3rd pregnancy, fecal incontinence, feeling horrible and scared....

[misswyoming]

I had a 3rd degree tear with dc1, a vaginal birth with 2nd degree tear with dc2, and am now 31 weeks pregnant with dc3.

I have been suffering with terrible wind, and today lost control of my bowels. It was horrible, I had no sensation that I was going to poo, and could not stop.

I haven't really had any incontinence issues since having dc1 (4 years ago), apart from the first couple of weeks after giving birth.

I have never been internally examined to make sure everything healed properly, and am now panicking that something is wrong, and I will be left incontinent after having dc3.

I have been told by my consultant that the hospital don't do elcs for people who have had 3rd degree tears, and today has left me terrified of what could happen if I sustain another tear.

Has anybody else had any similar issues - I am feeling really low.

thankyou

Have no experience so no real advice to give other than to suggest going and see your GP and/or midwife asap and tell them about your concerns. And so easy to say I know but try not to worry.
x

i would def ask for a referral to the consultant if they arent already doing so. i think telling your midwife about the fecal incontinance youve had is a good idea, it could possibly mean some kind of prolapse? thats all that i can think of. either way, call your midwife, explain what happened and ask for a ref to the consultant to discuss through managment and birthing options

Thankyou.

I am going to call the Midwife this morning, I felt so down last night, it is such a humiliating experience, thankyou for posting back to me.

I did everything I could to avoid having a cs with dc2, and now I am worried that that was the wrong thing to do, and I am going to end up being incontinent.

The hospital I am with now seem very anti cs, so I don't even know if that will be a possibility.

There's a thread on MN for people with 'ragged bits'. I'm not on it but they seem a friendly bunch who have unfortunately been through some difficult experiences as a result of childbirth.I hope they don't mind me linking to them but I thought they might have some advice or just support for you. Ragged Bits thread

It sounds like you're going through a pretty tough time at the moment. I hope you find a HCP who really listens to you. Good luck.

Have you TOLD your consultant what is going on? or does he just think youhave a tear with no side effects

Thanks for the link Omricon.

Colditz, I spoke to a consultant at 16 weeks, who asked a few questions about the tear I had with dc1, I explained that I hadn't had a physical examination, and that I hadn't really had any problems with fecal incontinence (which was the case then), and she said that because I had had a vb with dc2, I would not be eligible for an elcs, and she would see me at 38 weeks.

I had dcs 1 and 2 at a different hospital, and saw consultants at regular intervals throughout my prgenancies. They seem a lot less keen to see me here (the consultant barely looked at me in the 5 minutes I was in there), and it is very difficult to get hold of my MW.

It is only in the last few weeks that I have been really suffering with constant wind, I don't know if this is related, but again it is something I have no control over.

Have just spoken to the mw on the phone, couldn't stop crying, I feel like a bit of a wreck.

She is going to make an appointment for me to see the consultant again.

Have to run to take ds to nursery, but just to say I am going through something similairish in that I had faecal incontinence after ds's birth for 8 months or so. The consultant I saw after the birth for a debrief was clear that that is grounds for an elcs - at my hospital at least. I know it is horrible, but when you see the consultant I would be absolutely clear/graphic about what is going on. DO you know when your appoointment is?

I have a similar thing going on, although slightly different.
I'm currently 31wks with DC4, and since my last pregnancy I have what I think is a slight bowel prolapse, although the dr said it would all sort itself out... It has not!! I was too embarassed to go back again, so I'd been coping but just recently I have been struggling with it again (I presume its worse due to pregnancy pressures). My problem is actually teh opposite of yours, I struggle to go to the toilet, and its making me feel constantly sick.

I talked to the mw about it on Monday, she told me to go to the dr, so I've got an appointment this afternoon! Unfortunately my appointment is with a male dr, so I'm a little concerned I will get all flustered and embarassed about the whole thing

Hope you get some answers, I know how embarassing it is to even acknowledge you've got a problem! xxxx

misswyoming, is the mw going to call you and tell you when your appointment is?
i think you need to push the matter, as you need to see someone asap

had a 4th degree tear myself so iknow about these sort of problems, i really feel for you.

Im glad the midwife listened and got you an appt to see the consultant sooner. i think you need to be brutally honest about how its making you feel. a friend of mine had a slight prolapse after DC4 and ended up having a csection with DC5 (she also had extremely severe SPD) and they also fixed her prolapse at the same time as the consultant didnt want her to delivery and make the prolapse even worse so they did the csection and fixed the prolapse at the same time.

i really hope you get someone who listens to you, im not sure the guidelines, but theyd have to checked what kind of prolapse if thats what it is (sounds like something similar if its not that exactly) and if your safe to do a vaginal delivery.

good luck, keep us updated

Really push them as much as possible. Be as graphic as you can and don't be embarressed. I am having an elcs for DC2 in June as my bladder is still dodgy after rotational forceps. I know some injuries worsen after menopause too as the hormones change in your body so be very pushy about longterm risks v.shortterm risks if they are pointing out the benefits of vb over elcs risks.

At one point the royal college of surgeons were recommending elcs for women who had had 3rd degree tears as standard. That may have altered now but without having had scans to check the sphincter strength I don't think the consultant should be gambling it'll all go easily if you have reservations.

In this situation I would read up as much as possible on the risks of an elcs in general, and the risks of an elcs for either rectal prolapse/anal muscle damage - whatever they think is the cause of the wind and faeces loss - and then push for whatever you feel is right for you.

You have to manage the day to day consequences and while there are treatments and surgeries it is really important that they don't dismiss this as something minor. It might fix easy or it might not. Squeezing a baby through your pelvic floor weakens it too so maybe consider whether the remaining strength there is worth preserving.

If your consultant ignores your concerns get moved to another consultant asap. Also consider asking for an appointment immediately with a colo-rectal consultant or whoever specialises in this area for your hosptial. A few quick scans might make the decision clear for you.

Thankyou so much for your kind replies.

My MW just called and said that the consultant can see me on Monday, which is good. She has also referred me to the physio, which I guess is for a pelvic floor chat, although I have been pretty religious about pelvic floor exercises since having dd1.

I don't really know anything about prolapses, so will have a google, whilst trying to not scare myself further!

I have had to harangue my way through medical situations in the past, having to fight to be listened to, I just feel like I have had all the stuffing knocked out of me.

I'll let you know how I get on. Thankyou all again, Mumsnet is truly wonderful sometimes

misswyoming I feel for you I really do. I am 37 weeks with DC3 and I had a 3rd degree tear with my last pregnancy. I saw my consultant at 20 weeks who recommended a CS, I was unsure so he referred me to see a Colorectal surgeon for a scan of my sphincter. As it happened I wasn't scanned as the surgeon said that he didn't want to put me through that whilst PG and from my symptoms, not being able to hold in wind and urgently needing to go to the loo plus the fact that I'd had a previous 3rd degree tear and have large babies that he would definitely recommend a CS as if I had another 3rd degree tear it would more than likely do irreversable damage ie I would be incontinent.

You really need to make your consultant listen to you. I can't believe how insensitive they are being.

lovethesea, any chance of you posting the link for that recommendation? (need it for friend!)

OP, big sympathies! I had a 3rd degree tear, and, like you, suffer from flaturs/faecal incontinence (oh the glamour! oh the fun!) But I was really pushed toward elCS, to the point that I really struggled to make them listen when I said no (it wasn't the right choice for me, very personal decision)

I am amazed (and shocked and upset for you) that they are not being supportive. I agree with all other posters that you need to be very clear. Don't be coy, I know it's awful to talk about (esp with male consultant) but really it's the best way. (and umm, if you cry that prob won't hurt in terms of them seeing how upset this is making you?) I can strongly recommend a referral to a colorectal surgeon, they tend to be the experts in this area (and mine has never examined me when pg if that helps)

I do recommend the ragged bits thread. Will you let us know how you get on?

Link to advice on repairing tears and future birth plans:

www.rcog.org.uk/files/rcog-corp/uploaded-files/GT29ManagementThirdFourthDegreeTears 2007.pdf

Royal College of Obstetricians & Gynaecologists. The future birth points are at number 12 of the article.

Hope it's helpful.

The main points on future births are:

1. All women who sustained an obstetric anal sphincter injury in a previous pregnancy should be counselled about the risk of developing anal incontinence or worsening symptoms with subsequent vaginal delivery.

1. All women who sustained an obstetric anal sphincter injury in a previous pregnancy should be advised that there is no evidence to support the role of prophylactic episiotomy in subsequent pregnancies.

1. All women who have sustained an obstetric anal sphincter injury in a previous pregnancy and who are symptomatic or have abnormal endoanal ultrasonography and/or manometry should have the option of elective caesarean birth.

Bless you LOvethesea

Thankyou Lovethesea, I will print off that list and take it with me, to give me something to focus on when I go to see the consultant on Monday.

Mampam, can I ask how did you deliver your 2nd dc? I was so desperate not to have a caesarian with dc2, partly through fear of having a major operation, and partly fear over how I would look after a newborn and a 14 month old. Now I am worried that my decision may have just put too much starin on my already 'ragged bits'. I don't remember future continence issues being discussed at the time then - the focus seemed to be about preventing tearing again.

Bollocks, I had namechanged due to huge embarrassment, which in hindsight is probably silly, but forgot to change back! So, I am misswyoming, thankyou again everyone.

Let us know how your appointment goes if you can - I've made my choice and with 4 weeks to go I am feeling confident it's the right one for me, but I am still askance at how different the advice/best practice is across the NHS.

Hope the weekend is restful and that you get the answers and clear guidance you need.

good luck with your appointment

Just to let you know, I saw the consultant today, she was very dismissive of my fears, and said that as the damage is already done (she said I would almost certainly need corrective surgery to my back passage after having dc3), then a c-section would not prevent further continence issues. She also seemed convinced that I would not tear again, (despite having torn twice), and that having an epsiotomy would be enough to prevent a tear (despite having had an epsiotomy both times previously). Eventually, she said that she could understand why I was terrified of giving birth, and set a day for a c-section. It felt very strange to be arguing for something which I am, tbh pretty scared of (a section), but at the same time, my fear of tearing again, and causing even more damage is overwhelming.

I have had a couple of 'close thing' incidents, which has left me pretty fearful, it is such a horrible thing to deal with.

Thankyou so much for your support, especially the link you provided, Lovethesea, which I used when talking to the consultant. Despite being on the verge of tears and shaking quite considerably, it gave me real strength to be able to have even a small amount of knowledge to back up what I was saying.

Glas you have the elective planned and well done on sticking to your guns

I'm in very similar circs to you, except my consultant favours the elective and has sent me to see a colorectal surgeon (awaiting results). I had a traumatic delivery with dc1 resulting in incontinence. Because the advice was less definite then, I had the choice of an elective or a a vb with dc2 (had a good vb with epidural with no trauma sustained) but there is no doubt my pelvic floor and bowel control is worse in my third pg.

It IS now the advice from the Royal College of Obs to have a elective following damage to the bowel and/or fecal incontinence and any colorectal surgeon would advise the same.

And your consultant is quite frankly wrong re the damage already being done; childbirth can make an existing problem worse. My consultant has given colostomy bags to women whilst waiting for bowel repair - she has definitely come to change her opinion. And those involved in gynae need to think about the impact post-menopause, not just the immediate outcome. Most cases of incontinence postmenopausally are as a result of childbirth.

Ensure too you get good follow up with the Colorectal dept and also Women's Health regarding your pelvic floor. If your consultant is not hot on this I think you can bypass with a referral from a sympathetic GP.

Current advice from NICE is that ALL women who have had a third degree tear be offered an ELCS, if ANY degree of incontinence is present.

Your consultant was being obstructive - and wrong, and ANY damage to the rectum is going to get worse as you age, typically worse after the menopause.

Have same issue myself, previous DC were born before the recomendations changed, so ELCS not mentioned, but have app to discuss ELCS at 20 weeks and it seems standard.

BTW, read up on this, old thinking was, section was big op, and to do this to avoid another 3rd degree tear was stupid, however, it turns out that actually, even if an ELCS goes wrong and needs further operations to sort out problems (such as infections, perforated bowel etc), this is rarer than problems caused by increased bowel/anus damage during birth, and much easier to sort (fecal problems are very difficult to sort out).

You could change consultant......