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Original poster

3rd degree tear or sphincter tear?????

58 replies

bubblebell1 · 05/12/2006 12:27

this is a rather personal problem and i was wondering if any of you have experienced the same or heard of someone with the same prob.

during my previous labour i incurred a tear in my sphincter (please excuse spelling). it was very very painful and after 15 months i was finally operated on and the muscle was repaired.

at my 30 week check the midwife mentioned, after flicking thru my notes, that this may cause trouble with my bottom again. baby is large and muscle is weak after having operation.

if i tear again it is unlikely they will be able to repair the muscle as it leaves a high risk of incontinence

then that was it. no come back see a consultant nothing, i do have an app at 36 weeks for a growth scan but i wondered what you would do. its awful being left in limbo.

any advice would be gratefully recieved

thanks xx

OP posts:
incy · 06/12/2006 17:35

The consultant did say to me that they usually left the choice of delivery open until 36 weeks ish (when they do a growth scan) because a lot of women's decisions rest on the size of the baby (lots of women tear with a big baby although I has a 3rd degree tear with a 7 lb baby because his hands were up so you never know!).

Perhaps this is why they have left it so late (but they should have told you this).

But basically it is entirely up to you. So think what is best for you. For what it is worth my consultant was very nice.

Original poster
bubblebell1 · 07/12/2006 08:45

thanks... am off to hosp now for appointment and am so nervous never slept a wink and feel sick i will however let u know what they say

OP posts:
spudballoo · 07/12/2006 09:33

Hope it goes well for you. I had a 4th degree tear with a 6lb 3 baby, and was told in absolutley NO UNCERTAIN TERMS by my colorectal consultant that any future babies should be delivered by early section. A section will protect your pelvic floor muscles, but not your pudendal nerves (nothing can protect you against damage to those, you just have to hope for the best!) but any amount of labouring can cause damage, often unseen and without obvious effects, for many years if you're pelvic floor has already been damaged.

So a section it is for me. I'm desperate to lose the colostomy bag I currently have as a result of my 4th degree tear, and protecting my weakened pelvic floor is absolutley my priority. And no arguments from my obstetrician, but then I'm going private and they don't argue with anything ifyou throw enough wonga at them....

Good Luck! xx

incy · 07/12/2006 09:57

Good luck Bubblebell. Let us know how you get on. For what it is worth I have opted for a c section (NHS) and the consultant left the choice entirely up to me.

Original poster
bubblebell1 · 07/12/2006 14:18

it was awful. no conclusions were drawn and i have been told to wait until i am 36 weeks to discuss it again as this is the hospital procedure. the dr i saw said there was no chance it could happen again.and that if i already suffer with fecal urgency then not to worry to much because im already having problems. i asked him to explain and then he said well its not like u are working perfectly in that dept so dont worry about it.
he then went on to say well by the time your 36 weeks something terrible mite happen and then u will have to have a cs anyway.

i feel deflated and emotional and feel like nothing has been sorted.

i had a list of questions and went thru them. he spoke over me and when i left the room i was intears.

OP posts:
mears · 07/12/2006 14:29

bubblebell1 - here are the guidelines for 3rd degree tear management incase you didn't see them on the other thread. If you have ongoing problems it is reasonable to have an elective C/S this time round. Infact, even if you didn't have ongoing problems you could have C/S if that is your choice. No-one can guarantee that it won't happen again. I have seen women with previous 3rd degree tears deliver with no problems at all. Everyone is individual though.

Spud - why do you have to wait till you stop breastfeeding before reversal?

incy · 07/12/2006 15:55

That is awful - I think you should ask (demand) to see another consultant.

As I have already said I had a similar meeting yesterday (3rd degree tear last time) and my consultant said the choice was entirely up to me. He said there is an increased risk of a third degree tear happening again (I think he said 10%) and there is a (small) risk of further damage (about 1-2%).

I have opted for a C section but was told if you change your mind we will support you either way.

He did say that decisions were not usually made until 36 weeks because size of baby may be a factor when women make their decision. Also there may be other factors which meant a C section was my only option (ie plancenta previa).

However I was certainly allowed to opt for the C section before 36 weeks - I did say I was really worried about the whole situation and wanted a decision to be made there and then.

I am quite shocked by your experience - could you go and see your GP and ask to be referred to another consultant?

I did experience some very unsympathetic midwives but I must say my consultant was lovely.

Thinking of you.

queenceleste · 08/12/2006 10:18

bubblebell, how horrible and confusing for you. Do you have a good relationship with your GP? I would get an urgent appointment and tell her/him what you've learned here - maybe he could wangle another referral somehow. Or at least you could go through all the information with the GP and say you are not at all reassured and are not happy just to leave it.
All the best to you and hope something can happen to help soon.

uwila · 08/12/2006 11:03

Bubblebell1,
This is outrageous. They are messing you around, and that popus doctor should be written up for his unwillingness to sympathise with the patient very real concerns.

Do you want a section? If you do:
1- they are not that bad... really! Certainly better than the tear you described.
2- You need to put it in writing and ddemand one. Tell them under no uncertain terms that if they refuse to schedule one then any consequences will be a result of their action, not yours. Write it loud and clear on your maternity notes and mention to the consultant at 36 weeks thet you have a copy of those notes. This will probably piss him off but it will get you a section. Make sure they know that THEY are liable. Then, see if they suddenly have a different view.

CAT me if you want. I had an emergency section, and then was encouraged to go for a VBAC , but I refused loud and clear.

What hospital are you going to? I suppose it is too late to change.

Original poster
bubblebell1 · 08/12/2006 17:16

thanks so much for your support.

its a real mess at the moment. i think a cs would b better.

but i was thinking of approaching it differently.

i suffer with feacal incontinence and wondered if this alone without regard to any previous anal injury would be grounds enough for me to have a cs. if possible damage to my pelvic floor and anal muscles could worsen my existing condition then surely that is enough.

i wanted to be able to inform the dr that altho there is a chance it may not happen again i dont want to suffer any more than i do now. without medical jargon i can say that i am not a professional in this field and dont wish to be bamboozled with technicalities and that een a slight risk to me is more than enough to sway me to a cs.

i hope this comes across right.. and not the confused ramblings of a pregnant woman.

OP posts:
Original poster
bubblebell1 · 08/12/2006 19:17

bump

OP posts:
jenwa · 08/12/2006 20:04

bubblebell1
I had simular experience with 3rd degree tear but recovered quite well.
I would def have c-sect next time and feel that you are abe to make your choice and tell the dr that that is what you want, they can not refuse your choice. Most Drs prefer C-sects anyway as they are often quicker.
I hope you get the birth you want especially 2nd time round as you are more aware of the consiquences (sorry thats not spelt right!)

incy · 09/12/2006 10:55

Would suggest you make an appointment to see the most sympathetic GP at your practice - explain your concerns to them and what happened with the consultant.

Say and that however small a risk there is you are not willing to take it - ultimately it is you who could end up with major problems (ie a colostomy bag/anal incontinence) and so only you should make the decsion.

Get the GP to write a letter to the consultant saying all of this and stating that you want a c section. Agree with uwila that would be worth a mention in the letter that you will hold the hospital responsible if they go against your wishes and a natural birth results in damage.

Could you take someone along with you for support - both to your GP and any further consultants appointments ? I took my husband to the consultants - he is not a Dr but has a science background so could explain things to me and was very firm with the consultant (although he was very nice.)

Might be worth checking it is actually the consultant you have seen - often a senior house officer will see you at these appointments(they work for the consultant)

Original poster
bubblebell1 · 09/12/2006 17:09

i have an app with the midwife mo so will discuss it again with her. she agrees and if it was down to her i would of had my mind put at rest weeks ago.

unfortunalty it looks like i will have to wait 5 weeks to get a definate answer

still if any of you ladies know women who had cs due to incontinence not caused by tears it would be most appreciated
xx

OP posts:
uwila · 11/12/2006 09:05

Have you marked up your maternity notes and copied them? Please do this. At least state that you are very concerned about the possible risks associated with natural delivery and aren't really happy to wait so long to schedule a section. Make it clear you want a section. And then, if you should happen to change your mind I'm sure they'd let you go for a vaginal delivery (as this is what their stats will prefer). But, definately push to get a section scheduled so it's there is you want/need it.

BTW, QC (where I had my second section) also wouldn't schedule the section until 36 weeks. I hated this and was a nervous wreck until it was scheduled. I felt 36 weeks was way too late to be making a decision. Why why why do they insist on adding to a pregnant woman's stress??

Good luck. Let us know how your appointment goes.

bctmum · 11/12/2006 09:09

bbell1 - just to give you support through this. Shocked at your drs appointment. Agree with the others on going to your gp.

lulumama · 11/12/2006 09:14

birth trauma association...women on here with experience of this who you can email......

am appalled you have to wait 5 weeks..that is absolutely disgraceful...........

expatinscotland · 11/12/2006 09:17

I would complain about this doctor to the GMC. Honestly, he's beyond unprofessional.

I'm on your behalf!

You are still experiencing serious consequences to your health as a result of the tear - not to mention the major surgery you needed afterwards.

And he's poncing off about stuff?

Honestly, people like that have no bloody business in medicine.

Original poster
bubblebell1 · 11/12/2006 10:59

thanks very much spoke to my midwife and she is much nicer, spoke about an elective episiotomy and such like.i still would prefer a cs. i have photocopied all my notes and i have asked dh to book the time off work to attend the next app with a dr. (i mite not even see this man again there are 2 drs in my team at the clinic and whoever picks your notes off the pile first sees you!)midwife explained why they mite be reluctant to perform a cs but said i can ask and if i explain all my worries then she cant see why it would be a prob.

lo has moved tho at 32 weeks gestation to the breech position. think that dreadful dr jinxed me when he said last week thateverything mite go wrong and i need a cs anyway.

thanks again tho you all have given me extra confidence to stand up for myself because it seems that whenever i see someone in a white coat i revert to acting like my 5 yr old

OP posts:
expatinscotland · 11/12/2006 11:07

'Might be reluctant to perform a cs'

On a person who had to have bowel reconstructive surgery as the result of a tear?!

NO. That's bolleaux.

I'm w/uwila, I'd pull no punches that you are to have a CS.

You still have faecal incontinence, and they're reluctant?!

To hell w/that attitude!

I'd write them a letter, recorded delivery, stating that your wish is to be delivered by CS and NO OTHER WAY.

I don't see where elective episiotomy would make a difference. It's still possible to tear.

It's utterly ridiculous that you even have to do this.

I think having your partner along at the next appointment is a VERY good idea.

Keep fighting your corner! This is YOUR BODY and YOUR HEALTH here.

puccaupunderthemistletoe · 11/12/2006 11:17

Bluebell...
i had a 3rd degree tear with my dd (now 3) and had a elective c-section with my ds (18 weeks) i can't remember exactly when it was discussed but i know it was a lot earlier than 36 weeks (i actually got my section date at 36 weeks) i do have on-going probs though (bowel urgency every now and again since my tear)which i have to go and have investigated now ds is born.

Ds ended up being a big baby was 9lb 6oz at 38 weeks (ended up going into spontanous labour but still had a section).

The section itself was fantastic (obviously was quite painful certainly not a walk in the park ) nothing compared to what i went through after my tear (even managed to have sex 6 weeks after section, was 18 months before i let dh near me after my tear).

If you want to know anything about the section, just ask.. but i would certainly would want to discuss options NOW if i was you.

HTH

puccaupunderthemistletoe · 11/12/2006 11:17

Meant BUBBLEBELL lol.

puccaupunderthemistletoe · 11/12/2006 11:19

Forgot to add, my consultant read my notes and listened to what i said, and she advised that in her opinion a section was the way to go, i had decided not to push either way but to go with what consultant said.

Original poster
bubblebell1 · 11/12/2006 11:27

thanks pucka

i thought i should wait and see what the drs say but each say different things 1 said big baby and this fool from the other week said no it isnt and that get this i have big hips so it will be fine.

the hospital is due to close and has a poor history.

my dad is in the process of taking the trust to court.

i seem to swing from being angry with them and feeling that he is a professional so should know better and perhaps its me being neurotic.

OP posts:
uwila · 11/12/2006 12:53

Why are you going to this hospital. I know it's really late in the game, but if I were you, I would refuse and I wouldn't give a toss if anyone told me I couldn't.

Where do you live?
What is the hospital?
And what other hospitals are in say a 10 mile radius?