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.

Oh hi! Sorry to hear about your tear. How far pp are you? Are you breastfeeding?

So recovery: a bit of a mix. Prolapse is a little bit maddening still but I have a pessary to wear which helps. Sex is fine, somehow better than before (!?). Saw a consultant who said if I keep doing my pelvic floor exercises I might get to my 70s with no bowel issues which I found reassuring. My scar still gives me some trouble but I squish a vitamin E capsule and do massage on it every night which helps. Urinary incontinence- hmm. Still a bit of an issue very occasionally if I leave it too long and then sneeze or pick the baby up, especially if I've got the pessary in. But if I'm being perfectly honest, not too much worse than before I gave birth. I was never good with trampolines or skipping ropes. And it's not frequent or serious enough that I would need a pad or anything.

If you're still having urinary incontinence issues some months on, make sure you get checked for prolapse (cystocele). Do not freak out if you have one. It is an inconvenience but your life is not ruined. Although if you've had physio and they haven't found one you're probably in the clear.

If you don't have one already, maybe try a Kegel8 machine? I got mine in the Black Friday sale and am a bit obsessed with it. If your incontinence is caused by nerve damage it can help with that and it activates more muscles than just doing squeezes alone. If you can't spare the money for one, make sure you are doing your squeezes in different positions. I used to do mine while feeding the baby so was always hunched forward, never exercising the back bit of my pelvic floor (hence bad squeeze pressure there). Now I do some upright, some leaning forward, some leaning back, some lying down with alternating foot slightly off the floor, just to make sure I get right into each muscle group.

I did do private physio as advised by pp on here. It was expensive but so worth it. Just nice to go to a place that smells nice and where the person has time to look at you properly when you talk.

I'm nearly 10 months on from my tear and would say I'm only just now starting to feel ok about it. I've had lots of therapy. I recently had to persuade my husband to get some too. But I am now happy and optimistic about the future.

I had a 3rd degree tear. 8 years on, my only issue is that I occasionally fart when I cough. But embarrassing but in the grand scheme of things could have been worse. I had to have a lot of physio through the gynecology department, though, in the first 18 months as sex was excruciating. It's fine now though, and has been for ages.

Thanks so much for your detailed reply @Bubbles332. I am 10months on as well.

I know things are better than at the beginning as at least I can stand up now without leaking urine, but I can't do walks or high intensity exercise. I am dreading going back to work- it's just so demoralising being incontinent in my 30s.

The physio has come to a point where they are not sure where to go next. Initially I had an overactive pelvic floor so was advised against kegels as it would increase tone. I've got in touch with gynae again for more diagnostics. I haven't had any particular tests done to explain this leaking (other than the physio working with the diagnosis of an overactive pelvic floor, causing pelvic floor dysfunction). I'm just desperate to get back to 'normal' and chase my children, go for long walks etc. It really gets me down.

The Kegel8 sorted out my fart-cough thing as well! (I swear I am not a Kegel8 saleswoman in disguise, I just really like it.)

Hi @ChopstickNovice can I ask what kind of therapy you were doing with your physio? I've been having manual therapy to release high tone but there doesn't seem to be anything more suggested now that's generally resolved.

Are you relaxing your pelvic floor properly after you exercise it, eg with Pigeon Pose or the figure 4 leg hold thing?

There's also those Contiform pessaries you can buy which you could try out but I get that obviously you want to resolve it forever.

I do get it. It's very annoying to be thinking about one's undercarriage all day and constantly having to shell out for it. If I had to add up all the money I'd spent on things under the umbrella of 'pelvic health' it would be a lot. With the NHS, you do unfortunately need to push and push for stuff, not because they don't care but because there's no capacity. Why haven't they carried out any further tests?

Also I'm in no way suggesting that you should put up with it, and obviously no woman should ever have to put up with incontinence due to birth, but I did find that moving my benchmark from 'I want to be like I was before' to 'I want to be like someone who had a non-massacre of a vaginal birth' as an ultimate goal, with smaller goals along the way, helped with my mental health and helped me give myself a bit more grace when worrying about going back to work etc. Like I'm never going to be able to hold a wee/poo for 4 hours like I could before, but I have been able to increase and increase the time to the point where I know I will be broadly ok if someone is on their break and I have to wait for them to come back.

Also I think it's quite out of order that the physios are saying they don't know what to do next. WTF? If they don't know, how are you supposed to know?

@Bubbles332 They have referred me for urodynamics (not sure what that will show) but I still haven't been called. I'm not sure what else to push for?

The NHS physio did suggest bulkamid but I'm undecided. I trialled contiform and diveen but didnt notice much differnece... I feel like I have no clear diagnosis/ reason why it's still ongoing.

And also maybe I am unreasonable and expecting too much too soon. Maybe I need to adjust my expectations and accept that my bladder just won't be the way it was. A shift in mindset certainly couldn't do any harm as I do think I've let this consume me more than the next person might. It's just a lot to deal with, as you sadly know too.

It does seem unusual that it's still ongoing. Could you see if you can see a different physio for a second opinion?

Have they said don't do any Kegel exercises at all or said just don't do the slow ones? Because my understanding was that the slow ones build tone but the fast ones train your pelvic floor to react quickly when you sneeze or cough or run etc.

Sorry for all the questions.

The problem I've found is that they sort of half follow things up. So they'll be like 'oh she's had a bad tear we'd better check her over' then you go get checked and they tell you that part of your body is wrong, but then after that it's just.... crickets. So you end up knowing that part of your body is wrong but then have to invest all this energy in finding solutions yourself. My private physio said I should change my middle name to 'Sphincter' because I've learned so much about effing sphincters and defects and function etc etc.

@Bubbles332 yeah they've said not to do any. I'm at the point of buying the kegel 8 and saying to hell with it, can't get much worse? Lol I'm just sick of it!

Another option is a second private opinion... best of 3 physios, eh? 🙄

Again, I swear I'm not a Kegel8 saleswoman, but there are settings for relaxing the pelvic floor and for improving blood flow to help with nerve damage etc etc, so it isn't just clenching. Even if it does nothing it'll make you feel like you're being proactive, which is half the battle innit.

@Bubbles332 yeah I think you're right. Worst case scenario I stay the same... so, do you have the ultra 20 or the less expensive one (tight and tone)? And send me your promo code 😆

Just DMed you.

They recommended manual stretching exercises (probably exactly what you are imagining) and I had a wand thing, that I inserted and when it wasn't painful anymore I went back for a larger one and so on.... They also showed me how to massage the scar tissue area.

11 years on from the same as you. Also had PTSD, PND and double incontinence.

Ok, so now it's much better. I still rely on lots of fibre to keep number 2s smooth, I had a really difficult few years when I needed daily laxatives, but that's less.

I still have a terrible pelvic floor and a prolapse. But I only have small accidents, not significant ones.

So yes, I do have permanent effects but it's not debilitating! I can carry on with my life as normal.

I had an ELCS for my second daughter. Was very easy and no long term effects. Also helped to heal mentally from the first birth, as it felt much more as though I was in control