Anyone still have a defect after 3rd degree tear?

[Bubbles332]

Hi all,
Really looking for some reassurance.
Had a 3b tear with my son's delivery 6 months ago. Generally fine recovery, was doubly incontinent for a couple of days but that cleared up. I developed PTSD and became a bit phobic of any internal exams immediately pp so I'm only just going to all my physio and stuff that I should have had before. Vagina is a clusterfuck, everything falling out, but I was convinced that bum would be fine because I don't really have any issues apart from having slightly less advance warning than before.
Endoanal scan came back that I've still got a defect between 11 and 12 o clock on the external sphincter but internal seems fine, no surgery will improve it and I should have ELCS next time and biofeedback. NOBODY WILL TELL ME WHAT THIS MEANS. Rang colorectal, they said ring GP. Rang GP, they won't see me for 3 weeks. I'm so upset I rang the mental health crisis line in my area, they said tell GP it's urgent but they still won't talk to me.
Google is in no way reassuring and basically says 3DT prognosis is good if you have a decent primary repair. But it looks like mine failed, no? Or is this normal? Presumably 11-12 is better than 9-12 or 6-12 but I don't really know. Does this mean somebody messed up with the sewing? I was bleeding to death at the time so it was all quite hurried. When I look at implications of ongoing defects it seems to be loads of women who have a horrible time with fecal incontinence then need stomas. These stories deserve to be told obviously, I'm not saying they don't. I'm just worried that I'm not as continent as I think I am and it's all going to go to shit (pun intended) when I go back to work. If I so much as fart when I sneeze I'm convinced that it's the start of it all going downhill.
So does anybody have an in-between story that isn't 'I had a great primary repair and am now back to normal' and also isn't 'my life is totally unrecognisable'? I would settle for 'I still have a defect but I had a bunch of physio and I put linseeds on my porridge in the morning and do my pelvic floors and it's broadly fine'.
I would be reassured by the fact that no health professionals seem to think it's particularly pressing to engage with me, but I've learned that that tends to be the norm with all things postpartum unfortunately.

Go back to the gynae for reassurance. Post partum physio would be helpful. Get referred for PTSD treatment.

Thanks for your reply.
I referred myself to talk therapy for the PTSD and it's finally come through the past month. It's helping. My therapist even rang the GP for me today and said please can they talk to me about the scary letter and they told her no, I can have an appointment in 3 weeks.

I've badgered and badgered the GP about the fact that I'm in constant discomfort from the gynae stuff and my scar still hurts months later but they classed it as routine, wouldn't see me for 3 weeks and then wouldn't refer until I called every day for another two weeks after that. This was a month ago and I've heard nothing.

I'm really disappointed tbh about everything- I am telling and telling health professionals that I am very upset and need more but I'm getting nowhere. There seems to be this attitude that my son's alive so I should be happy with that. (I obviously am but what a low bar.)

I've got a PALS complaint brewing about the colorectal dept at the hospital, but I want to wait until they're done with my bum first.

OK take some deep breaths. It will be OK. The comms around these tears are horrific and terrifying, but they are surprisingly common. I didn't even know such a thing existed til it happened to me, then the only specific aftercare I got was a leaflet saying I could be faecally incontinent or poo myself during sex.

I had 2x tears with my first 2 children 20 years ago ish, never been scanned but the first repair wasn't great and I'm pretty sure I have "defects". Not got a stoma or rectal incontinence, so just saying that to reassure you.

It took around a year for my scar to stop hurting and sex to be OK. The tears were harder to recover from than my ELCS.

There is some good guidance on RCOG about management of tears, I'll go and dig it out for you.

Sorry you are going through this.

Ah, middle of the road story is sometimes I can not hold in farts, I get some urgency if I need a poo and it's a bit harder to wipe up after than before I had kids.

Annoying, I wish it was not like it, but in the grand scheme of things it could be a lot lot worse.

https://www.rcog.org.uk/for-the-public/browse-our-patient-information/care-of-a-third-or-fourth-degree-tear-that-occurred-during-childbirth-also-known-as-obstetric-anal-sphincter-injury-oasi/

@CassieMaddox thank you so much. That is the kind of middle of the road story I need. Sorry about your experiences.

I really hope I can get to the point where this is just a bad memory (although obviously I know I will need to do pelvic floors forever, eat really well and won't be able to hold a poo all day at work like I used to.) I know I'm lucky the follow-up is so good but it doesn't help with moving on, especially when they just text me saying I've got an appt in 'colorectal' every few months and then won't tell me anything about it when I ring up. So I'm in a constant state of knowing something is going up my bum but never knowing what or how big or how long for or why. From my googling of 'biofeedback' I assume the next thing is a little balloon. Fun! I think it's fairly normal to have trepidation about that, it's not even a PTSD thing. Kind of wish I'd never had the scan now. I'm sitting here clenching my bum trying to discern if I can feel the defect .

Also I should add that I've got a really nice baby out of everything. Got so lucky with him, not refluxy or cry-y or anything. I wish I could enjoy him a bit more instead of just focussing on my mess of an undercarriage.

Aww poor you. Yes you will get to that point! The appointment probably won't be that fun but it will be done quickly. And if they can help you get back to normal it's all good x

Childbirth is brutal!

Ashley James on Instagram had a bad tear and experienced double incontinence etc after her first child, she documented in some detail her recovery and the steps she took - might be worth a look?

Thank you, I'll check out Ashley James. I feel less alone now.

The sad thing is this has all taken the shine off the memories of the birth now. It was actually just the birth I wanted (until the end when he got stuck) and I was initially really grateful to the doctors who yanked him out and then sewed up my bum for me, even though I was extremely traumatised from the haemorrhaging bit. Got great care at the hospital after, private room when I kept pooping all over the ward etc. Six months on I just feel really, really pissed off about the fact forceps were used and that I was put in a position of deciding what to do after hours of pushing. Had the hospital debrief and it just pissed me off more. Now this. Argh!

@Bubbles332
'Between 11-12' is the position of the scar, not the severity of the weakness. Imagine 'o'clock' after the statement. Read the report as 'There's still a small area of weakness on the perineal side of the anus. Not serious enough that surgery would be worthwhile.'
I hope this helps.

@ODFOx thank you!

So it's basically like if I had a dodgy knee that I'd had surgery for, but it still wasn't exactly the way it was before? But not bad enough to warrant further surgery, just a bit of physio?

Biofeedback is a physio device. They pop it in and you do your kegels etc and they can measure the muscle contractions and strength.

If you're internally ok, it's really just physio and time and that's why your GP isn't calling you.

I had a 3c and internal tear and haemorrhage and had an anal exam with ultrasound thing. Never ever had a problem since. Everything as normal as I can remember. Definitely weaker as I do zero PF exercises which is fucking stupid

I had an operation about a year after the birth to correct the damage as it didn't heal correctly. I actually went back to see a consultant (in the maternity department) to get it examined by them and they recommended the surgery. It was done as a one day inpatient and I've never had any problems since but i insisted on an elective c section for subsequent births and they were happy with this. I made the consultant write it in my file after the operation, that if I was to get pregnant again I could have a c section. Recovery after c sections was like a walk in the park compared to my first experience. But I will say I think the first birth left me with ptsd and I wish I had done something about it at the time. Take care of yourself and be kind to yourself, I didn't realise how much it had affected me til a long time after.

If you can afford it I would massively recommend going to a specialist pelvic floor physio who can help you with your recovery. During a "mummy MOT" they will check your PF function and can recommend tools / pessaries/ exercises to help you. They are also a fountain of info that you GP either wont know or wont have time to give you in a 10 min appointment.

In my experience GPs are shit for this kind of thing.

My tear was in no way as bad as yours. (was told 2nd degree but found out later I was only 1mm off a 3rd with internal tearing all the way up).
I've ended up with front and back prolapse. The GP when diagnosing it just said to do pelvic floor exercises and avoid alcohol and coffee.

I did a lot of work on my pelvic floor - Femfusion fitness on youtube has a great 30 day "kegel camp" where it really slowly goes though the absolute basics.

My sister in law had a 3C after her second and has recovered really well since getting into pilates which is very PF focused.

A friend of mine has a nightmare birth second time also where they destroyed her pelvic floor using Kellands forceps. With the help of a PF physio and some kind of electric wand shes doing loads better also.

Thank you! Yes I think I definitely need to see a PFPT. The NHS physio I saw put a head torch on when she examined my vagina, as if she was going caving, which I think says it all. I don't pee myself anymore since I started using a Perifit every day, but it's all still very prolapsey and disastrous. I feel guilty for spending money on myself instead of him, but I'll try to remind myself he doesn't know the difference between some expensive Baby Sensory class and a Stay and Play session at the church hall.

I was doing ok for a while, but there came a point where even my friends who'd had horrific EMCSs were up and about baby wearing and fully recovered and that's when I started getting annoyed and resentful.

I think also give yourself a break - you’ve gone through a lot and just bc they kick you out of hospital at speed it still takes time for your mind and body to heal and adjust. And the other thing is to allow ample time to recover and strengthen before you consider having another child. I had mine close together and that’s what really wrecked me. Nine months with a huge baby inside on top of a weak pelvic floor… even though the second was much better experience. Also I think that bf does help your body contract and return to its natural state.

I wouldn't even worry about spending money on youself and your current (and future!) pelvic health! At ALL! And mat leave is a great time to start investing the time in looking after yourself

What your son will remember is if his mum is able to chase after him, bounce with him on a bouncy castle, can carry him around and do stuff with him. Not all of that will be perfect (I still feel weird on a bouncy thing/a bit draggy before my period but doing the work early will really improve your confidence and quality of life afterwards.

My sister in law who had the 3C tear is happily running half marathons and 10Ks these days. The friend with the awful forceps delivery went from a 0/5 to 4/5 on her pelvic floor response after 6 weeks of a tbf quite intensive hourly program from her physio.

Honestly it's worth every penny making sure you are continent and able to be active as you get older.

@coffeeandfags99 no risk of another child at the moment. I'd have to have sex for that to happen
Tried at about 4 months pp and decided not to do it again until conditions had significantly improved!!

@Bubbles332 don't leave it too long, sex can help with pelvic floor you know and you want to monitor any other issues... but obviously get your GP's go ahead. You might want to ask them about topical vaginal oestrogen to help with healing and blood flow to the pelvic region as it is flipping excellent for leakage and weakness. Get the cream not the the pessaries which are irritating sometimes.

Thank you to everyone who has replied. I am really feeling a lot better today about everything and a bit more level-headed thanks to the responses here. I just need to remind myself that it takes time and work. 6 months is still early I guess? Hopefully in a year's time I'll be in a much better place physically and mentally.

Also learning that Google is not my friend as far as bum defects and prolapses are concerned.

I was doing ok for a while, but there came a point where even my friends who'd had horrific EMCSs were up and about baby wearing and fully recovered and that's when I started getting annoyed and resentful.

This was me! I was jealous, but felt ridiculous as I wasn't the one who'd had "major surgery" so thought surely I was missing something. I was pretty angry about it and kind of felt belittled for a long while, I'm possibly still not quite over it (I do SO much baby wearing with DC2 partly because of that I experience I think!). Having had a planned C section 3 months ago, I now know that's not easy either, it's just different. I'd still take a planned c section over 3/4 degree tear though.

My middle of the road story is that I went back to work with urgency, and was petrified about being far from toilets at 10 months pp, but I've had zero accidents and urgency is SO much better now (DC1 is 2.5 years old). I don't really do kegels, I do other exercises from women's physio and it's helping massively. I still get prolapse symptoms and suffer from bad constipation, and I know BF is making symptoms worse, but honestly it does get better.

Spending money to get both your strength and confidence back in your body again will also pay back in more ways than you can think of right now, it's so much more valuable to both of you than a baby sensory class.

Hello!
Just wanted to update this because I wouldn't want anyone who's just had a third degree tear to find this thread and freak out.

Booked a Mummy MOT as a PP recommended. Wow! She gave me loads of exercises to do that weren't just kegels and lots of practical lifestyle advice to keep the gynae issues under control. She also gave me a pessary which fell out on the way home, ha, but I've actually had a few days with no symptoms anyway. She said the defect isn't great obviously but there's loads of exercises you can do to make it as unnoticeable as possible.

Complained to practice manager of GP about how every women's health issue I go to them about is classed as 'routine' and nobody will ever see me in a timely manner. I said I couldn't conceive of a situation where a man would be sent a letter saying he had a mysterious defect in his body and nobody would spare 10 minutes to meet with him about it. Got an appointment earlier this week with a very nice doctor who totally got it- she said it wasn't good enough that my birth hospital hadn't made an appointment to follow up on the letter and has re-referred me to them. Also referred to a urogynaecologist. She wants to see me every 4 weeks to check in on the mental health stuff as it is likely I have PND secondary to the PTSD. Was so nice to see someone who gives a shit.

I feel like it is going to be ok.

Hi @Bubbles332. Just wanted to ask how things are going now? I am still suffering urinary incontinence months after my baby's birth (&3b tear) and I don't know what to do next. I have been to lots of women's health physio sessions and although things are improved I can't see it ever being 'normal' again.