Episiotomy that did not heal shut?

[salixbabylonica]

I've been searching for a while, but haven't found any helpful advice for my particular situation.  I was hoping there would be someone out there with experience in a similar situation.  I'd be grateful for any advice for how to heal from this, either physically or mentally. 

Here's my situation, I'll try to cut a long, miserable story short:

My homebirth was in August 2010 (so son is 15 months). After long, unpleasant labor (silly me, I didn't expect continuous pain for 24 hours), and pushing for what seemed like forever, I ended up asking for an episiotomy, which the midwife consented to because they lost my son's heart rate.  Baby was 9lbs 8oz, first birth for me.  She cut me twice, says that it was smaller than a typical hospital episiotomy.  After ensuring that I wasn't going to bleed to death, the midwife transferred us to the hospital within an hour of my son's birth, due to what we later found out was a heart defect.  Left baby there with his father, I went to midwife's house to be stitched up.  Labial tear, vaginal tear, episiotomy with some tear extentions.  I went back to the hospital to be with baby.

We spent the next two weeks in the hospital for my son's surgery/recovery, which involved lots of me shuffling in agony down the halls so I could be with him.  Sometime during that time, I snapped the stitches on another part of the tearing, but that loosened the stitches on the episiotomy.  When it eventually "healed" about 7 weeks pp, the lips of the cut only sealed together partway up. My midwife said she wasn't able to re-stitch, referred me to an OB/CNM practice.

I also had hymenal ring fragments hanging down out of my body, getting irritated and would not heal.  So, 3 months pp, went to the OB/CNM's and had one of them cut off.  The second one only hangs out of my body when I sit, not when I'm lying down, so I didn't realize it needed to come off too (though probably it only does this because my vaginal opening is so much bigger now).  I couldn't go back to have it removed too, because I lost my insurance and we can't afford to pay out of pocket for it.  The CNM who examined me told me that the episiotomy not healing right wasn't really that bad at all, in a year at the latest I'd be back to normal, able to enjoy sex again.  She made it seem like re-stitching the episiotomy wasn't even an option at that point.  And that it didn't really matter anyway, since I wasn't experiencing fecal incontinence. 

Well, suffice to say, that hasn't happened.  The episiotomy cut, where it did not seal together is extremely sensitive still - I can't be touched there without cringing.  It's not like it's agonizingly painful, it's just intense discomfort.  Sex is still either uncomfortable or merely at very, very best, mildly pleasant for a few seconds, then feels like nothing.  My husband is very understanding, but this is definitely causing tension in an otherwise great relationship.

I feel like I'm permanently mutilated, that my vagina's been ripped to ribbons, that my perineum is going to act like a notched plastic bag and tear straight down what little's left of it with the next pregnancy.  I really want the episiotomy cut stitched back together, but it seems like it's impossible at this late date.  So, do I just accept that my chance at an enjoyable sexual life ended at 25 with my first birth, or is there any hope that this will get better eventually? 

Maybe the problem is "all in my head," but if so, how do I make it better?

[somelady]

ok, I don't know too much but since no one else is saying anything..... I think the thing you want to look into is having the scar "revised" or perinealplasty (sp?) where they recut and resew it.

From your description (sensitive scar that the provider says is ok and sex problems) you may also want to look into pudendal nerve damage, but that requires a seriously specialized person (if you're marylandish I can recommend someone). Especially if while you said you don't have fecal incontinence you are having problems in that department too. The nerves for all that stuff are linked together.

[salixbabylonica]

somelady, thanks for taking the time to reply.  Is this really that rare?  With the number of people who end up with episiotomies, I thought there would be more people who've had this problem. 

I guess I'll go back to the OB practice and ask, though I doubt they'd recommend the surgery now, since they didn't at 3 months pp.  Not that I could afford the surgery even if they'd do it.   

Anybody out there have advice for how to come to terms with something that can't be fixed?

[Sarasyn]

I actually have an episiotomy scar that never healed right.  No one has been able to tell how it happened, but both my past midwives have said it looks pretty irritated and it's still quite sensitive.  Sex has never been the same, not even close.  Most of the time, it hurts.  When it doesn't, well, let's just say I've never been able to enjoy it quite like I have before birth.  Thankfully, my fiancee is very understanding where my ex-husband was definitely not.

I can't say as I understand you on the rest of it, but I was beginning to think I was the only woman in the world with scar tissue that didn't heal right.  I guess I can kind of say I'm a bit relieved to know I'm not, but I'm also sorry you have to go through it too.

For me, I've been living with this painful scar tissue since my daughter was born, which will be nine years ago in May.  I've talked to several doctors, but no one seems to know of a way to fix it.  It's just a matter of living with it.  It hasn't been easy, and to be honest, I really do feel like a mutilated woman.  I feel like less of a person because I can't enjoy something so natural and have even considered writing off sex entirely.  I've been suggested to use a lubricant for sex, or to research oils that might soothe and help the elasticity of the scar tissue, and it's helped, but it hasn't entirely solved the problem.  It's made me completely avoidant of sex, which has seriously caused complications in my relationships.  It's certainly not an easy road to travel, feeling like I'm somehow damaged goods.

It's not easy to live with, but through it all I've still found a way to have two more kids, and I'm pregnant with my fourth now.  It's meant a lot of patience on my partner's part, and it's definitely made things challenging for us.  However, knowing he's there for me and he understands definitely helps.  The best thing you can do for yourself is find a good system of support, people to talk to when you're feeling defeated or broken.  Maybe a counselor would help, but often times a good friend that listens well is all that's needed.  Even a spiritual leader, if you're spiritually or religiously inclined can be a good option.  The most important thing for me has been knowing that I can express my emotions without being judged, and the people who love me don't view me as a damaged woman.  They don't see me as broken.

I really wish I could offer more.  Unfortunately, when there isn't an available way to fix the problem, sometimes support and love is all you get.  Be strong and know that there are people who love you and will support you as much as they can in your life.

[RStelle]

I don't really know what I'm talking about because I haven't been through anything even close to that as far a birth trauma, but If I were you I wouldn't give up yet! If you go back to the same OB you saw before and they say they say they can't do anything, go to someone else (could you find a women's clinic that has a sliding fee?). I once had a medical problem that I swept under the rug for several years because I didn't have health insurance and had a very limited income, I went to a Dr and she didn't take me seriously, so I just gave up.  When I finally went to back to a different Dr it was such a relief, I couldn't believe I had put it off for so long. You owe it to yourself to at least try, find out what your options are, and if you need surgery, talk with your partner and try to figure out a way to pay for it. Many clinics and hospitals actually have programs to help low income people pay, it can take some research but there is help out there. I had a medical bill that I payed $15 a month on for a long time before it was payed off. This is your body, your comfort, your relationship, your mental health---all things that should be  priorities. In my book, if there is a way to fix this or at least make it better you deserve to have it fixed.

[somelady]

So episiotomies are common, but it's not really the episiotomy that's the problem, from what I can tell from what my doc said. It's some irregular anatomy that got irritated/aggravated/whatever by what caused the episiotomy to be necessary (and going back your story sounds even more similar, I spent a looooonnnnngggg time with my son's head in my vagina). If you pm me your email I can scan the handout my doc gave me and maybe it'll help (also has some self-care stuff that mostly consists of don't sit).

Though the test seemed straightforward enough to me, so maybe if there's not a pelvic pain specialist in the area there are regular obs that do it. And on the bright side while treatment involves meds at least they're cheap. I also found some relief with PT but I imagine the regular OB would've prescribed that if there was any chance of it helping.

[northernadvice]

Some would tell you the problem is just in your head.  However, I have a similar issue I will continue to seek answers for.  I had extensive cutting with my first born inside and out that did not heal shut leaving a larger gap and tissue protruding, and an abnormal bowel exiting path afterwards. (Occasionally, I would have to press on the perineal area to assist exiting during a bowel movement)  This caused physical and emotional discomfort.    After child two, I suffered more tearing higher up by the clitoris and those stitches didn't adhere the skin back together either. That changed the way urine exited, and more visual deformities.  (Not comfortable)  At this point, appearance wise, my vagina opening was much larger, the inside incision made it look like it was split in two as it pushed outward and other smaller tissue parts (I wouldn't know the medical term of)  protrude as well (I'm guessing it is the hymen ring).   I don't like my husband looking at me down there anymore during intimacy because I think it looks like something out of an alien movie.  After the third and final child, when I thought things couldn't get worse, they did.  I began experiencing added discomforts and more protruding.  I started doing those kegal exercises which helped with the pain.  But now I have chronic fecal incontinence, and chronic vaginitis.  A Doctor said that those two things have nothing to do with my episiotomy damage or each other, but I am skeptic.  When I asked what they were from,  I was told that it's from...... wait for it.......  old age!     I'm 41 yrs old, healthier than ever eating right, at my ideal weight, work out and remain active, and have been dealing with this since birthing.   In which my last child was born 9 yrs ago.  I am so frustrated. I am still without answers, but refuse to subside with the idea that it's just in my head.  Pain and discomfort is very real! 

[Alenushka]

I am very sorry to hear that so many of you have those issues. May you all feel better soon.

Sometime, local estrogen  cream can help with pain because pain is cause by unhealing micro tears.

IF there issues with urination and stool, it is very good idea to get a second opinion from UroGyn. They offer very different surgeries that a garden variety OB can.

Pelvic PT and biofeedback can also help and UroGyn can give a referral.

[Rellypoppins]

What is wrong with medical practitioners who DO NOT listen to their patients?
I gave birth to my daughter 19 months ago after a 48hr labor and extensive episiotomy (without instruments) due to fetal heart decelerations. I was stitched up by the OBGYN in delivery suite. The pain in the following month was terrible. After 14Weeks it was impossible to have intercourse due to intense pain and bleeding at attempted penetration. At 6 months I still had pain and it felt like my internal sutures were still in! 10 months post delivery I was unable to put a tampon in during my first period and sitting for longer than 20 mins was still very painful along the episiotomy scar line internally. I returned to the doctor I delivered with multiple times and was reassured everything was normal each time. At 12 months I sSought a second, then third, then fourth opinion. The last 2 specialists agreed the scarring was extensive and due to my pain level and sexual dysfunction treatment was required- to my absolute relief.
They both thought I had a vaginal neuroma and each recommended conservative treatment before opting for surgery which I gladly tried.
I underwent myocardial release by a specialist post childbirth physio which has excellent results for vaginal scarring post episiotomy/perineal injury (unfortunately this made mine worse). I also had a vaginal cortisone injection into the painful area ( which doesn't generally provide great relief 18 months down the track) but did improve the pain a bit for me and softened the really painful are quite a lot. I then opted for surgery with a specialist OBGYN who specialises in gynecological oncology surgery. I consented for an episiotomy scar revision. I was told after the surgery that my episiotomy incision had extended in to my rectum and that I had huge scarring. My vaginal introitus was also repaired and greatly improved in terms of appearance. The scar tissue that was sent to pathology revealed a large traumatic vaginal neuroma. The next day after my extensive repair I was sooooo sore but my perineum felt more secure than it had since the delivery and the tight feeling was gone . Am still recovering so mo intercourse as yet . My advice to anyone wit ongoing vaginsl pain/ discomfort 8 weeks post delivery is:
1) make an appt to see your delivering midwife/dr
2) it is NOT normal if you are unable to have comfortable intercourse after 8 weeks of vaginal delivery
3) if your health care professional doesn't listen find someone who will. You are not imagining your pain!
4) you only have 1 vagina so seek at least 2 other opinions 10 if need be
5) go with your gut instinct- if something doesn't feel right- with you or the persons opinion you are seeking believe in your own innate judgement.
6) don't leave it. You owe it to yourself, your baby & your partner to get the right help as soon as possible so you and your relationships can be fulfilling
7) DO see a womens physiotherapist for myocardial release of scar tissue as they deal with vaginsl scarring every day and will give you a great deal of info on your muscle tone, spasm from any nerve damage, likeliness of neuroma etc.

I hope this is helpful even if it's only to 1 other person. I feel for all women who have to deal with vaginal pain post delivery. Rest assured there is always hope and there are some amazing health professionals who deal with issues such as ours. A good GP will also be a great starting point. Good luck. Things can always be improved you just have to see the right specialists!

[doulawoman]

this won't help for the part that didn't heal together but in terms of pain and sensation an osteopath who has experience working on this stuff is great. I had a 3rd degree tear from an episitomy that is pretty intense and I have a midwife/osteopath who has worked on friends' scars even years afterwards and been able to help them immensely. I highly reccomend seeing a good one.

[Tananna]

Dear brave mother (Salixbabylonica),

I was just on internet research to find articles about epiosiotomy  and energetic healing. And I found your question.

How are you doing by now ?

As I had myself an episiotomy after experienced 20 months before with my first born an urgency C-Section, I was, during my formation and practice as Soul Voice Practitioner (Sound Healer through human voice),  guided to look into these issues.  And it seems larger than I thought.

One of the main energy entrances for terrestrial energy (gives stabilisation, grounding, feeling well in your body, self confidence etc.) is running through the perineum. The side-effect of such interventions are enormous on our female system. They create energy leaks and let us be open for unhealthy energies to enter. In short: destabilzes and makes weak, tired, emotional imbalanced, ...

Right now I am called to do more research on this subject and to study how these lesions can be healed through sound, so for we women can become strong again; confident and trustfull; with the consequences that our children do have more stable, beautiful and powerful mothers to get educated from. A benefit for us and the next generation.

Are you interested in supporting my calling ? To share further your issue, so I can get even a bigger picture ? And maybe to receive yourself a sound-healing session ? Or learn how you can help you yourself through your own sounds ?

I would love to hear from you.  Tananna

[Mary Blackburn]

Not really sure if thats my problem or not but I gave birth in a hospital but not with my ob she was on vacation but when I was checked at my 6 week check up she said I healed great but there is a very painful spot right on the scar that I did not notice until 2 months long after I had lost my insurance It almost looks like to me that a small part of the scar has came apart but Im not sure ifs that is even possible not sure what to do about it since I def cant afford to pay for a visit with my ob any advice

[Tananna]

Dear Mary,

What a beautiful picture!

Concerning your issue: are you already familiar with energetic healing ? Here a small selfhealing exercise for you personally.

Take some time for yourself, where you sit or lay down as much relaxed as possible. Turn off the phone, the doorbell, etc. so you won't get interrupted.

(1) Start the self-healing session simply by observing for a while your natural breathing. Allow yourself to let go, what you don't need at this special moment. Allow yourself to feel embraced, to sink in into the armchair or matress. Open up to your inner wisdom. 

(2) Then send out your positive intention for healing towards the hurting spot.

(3) Visualize first the color rose, surrounding, carressing this vulnerable part of yourself. If any other color is coming up, take it (otherwise stay with rose) and imagine something like a silk scarf in this color, that touches your intimate area very soft and gentle. And each time the scarf is passing by in between your legs, it takes away a bit from the pain and brings a soothing healing. Go on with this visualization as long as you feel fine with it.

(4) Then take some deep breathes as described: On the inhale you breathe in all the cause of the lesion and on the exhale you breathe it out into the "source of all life". On the next inhale you receive pure white energy from the "source of all life" and on the exhale you fill yourself with this purity and healing energy. .... When your intimate area feels cleaned and nourrished you stop.

(5) and just sit/lay in silence. .... listen to yourself and your body .... and receive whatever feeling is coming up. Let the healing happen.

You can do this exercise as often as you feel it is needed.

It costs nothing, gives you a special time with yourself and brings you closer again to your body and your feminity.

Enjoy.

Tananna

[Christine Kent]

My hope is that our culture(s) will begin to see the female perineum as being as precious as the male scrotum, which it most certainly is, yet is often treated blindly and carelessly by gynecology. Absolutely nothing is new in urogynecology, which formed in the late 1970s to take advantage of a huge market of women being surgically managed for conditions that should not exist.  

I would like to offer a couple of thoughts to this discussion. First is the reality that once the muscles of the perineum are severed, there really is no bringing them back to full function. The ends of the bulbocavernosus muscles retract and even if they are located and drawn toward the midline, nerve and blood vessel damage still causes them to atrophy over time. By menopause, generations of women who were given routine episiotomies have little if any perineum left, as the area becomes very thin and short. 

Only a woman with a ruined perineum and an intact anal sphincter can appreciate the great strength (and blessing!) of this highly developed organ. If a woman’s anal sphincter has been compromised, it too, is very difficult to “repair”. Here is an article http://wholewoman.com/blog/?p=36  that may help you understand the important issues to consider when thinking about anal sphincter revision surgery.

A revision of the perineum is not a cut-and-dried matter either. During perineoplasty, the area is “debrided” by removing skin, fat, nerves, and connective tissue from either side of the scar. Muscle tissue does not respond well to sutures, so basically what remains after healing is an area that is neater, but not necessarily stronger or more pliable. If dissection extends deeply into the back vaginal wall (rectocele repair), this often become fused with the front rectal wall leading to far-reaching problems. With perineoplasty, nerve issues like Rellypoppins was dealing with may improve, while others may be created. I would argue that estrogen cream may make symptoms worse, while creating imbalances elsewhere in the system. It is actually luteinizing hormone (and its analog, hcG, which rapidly builds fetal brain tissue) that helps build and re-build nerve tissue. The vagina/vulva is most comfortable when cultured with a healthy population of microorganisms. A drop of raw, local honey applied high in the vagina will act as a prebiotic for healthy colonies of lactobacilli, which you may find makes sexual intercourse much more comfortable, especially during the last half of your cycle. 

The most important concept for women with old episiotomy scars, and the prolapse that often accompanies them, is learning natural female posture, which places your organs at the front of your body. Pressure is relieved from the perineum, back vaginal wall, and anal sphincter when you learn to sit atop your *true* pelvic floor, which are the pubic bones that come together underneath you like straps of a saddle. This becomes essential to avoiding symptoms of serious prolapse as millions of post-episiotomy women age into menopause with little or no perineum left.

At Whole Woman, check out posts by Alemama and Granolamom to see how natural female posture is helping young mothers live well with unrepaired perineal lacerations.

Hope this helps!

[modadan]

Great information Christine. With your comments about repairs, it seems they are just cosmetic? I too had one that didn't heal shut (stitches came out, so left it to heal on its own) and feel like I am missing half my perinieum. I chosed to leave it and not have it repaired till I finished childbirthing. So if i dont repair it, when I am in menopause will I end up with no perineum?? Aside from the gapping and unsightly view, should it be left alone or repaired? Would like my perineum back

[Christine Kent]

Hi Modadan,

If you do a search on perineoplasty at wholewoman.com, you'll see how we have agonized over this subject. Yes, I believe that in virtually all women who have had large, midline episiotomies the vaginal sphincter muscles are permanently damaged. I understand how much you want your perineum back! The reality is, the issue is not nearly as simple as sewing it up. One must weigh how much more damage might be incurred, not only to the perineum, but to the back vaginal/front rectal walls. Also, will the front vaginal wall (bladder and uterus) be pulled toward the back if that area is "tightened".

The good news is, in normal anatomy the organs are carried at the front of the body and away from the outlet at the back. If you learn to tip your organs forward, while at the same time stretching your pelvic diaphragm taut, the gaping will improve. Take a handkerchief and pull opposite corners to see how the middle comes together like a pair of elevator doors. Unlike the purse-string closure of kegels, this is the real closure of the "genital hiatus", where the vagina flattens against intraabdominal pressure. It is a head-to-toe posture that self-locks your pelvis and protects against prolapse and incontinence. Any degree of "tucking the ribs" or trying to find a "neutral pelvis" collapses this highly developed, gravity-free physiology. 

Christine