cried all the way through it. The anaesthetist kept asking if I was ok because I was closing my eyes and I just kept thinking "leave me alone, I don't want to be here and if I close my eyes I can almost pretend that I'm not". It didn't help that my surgeon appeared to be flirting with the medical rep who was in with theatre.

Also when I come out of theatre I always ask for the curtains around my bed to stay closed so I can cry in private. I hate the bonhommie of strangers on the ward asking what you've had done, why you had it. Nothing worse than having to shout cross a ward at a woman asking why you've had your arse repaired.

Curtains and ipod!

oh yes, Jacks my consultant reckons colostomy is my prognosis so we're just firefighting with the procedures I've had so far. He says the fact that they can't fix the internal defect not (which controls passive passage of stool) means as the muscles of my pelvic floor atrophy through menopause I am likely to find I need a bag.

At the moment I am ok with it. I am 33, pg with DC2, menopause seems so long away but he said he thinks I have "10 good years". He said that in 2009 so I guess the clock is ticking...

Titfer I have really, really thought about how to reply to your post because I think my gut instinct goes against my beliefs and it's hard to write that down (I teach antenatal classes in my spare time so I am very pro-vaginal birth).

On the issue of breech baby, it doesn't have to be an issue. Breech babies (depending on the type of breech) can be born vaginally without problems. You can also do plenty to try and turn your baby around (see the spinning babies website for some fabulous pointers).

The induction thing is more of an issue I think.

Cholestasis is dread and uncomfortable and, like you say, comes with risks to the baby. Everyone I know who has had this condition has been induced. One person twice and she went on to have quick, intervention-free labours.

However, most mums I know who are induced find the labour more difficult. Obviously this can depend on the method of induction but if you end up on syntocinon (pitocin in states) then the contractions can be very hard to manage naturally which makes it more likely you will want an epidural which will put you on your back and relax your pelvic floor. This increases your risk of forceps/ventouse and even just pushing on your back increases your risk of tearing.

In your shoes, I would probably be giving ELCS serious consideration. It depends on how keen you are to avoid another tear. I am less worried about tearing again because, in my surgeons words, "all the damage that can be done to you has already been done. Another tear won't worsen your prognosis". So as long as I prepared to face another repair op post birth and all the pain and recovery afterwards then I might still opt for a vaginal birth.

However, if you are terrified of the thought of tearing again then an ELCS would be a good option.

The thing with induction is once it starts you have to finish it so if the pessary doesn't work they move onto something else (syntocinon).

I don't mean to type a post that makes you more afraid, this is just my opinion on it.

kelly thanks so much for taking the time to write a thoughtful considered post!!

I saw the consultant yesterday and we discussed everything you mentioned - and as a result of considering all the risks, I've decided to go ahead with an ELCS. I am looking into some counselling in the meantime so I can hopefully go into this in a more positive frame of mind. I am very sad about having to recover from a CS with a toddler and newborn but I just think that my DH and I would find possible incontinence and the lack of sex following recovery from tear/further ops would be too much to bear. When I asked about the pressure on the defects, the consultant said that yes, pregnancy itself puts pressure on the pelvic floor, but natural labour puts 10 times that pressure on the PC. The defects (holes) I have are one on top of the other which makes me think that if one layer of muscle gets damaged, the 2nd layer is very likely to get damaged also.

I should also say that I have not had any particular incontinence symptoms, I do occasionally have to get to the loo pretty quickly but no incontinence. Doc yesterday said that I do have reduced pressure in the sphincter which I guess means that my body is not as efficient at telling me I need a poo (sorry ) but generally I feel fine - and I think I would have been very upset if I'd had a natural delivery and ended up with any incontince issues. Obv I understand that there are risks attached to having a CS but I have accepted them.

I had hoped that somehow my liver results might come down and I could go into natural labour (ha! itching is increasing day by day!), which at least would be more manageable, but as you say an induced labour is much harder to manage. I have read about a lot of labours since I had my DD via induction and I have come to realise that the 2 processes are quite different. I was having double contractions with DD and went from 4-8cm dilated in 2 hours!! The intensity was utterly exhausting. It was very difficult to do the epidural because I was writhing around so much. I am also quite scared about having an instrumental delivery which of course is more likely to happen with induction.

The person who has recommended I have a CS is apparently "the" perineal dr so really, there is not much point in seeking a 2nd opinion. I think that re: yr comments about VB after 3rd deg tear vs 4th are relevant - most people who've had a 3rd deg tear AND have healed well from it seem to go on to have few problems in their following VBs, but ppl with 4th deg tears are advised not to go for a VB - I think my case, a 3c with remaining defects, should essentially be treated as a 4th.

I'm seeing my doula soon so again will be seeking to look positively at how to handle my CS.

I've written the above in some detail just in case there is anyone in a similar situation. I think that really, I have just been very, very unlucky to be so anti-csections and to end up needing one! I am sorry for the huge post but hope it helps at least one woman making the difficult choice between VB and CS.

Titferbrains, it sounds to me like you've made the right decision for you. And may I just add, there are LOTS of things in life that we think or say we'll never do... I've often thought that those statements are meant to be challenged as we go through life :). I remember saying that there was a moral issue/thing that I thought I would never, ever do, and ended up having to do that very thing - we never know what we'll do when circumstances change. I'm so, so sorry you're in the position where you have to consider having a section, but if it's the safer, right thing to do, it's ok to change your mind.
Also never apologize for huge long posts. Read back to mine, sometime, in the first thread... there are some epic ones. I think when we're actually able to unload this burden on others who really, truly do understand, it's hard to stop, and really, why should you stop?
So - when is your section scheduled, so we can keep the fingers crossed and check in with you after? :)

section will be on 12th Sept. God it feels strange to type the words. As I suspected, DC2 will be my biggest birthday pressie as it will be born within days of my bday!!

Am now trying to get my head around post-op child care for DD and am already feeling stressed jsut thinking about it. Got to go and toddler-wrangle but will post again soon.

On a Monday then! :)
Good to know, I'll be thinking of you!

hello... may I join you ladies? Seems like there is loads of experience on this thread. DS is 13mo and after being in denial for some time, I have finally seen a gynae about ongoing pain. I had a forceps delivery with episiotomy and tearing. I don't actually know how bad the tearing was because I was never told!! I've not been able to DTD since, and have pain daily... so have now been referred to a surgeon tuesday week (9days time) and am nervously awaiting the prognosis. Would be nice to be able to get some support/advice once I find out what my options are. They mentioned a Fentons, but apparently are concerned that the stitching (and scarring) doesn't appear to go all the way up - and there may be an unrepaired hole high up. :(

anyway, it's nice to know I'm not alone. Thanks for all your stories, its really helpful to be able to hear about people who have come through it and managed to ttc again and go on to have more kids!

Hi sillyworriedmama - I'm so glad you're getting checked out. Welcome to the thread. I always say the same thing - we're sorry you had to find us but we're glad you did :)
Poor you re forceps and episiotomy and tear :( - another battle-scarred veteran here. If I can just reassure you - for anyone I've talked to, the recovery from the repair op is nothing like the recovery from the original injury.
Please come back and update when you've had your app't - or come back and chat before that!! :):)

hi Jacksmania :) thanks for the welcome. I've been watching the thread for some time... I guess under the denial I knew I'd probably have to come 'out' on here eventually! So not cool when your lady bits are, ahem, ragged. Not many RL friends I'd talk to about it tbh! But your brave stories and knowing that surgery is prob a good idea helps!

I'm not sure what to tell work if I need time off for an op though. Do you think I could ask my manager to just call it annual leave if colleagues ask, but give me sick leave? I really don't want it to be common knowledge or have people ask me how it went!! What have you guys said in that situation? Not sure how to protect my privacy. I've booked time off as leave for my appt with the surgeon next week.

Hmmm - not sure what to tell you. I was pretty open about what had happened to me and the upcoming surgery at the time. In retrospect, I may have been oversharing, but too late to worry about that now :o.

I suppose if you're asking for sick time, you need to tell your manager that you're having an op. But could you ask him or her to keep that part confidential? I'm sure you don't need to elaborate what the op is for, just hint at it, and say that you really don't need people wondering and asking about your private parts, and you'd be grateful if he/she could just say (if asked) that you're taking some personal time? I always find that if people ask about something I don't want to discuss, saying "I really don't want to get into it" (repeat as necessary, with or without a smile) gets them off my back.
It does take some practice, though - people can be very nosy.

Hi ladies,

my update seen stoma nurse and had a visit from a lady at colostomy assossiation not much help for me really.
Needing to vent

Wen I arrive at delivery suite I asked how how do u give before a section and mw said 6 hours well I was not there that long and was pushing for 4o mins then I overheard the mw say to the other mf about forceps I freaked and asked why?? was told contractions were too slow this meant nothin to me. Then I was told we are waiting on the doctor I asked why mw said he was the best!!! after that I went crazy not understanding why mw never told me this was happening was it that bad it was a secret I was terrified. I was only pushing for 40 mins.

Now my hubby resents looking after his daughter so I resent him does he think its my fault?? as kellykettle has said before it was my delivery and I can act in wot ever mannor to how I felt at the time. Now my hubby is drinking to try and block it out.

Sori for bad post

Oh and now I have ruined my husbands social life and he is angry with that as well

sillyworriedmama welcome to the thread but likes jacksmania said, sorry you had to find us.

Try not to second guess your appointment, it will only drive you insane .

What tests have they done so far? Your consultant should be able to tell you what degree of tearing you had.

When I had my op I told my line manager. I didn't intend too but she was so lovely and understanding that I ended up crying to her. If anyone asked I just said that I had torn a muscle in labour and it needed fixing. People assumed, for some reason, that it was my thigh and I never corrected that. It wasn't far off & it was repairing a torn muscle. People generally don't associate bum surgery with birth or the vagina with being a muscle so they never really asked anything akward.

In fact, when I had my 2nd op (sacral nerve trial - op is via lower back) I told people I was having surgery on my back which was true but I would use that again if I had to have more bum surgery.

Or just take JM's advice and opt not to discuss it.

soapy I am coming back to reply to you shortly - just have to see to DD.

p.s. Are there any more lurkers reading the thread who would like to join? Feel free to name change to post