Birth injury-3rd degree tear- sphincter repair

[Ouchhh]

Not sure if this is the correct place to post but I wanted to reach out in case anyone has been/is going through a similar thing! Apologies in advance this post talks a lot about poo.

So I gave birth to my beautiful son nearly 3 weeks ago, back to back labour, forceps and an episiotomy. Thank god he is absolutely perfectly healthy.

We were sent home the next day & in the following days I noticed I was completely constipated but also leaking poo. I spoke to a few people about this and was told this can be normal after having a baby but as a FTM I had no idea!

So I ended up back in hospital with a missed 3rd degree tear. After many excruciating ‘manual’ examinations, a very painful enema, a rectal scan , an MRI , 10 days of relentless diarrhoea due to antibiotics, constant fecal leakage, my episiotomy stitches opening due to constantly being wet from poo and constant showering, many days of not eating right because of surgery dates changing, fear of going to the toilet too much & having to eat a low residue diet, bowl prep , surgery to correct the default in my external sphincter, I’ve now been back home a week recovering.

The last week has been hell in terms going to the toilet and the general pain from surgery. Can’t have anything stronger than paracetamol and Ibrophen due to constipating effects (ended up having to have a suppository after taking Tramadol) then taking mild laxatives is giving me diarrhoea, it’s like I can’t get the balance right! Also I’m still leaking poo throughout the day and constantly sore and showering 😞

I’m absolutely heartbroken that this has happened to me in such a precious time in my baby’s life. The last few weeks have been such a blur , I’ve been so poorly and really struggled to look after my baby as I would have liked to during all of this. Thankfully I have great support from my husband and our family but god knows how I would have managed this on my own!!

I feel so angry and scared that this could be my life now, even though I’ve had surgery I’m still leaking poo and still have very little notice to get to the toilet for the ‘main event’. I know it’s still early days but it’s so difficult to be positive, it’s all been so traumatic. Usually I’m such a social person but I’ve shut myself off from friends during all of this, I can’t cope with the thought of telling people I’m incontinent. As I have to rush to the toilet and shower frequently I don’t see a way of avoiding telling people this or realistically how I can go out of the house and do normal things? It’s just so degrading.

Anyway, this post is very long and rambly (sorry about that!) so I’ll shut up now but please get in touch if you’ve been through something like this, I could really do with others who understand to talk to ❤️

Oh my goodness, big hugs for you.

Ok, first of all, remember you are only three weeks postpartum. There will be many new mums suffering with toilet related issues at this stage. Please be reassured by this.

Secondly, also be reassured that if your issues continue, it is usually possible to correct them surgically.

So, at your stage, I would ask for a referral to a pelvic health physiotherapist. If this could happen immediately, you could start on a pelvic health exercise routine which will aid healing. If the referral takes ages or doesn't get agreed to, you could pay for private physio if your funds allow.

At your six week postnatal check with your GP, insist on an action plan to treat whatever issues you still have. Don't allow them to fob you off with 'watchful waiting'. By six weeks, you will know whether your body has healed to a satisfactory level or whether you still need things correcting.

Thank you for your reply @LulooLemon , it's very kind of you.

Do you think there would be further surgery they could do? As I've already had the initial op to repair the tear.

Thanks for the advice on pelvic floor physio referral, Im definitely going to push for that as soon as possible. Do you/does anyone know when the optimum time to start this post surgery?

Yes, I do think further repair is possible, depending on what the damage was and what has already been done to address it.

But each operation needs recovery time during which the tissues/muscles can heal. You need to give the operation you had had time to heal and become effective.

Imo the time to do physio is now. But the NHS may have other ideas, which will be linked to cost, not optimum results.

If you ask MN to move this to postnatal health, you might get more replies OP.

Wishing you lots of luck. Meantime, enjoy your lovely new baby.

You could also very legitimately consider legal action if the trust aren’t being extremely proactive re. compensation. These tears are unavoidable sometimes but identifying them and repairing them correctly at the time is the standard of care you should expect.

I had a fourth degree tear with my first (went on to have second vaginal birth and a second degree that time) but thankfully was diagnosed at birth. Spent 1-2 hours in theatre. I remember feeling like everything was dropping out when I walked, that took weeks to go. Also, a rush to the loo at times. Also my dh had to help me clean up after a poo - it was humiliating. I could not hold wind for months and sex was painful for almost a year (perhaps psychological towards the end?)

Anyway, I healed well and after post-op check I was signed off. 23 years later the only issue is it's sometimes difficult to wipe clean (sorry tmi) as my exit is all puckered.

I would say give yourself time to heal and it's better to stay home as much as possible, eating fibre, as constipation will mean strain on your stitches.

Thank you for the advice @LulooLemon

@SwayingInTime yes I think the fact that it was missed is surely a case of medical negligence? However for now I just want to get well ❤️‍🩹

@crossstitchingnana thank you for sharing your experience!

They've told me if I were to have anymore children it would probably need to be a c section delivery to avoid anymore damage to that area. I'm surprised how bad my Incontinence is seeing as it's classed as a 3rd degree tear as I've read stories of some ladies that have had 4th degrees and still had control.

I completely understand how you must have felt regarding your husband helping you clean yourself, it's such a horrible situation.

I honestly can't even imagine having sex ever again at this point, it must be so hard to get to that point even once everything has healed! I darent even look down there 🙈

Been told to not eat fibre for a while to slow things down but that's had its own issues..

Sorry if this is tmi question but- Did you get any general bowl leakage ? If so how long did it take to ease up?

Just wanted to send a hand hold and heartfelt sympathies. It is bad enough having such a painful condition without feeling that you have to keep it to yourself and feeling embarrassed.

I have had bit of anal surgery and it is hell for a few weeks but does amazingly heal!

@Mischance thank you, what you've said is so true. Its quite a lonely condition to have. I'm so glad you've healed well ❤️

Ouchhh

Not that I remember.

I also had a third degree tear but it was noticed at birth and went into surgery straight after birth (I also had forceps and episiotomy).
The immediate urge you have when you need to go is very normal. I would go from being fine to needing to poo straight away. Didn’t matter what I was doing even if I was feeding my baby I would have to stop immediately and run to the loo, otherwise I knew I would have an accident.
I’m now 16 months postpartum and that urgency has massively subsided.
I sometimes do need to get to a toilet quickly but for the most part I can hold for a reasonable length of time.
The hospital I gave birth in also booked me in for scans and checks about 10 months later to check the strength etc. everything has healed well but I have been told they strongly recommend an elective c-section if I was to have another baby.
you should get checks as well and if you haven’t been told anything about this, insist on it.
I can’t comment much on the leaking poo side of things. It may just because your injury was missed (I’m so sorry about that, that never should have happened!) and maybe it needs a little more time to settle and heal but I would definitely push to get that checked.
with regards to level of control and degree of tear, unfortunately it’s all about position of tear. My friend had same tear as me but can have another vaginal birth because her tear was in a different position and so healed better. Mine broke down a little bit and I had to have more antibiotics and the position meant it never healed as strong as before.
again I’m so sorry you’re going through this. It’s a horrible situation to deal with as well as try to look after a newborn. I found it almost unbearable and struggled immensely so here if you need to chat.

Hi, I'm so sorry to hear you've had such a rough time. Your birth sounds very similar to mine. I also had a back to back labour, forceps delivery, episiotomy and a 3rd degree tear.

I didn't have the leaking, but did have an episode of incontinence and some urgency for a while which at the time absolutely devastated me and I just wanted to say I totally understand how angry/scared/heartbroken you feel, and I remember vividly how frightened I was as well that it might have been my life going forwards. I was honestly more traumatised by it than I was the very traumatic birth. It was nearly 12 months ago for me now, and things are much improved. The incontinence and urgency resolved. I saw a pelvic physio - definitely do this as a start, but remember you're only 3 weeks post partum, be kind to yourself and give yourself time to recover. Don't put pressure in yourself to do anything/go anywhere/see anyone unless you feel ready and want to. Look after yourself and make sure you talk to someone if you need to. X

I had a 3c tear. Again, picked up on immediately and straight into theatre.

I had the feacal incontinence issues. I couldn't 'hold' it so shit myself frequently. I leaked pooh n'all. Every time I was on my feet it felt like my internal organs were falling out. It was vile. I was distraught.

The Post-natal care was dreadful. I wasn't given any info in the hospital or discharged with anything.

A friend of mine told me I should see a women's health physio. I got referred by my GP and had my first appointment with her 10 days after I'd given birth. All I did was call my GP - explain I'd had a bad tear and wanted a referral to a WH Physio. It was that straight forward and easy.

If I'd not had this input and waited for my hospital appointment - at the 12 week point (they did a scan to check healing)... goodness only knows what state I'd have been in.

I saw the physio weekly for almost a year. All on the NHS. She was amazing. She educated me about pelvic floor health. She helped me understand what had happened to my body and why I was incontinent. She helped me resolve it. I looked at lifestyle factors eg resting with feet up, exercises, I got various gadgets to help. No stone was left unturned.

It took several years, but I made a full recovery. I just occasionally get a heavy feeling when my period is due or have a cold coming on.

So, yeah, don't wait... phone your GP tomorrow and request an urgent referral to your local Women's Health Physio.

I should add... my control is spot on now. I run occasionally. I can hold off the runners trots (basically diarrhoea which you can't hold brought on by running) until I find a toilet! That's how good things are. So from shitting myself and leaking pooh... to controlling diarrhoea whilst running. Hopefully that'll help you understand, with the right care and support, you can recover from this.

So just to update incase there’s anyone following this thread who is going through anything similar.

I’m nearly 6 weeks post op now! Control is loads better, I usually have at least 10 minute warning (as long as it’s not diarrhoea!)to go to the toilet now which is loads better. It’s still quite difficult to go if I’m slightly constipated though so I try to watch what I eat.

Unfortunately im still leaking a bit throughout the day but it’s drastically reduced to the point I only need to wear panty liners now instead of those huge maternity pads. Unsure if it’s poo or mucus & weirdly only seems to occur in the daytime, don’t seem to leak at night. I’m obviously still really upset about this though , it’s awful to see every time I go to the loo. Im having regular gynaecology appointments & the consultant is confident this should stop or at least reduce even more.

I’ve developed some hypergranulation tissue on my sphincter repair wound- this is a horse shoe shape incision around my perineum which joins to my episiotomy. I’ve been treated with silver nitrate for this granulation but may need more. The wound is still really uncomfortable and I’m still finding it hard to sit on regular seats or sit down normally for a long time.

I have been referred for pelvic floor physio & rectal physio. If anyone has any experiences about this, particularly what rectal physio involves, please let me know :)?

Does anyone has any tips or suggestions on how to further reduce bowl leakage?

Also this isn’t on the cards right now but if anyone else has had a severe tear post birth and/or sphincter surgery when did your sex life resume 😅

Thank you for your lovely msg @Pizzaandsushi , I’m so glad you feel a lot better now 16 months pp. Its really interesting to hear other people’s experiences . Not really sure how they missed my tear as they found it straight away when I was readmitted to hospital. Have had an incident review/debrief with the hospital now and they have assured me I was checked after delivery.

Thank you for your kind message @SunshineIndoors123 , it’s just so scary isn’t it. Did you not need surgery then? What did the physio consist of ? Glad you’re doing really well 12 month pp!

@theaeae thank you for your kind response, it was really helpful to read & has given me some hope. Glad you're doing so well!! My post-op care has been terrible. Came out of hospital without a written plan , everyone giving me mixed messages when I asked for help etc.
So did you not need surgery then? Why were you told to rest with your feet up? I’ve just started doing some simple pelvic floor exercises using the squeezy app but I’m hoping the pelvic floor physio will start soon.

@Ouchhh I had surgery for the initial repair of the tear immediately after birth, but not needed anything more so far. Physio consisted of a questionnaire about symptoms, physical examination then she prepared a programme of exercises for me which when I did them religiously really helped. I went private, and she's stopped her clinic now so waiting for my first NHS appointment later this month and I've noticed a difference now I've stopped the exercises. I also likely have a very slight prolapse. For some mad reason we would like to start TTC number 2 in October, so I'm going to get back onto the exercises once I see the physio again because I want things before another potential pregnancy. I've been told I can have a c-section if I have another baby and I will definitely be going down that path next time. I know you asked about sex life resuming- honestly, it is nothing like it was before, but that is mostly because we're too tired half the time running round after a toddler! It's still a little bit uncomfortable, but I've been doing a lot of perineal massage which has really helped improve the scar tissue, so I can recommend that (as recommended to me by the physio). You're still very early days though (I think?) so don't rush anything, just take time to recover. Take care. X

How are you doing now OP?

Thank you for your response @SunshineIndoors123 it was really helpful to read something so positive at the time.

@Mumofonexo I'm doing a lot better in terms of my initial sphincter repair thank you. I have really good control again now, no leaking or anything! Honestly leaps and bounds of progress from my original post so if anyone is in a similar position reading this please keep positive it's just severe tears are verrrrry slow to heal in my experience.I am beyond beyond beyond grateful that I am no longer incontinent.
Currently using a pelvic floor machine everyday on advice of a physio which I think has really helped.

Unfortunately though I developed a peri-anal fistula due to the wound where they did the surgery (and where the original episiotomy was) breaking down. So I have to go for a further surgery to hopefully remove that in a few weeks! Also think I may have developed a food intolerance or something as I have had a really funny tummy over the past few months 💩
I will be so relieved when all this stuff is over.

In terms of my MH I do think I've developed health anxiety & possibly ptsd so I'm currently trying to get some sort of support with that. I constantly spiral thinking I have some other health condition linked to all this now. I struggle to talk about everything that has happened to me/ what is still going on and I feel a sense of grief every time I hear positive birth stories & because I do want another child in the future but not really sure I'll ever be able to get past all this. I have constant regrets about the decisions I made with my little boys delivery. I could go on ... but you get the gist. It's been bloody hard!!

Thank you for asking xxx

Also just want to add in case anyone is watching and wondering about sex after a severe tear (mine was 3C but on some of my notes it says 4th).

I've only just been able to do it & I'm nearly 16 weeks PP, I'm not exactly swinging from the chandeliers or anything but i can say the last time we tried it, it did feel a lot more like it used to!

I have scar tissue inside my vagina on the side of the original episiotomy which is what was causing pain. My physio showed me how to put pressure on this and massage it to help relax it and honestly it really helped!

I would say if you're struggling defo try that, don't put pressure on yourself to have penetrative sex but when you do decide to try make sure to use plenty of lube , lots of foreplay, start out shallow etc. also pelvic floor exercises.

Hi Op I’m glad things are on the up for you but I’m sorry to hear about needing more surgery ☹️ I also suffered a 3b tear 6 weeks ago with a forceps delivery and I can completely relate to everything you have said about regretting how my little boy came into the world. I honestly wish I’d have a c section but I found when I talked about it people would say things like it’s so much harder to recover from than a “natural birth” they clearly haven’t experienced the trauma we had to endure being stitched up from front to back..
like you mentioned about worrying about future problems from this I also feel the same way and it’s causing so much anxiety and stress, I’ve cried constantly since he was born.

Have your hospital mentioned anything about having a scan done to see if the repair was to a good standard? I’ve seen posts from others saying they got offered a scan and to be honest I’d like to have one done to stop the worrying.

what pelvic floor machine do you use? And does it help strengthen one area of the pelvic floor or does it target all of it?

I just wish they talked about all of this when you have your midwife appointments ☹️

OP I am really sorry to hear about all your awful experiences after the birth of your son.

When you next go to the doctor, just ask if they are completely happy that there's no other issues - whether it is possible that all the stress and trauma could have triggered an ibd for example. The only reason I mention it is because you say you have a "funny tummy" and a fistula and both of these sometimes arise in Crohn's disease. I believe my dd's Crohn's was triggered by an operation she had. It very probably is not this, but it's worth asking the question so you can be assured it's ruled out.

One other thing for anyone who's in this position - episiotomy scars often become troublesome in peri menopause and meno and so I imagine would this type of surgery. Do keep an eye out for things changing and if you do nothing else get vaginal oestrogen treatment (cream or pessary). Best of luck OP!

Sorry for being daft but what problems do episiotomy’s cause later in life?

@Mumofonexo I completely understand , I get so irritated by people talking about their easy births or their difficult births (as I always feel like I'm comparing my own experience) I don't think people can win tbh I'm just a bit bitter about the whole thing but it's hardly surprising really!

I'm so sorry you're going through it all as well, I remember how acutely it hurts physically and mentally at the stage you're at right now but I promise you it will get easier as time goes on, i know it's so difficult as I struggled and still struggle but the cliche that time is a healer really is true.

I tell myself to try not to worry about the future so much but to try live in the here and now a bit more. Are my symptoms improving - yes, do I feel better than I did last month- yes , do I know if I will develop anything further along the line linked to this, no, but I don't know I will either so there's no point worrying about it and stealing the joy of today. I'm saying all this to you but it is something I really do struggle with myself so I understand it's easier said than done. Be kind to yourself, we've been through so much.

Yeah I've had a pelvic MRI because of my fistula, the colorectal consultant mentioned my repair was holding up well but don't know if I'd have had one if I hadn't had further complications. Are you under consultant care or anything? You could ask them about it? Is there a reason you feel like your repair isn't holding up?

I would say you need to advocate for yourself as much as possible if you're not right, seek as much help and support as you can, I've found aftercare and communication has been really bad so it's been a constant battle and I've had to cause quite a fuss but I won't be fobbed off.

I bought the Kegal 8 ultra I think it's called, it's quite expensive but I was prepared to spend money on it if it could help. I use the probe that the physio gave me though as the one that comes with it is a bit of an odd shape. I'm not sure how it works or what it targets, but I can feel my pelvic floor tightening and relaxing so I think it must be working! The physio set a special program for me on it. Before you do any pelvic floor exercises I'd ask for some advice from consultant/physio/midwife- I was advised to not do any until I was 10 weeks to give chance for my repair to heal (I know a lot of people will advice to start much earlier than this but I think everyone's situation is different).

Also , I saw you post something about you having vaginal soreness/redness. This could be hypergranulation tissue. I had some on my episiotomy and inside my vaginal opening. Not saying this is the case for you but it could be a possibility.

I think if you haven't already I'd ask gp to refer you to a gynae consultant as it sounds like you could really benefit from their support.

Sorry for rambling, hope all this made sense! Feel free to pm me if you ever want to talk off this, you're not alone xxx

@MumofCrohnie thank you ❤️

This is definitely something I've thought of but anytime I've mentioned it I've been told it's unlikely. Sorry for the stupid questions but- Do you know what the signs of IBD are apart from diarrhoea? For example, what would my blood tests show? Can IBD be controlled by diet? Ive not had problems since I've been eating bland but obviously don't want to eat bland forever! Doing a bit of an elimination diet at the moment , introducing things slowly.

I'm having an ultrasound on my abdomen soon as my CA125 was slightly raised. The dr didn't seem overly concerned though.

Colorectal surgeon seemed sure my fistula is from my episiotomy/ sphincter repair breaking down a bit. It is in that place too. So hopefully he's right... 🫠

@margegunderson thank you for the advice xxx