fecal incontinence, fistula, short perineum - Mothering Forums

Forum Jump: 
 
Thread Tools
#1 of 16 Old 03-01-2006, 02:42 AM - Thread Starter
 
Sungold17's Avatar
 
Join Date: Jan 2004
Location: Harford Co, Maryland
Posts: 270
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Its very long...

Does anyone have personal experience with either of the above? I'm
looking for some answers to aid me in a tough choice.

When I gave birth to my son 21 months ago I received a 3rd degree
tear. I don't know why I tore so badly because I had a very natural,
easy (hospital) birth, and was not overzealous with the pushing. Shortly after
going home I started having problems with fecal incontinence. This may
be TMI but it helps to know, I have issues with leaking soft stools
and have never leaked a solid one. If I can keep my stools at the right
consistency I'm pretty much OK but I have soft stools a lot. I'd be in
trouble if I had a true case of the runs. It has
improved since the first few months after delivery. I typically don't
need to wear a pad but do sometimes get stained underwear, have
itching, and get irritated from having to wipe clean so much. I used to have
a lot of very uncontrollable gas with out warning when bending or
going up stairs. I still have more gas then pre-baby but I can
control it better now. So my quality of life is OK. I get depressed
about these issues sometimes but I don't let it get in the way of
life. My main concern is about the future. Everything points to it
getting worse.

I went to a specialist who determined that I have a sphincter defect.
The sphincters are normally like a donut around the anus but part of
my muscles aren't closing all the way which allows stuff to leak. (My
muscles aren't weak) The solution is surgery (a Sphincteroplasty)
to repair the gap by overlap muscles. In a few weeks I"m having a
colonoscopy to check my general bowl health and an ultrasound of my
rectum to get a picture of the defect.

In addition to that defect I almost have a recto-vaginal fistula (a
hole between the rectum and vagina which can allow gas and stool to
leak through the vagina.) The doctor says I have a "dimple"
that is paper thin but it isn't a hole yet. He says the
Sphincteroplasty will also take care of this because they will "pad"
the area. (I'm not 100% convinced its only a dimple. Maybe I do have a
hole already. I read that they can appear as dimples on first
examination and its very hard to identify where stool is coming from.
The ultrasound should show for sure.)

The plot thickens a bit more... I now have a short perineum. He said the
average/normal perineum is 7cm long and mine is much shorter. I didn't
ask him how short though so I decide to try to measure it myself today.
I used a q-tip as a ruler and then held it to a ruler. Obviously this isn't
going to be exact- but I came up with 3.8 to 4 cm long. That is pretty
short compared to 7cm! So if I tear with another birth I only have 4cm
until my anal muscles and possibly anus gets ripped again.

So, if I have the surgery now all future babies will need to be born
by c-section. The next baby will probably be our last (but I'd love 2
more.) If I wait on the surgery and have another vaginal birth the problems are sure to
become worse. But how worse and how soon after birth will I want/need
surgery? It doesn't matter to the doctor if I have the surgery now or
later because the surgery will be the same for him no matter what.
I really don't want to have a c-section but I have so much more to consider
now. I had planned on having a home birth but feel like that is probably
out of the question now.

Things for me to consider/ questions:
1. Tearing? How bad could it get? I've read about techniques to
minimize tearing and know that women don't always tear the second time
around. BUT how likely is that for me now that I only have a 4cm
long perineum? How worse will tearing and stress on my muscles make
the incontinence? Even if I don't tear will the pressure of birth
separate the defected muscles worse? (I fear starting
to leak solid stool.)

Can a perineum continue to shrink? I wonder because when I first went
to the OB for these problems he said my perineum looked fine. Does
that mean it has shrunk since then? Surely he would notice how short
it was?? Can anyone explain why tearing made my perineum so short?

2. How easy will the "dimple" open up to an actual fistula? It seems
pretty likely to ME that the force of vaginal birth will open it up. The
thought of leaking from my vagina as well as my rectum is very
depressing! I've read that sometimes (but not often) holes
close by themselves. Sometimes women have no symptoms of having the
hole but typically the women DOES notice either gas or stool coming
from the vagina. But, then I read that often stool only leaks
through there if there is diahrea. So who knows!! Do you think its a
given that the dimple will open with another vaginal birth?

3. The doctor believes another vaginal birth will make my problems
worse. But how worse will they get? How soon after giving birth will I
need or Want surgery? I'm having a hard time imagining going through
this invasive surgery with a young (breastfeeding) infant and a child.
I might be in the hospital a day or two, won't be able to lift, and will
need to be very careful with my pelvis in general. Before the surgery
I will need to empty my bowels completely. I know recovery will hurt!
Even with a 2 yr old surgery will be hard on the family.

4. Emotional- how do I give up my dreams of having a homebirth or at
least a nice hospital birth? I really hoped the next birth would be a
spiritual healing experience for my husband. (1st baby was an early
stillbirth, garrett's birth was very very nice but there was a lot of
emotional pain and detachment for my husband.) But on the other hand,
maybe I want the surgery now to just get this mess over with and past. How
much incontinence do I want to put up with (now and in the future?)

I've decided that there is no right or wrong with this choice. I'm very
much on the fence about when to have this surgery and after days and days
of thinking and studying I am no closer to a decision. I have many
questions to ask my doctor but have to wait until the ultrasound and
colonoscopy.

I"m so sorry this is so long. If anyone has any useful information or
knowledge please share with me.

Thanks for "listening"
-Dawn
Sungold17 is offline  
#2 of 16 Old 03-01-2006, 12:54 PM
 
BellinghamCrunchie's Avatar
 
Join Date: Sep 2005
Location: Alpha Centauri
Posts: 4,293
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Just some thoughts. I agree with you that it seems likely that a vaginal birth will cause the hole in the vagina to worsen, or open. But other than that, I wonder if it might be better to delay the surgery until at least the next birth, and have the birth vaginally as you want. The reason I think this is that its possible having another baby vaginally might result in some improvement - you might tear or you might not, but the tear, when repaired, might improve other things as well. I wonder if it isn't possible that the problems you are having with leakage might not have been from a less than perfect repair, and that if you do tear again, maybe that would be the time to do a better fix, and if you don't tear, well, good!
BellinghamCrunchie is offline  
#3 of 16 Old 03-01-2006, 01:23 PM - Thread Starter
 
Sungold17's Avatar
 
Join Date: Jan 2004
Location: Harford Co, Maryland
Posts: 270
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
not have been from a less than perfect repair
It def. can. I asked the doctor this and he said there is no telling if it could have been repaired better. Something about how everything gets squished and Obs thing they have good stitches but don't always. I actually read a study that showed a large majority of OBs don't feel adequately training to repair 3rd and 4th degree tears.

I'll have to ask the doc about what would happen if I tore again and how that repair will effect things.
Sungold17 is offline  
#4 of 16 Old 03-03-2006, 12:38 AM
 
moonmama22's Avatar
 
Join Date: Mar 2005
Location: CT
Posts: 549
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Wow - I can sympathize with you - I have been struggling with this myself (the fistula part). My son is 20 months, and I have been hoping over the past year and a half that it would heal on it's own. I count myself lucky that I have not, yet, experienced any fecal incontinence, only the gas you mentioned, but I agree that the emotional toll is still intense. Especially the fear of having a c-section, or not having another child at all. I had wanted one more, and wanted to have a less traumatic birth than my last. I pushed for two hours, suffered third degree tears, and took a long time to heal. Because I do not have health insurance (but will in a few weeks!), I have not yet consulted a doctor, but have pretty much diagnosed myself via the internet... I've never heard of the 'dimple' as opposed to a hole, but in my research have found some interesting points. First, someone on this site, at one point, I think even a midwife, had suggested that having another vaginal birth could actually heal a small fistula. Other people have disputed this vehemently, and feel that a vaginal birth can only cause more damage.
I also found that this problem is more common than anyone knows, probably because it is such an embarrassing problem that no one wants to discuss it. Now that people chat online, and can maintain their anonymity, it is becoming more openly discussed. And, it can most certainly be caused by a poor repair of third and fourth degree tears. Mine was only third, but not far from a fourth, and I really felt like the doctor did not take his time repairing it. However, the epidural had worn off while I was pushing, and so I could feel him sewing me, and I remember crying out a few times, which probably rushed him. Still, several people have said that OBs do not have the experience to stitch when a tear reaches the anal muscle or tissue surrounding it, and some suggest that a colo-rectal surgeon should make the repairs in the these situations.
I, myself, am still debating surgery also - obviously I will have my OB check it out first, and discuss it with him, but I am curious about other options. One person had suggested doing Kegals (I've tried, I'm not sure they make much difference), but I have been wondering if there is any type of alternative approach, homeopathic remedies, massage techniques, anything outside of surgery.
Anyway - sorry this is so long - I hope some of it was helpful - I have only just started talking about this with anyone - I agree though - it is something that is difficult to think about, especially when the information you get from people is so contradictory.

Erika, mama to Sawyer 6/04 joy.gifand Gracie 7/10energy.gif  :, dw Amy:

treehugger.gifsaynovax.gifbfinfant.giffamilybed2.gifRainbow.gif

moonmama22 is offline  
#5 of 16 Old 04-19-2006, 06:06 PM
 
Judes Mama's Avatar
 
Join Date: Apr 2006
Location: Maine
Posts: 11
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
So, I'm sitting on my couch, one week post-op from an anal sphincter repair and fistula repair. My son is now 8 months old. I had a 4th degree perineal laceration at birth which didn't heal correctly. The physicians spent over 2 hours trying to repair everything after the birth of my son. I have been experiencing fecal incontinence which became so bad that my OB wanted to operate. I also had a defect with the anatomy of the sphincter muscle. It was basically no longer a "donut" but more like a deflated "c". In addition, we suspected that there was a fistula (there was---lots of vaginal gas which can only be from a hole).

The surgery has a high failure rate so my OB was very apprenhensive about doing it unless I really needed it. He's seen many colo-rectal surgeons fail with this surgery and he has had to fix their work, so he was comfortable doing the surgery. I guess I lucked out in this respect, b/c my OB will not do surgery unless it's absolutely necessary.

As far as the surgery goes, I won't lie, it was very painful after. My incision site just opened up (which also happened with the repair after birth) which will make the recovery time more like 4 extra weeks. I can't pick up my son--that's probably the worst part.

Anyway, I can let you know how the healing process goes and if it actually worked (I found out this morning that the outer layer of my sphincter-there are 3 layers has already separated a little---great...)

The whole C-section thing does scare me, but the defect/fistula could not wait through another pregnancy. In addition because no one is quite sure why I tore so bad (4th degree perineal and 2 cervical lacerations), a vaginal birth was not recommended anyway for subsequent babies.

Hope this helps. Let me know if you have any questions or advice.
Judes Mama is offline  
#6 of 16 Old 04-20-2006, 01:24 AM - Thread Starter
 
Sungold17's Avatar
 
Join Date: Jan 2004
Location: Harford Co, Maryland
Posts: 270
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
What a timely post.

First of all- moonmama- I didn't see your post until today. Sorry. I talked to a lady on the phone who had a fistula repaired. She did very well with the surgery and went on to have 2 more babies vaginally. But she told me she later found our that homeopathy could have helped. She told me the specific remedy but I can't remember what they were called. So maybe you can give that a try? Her OB told her the vagina gets small holes in it often during child birth but htey simply heal up. The homopathy might encourage your body to heal the hole. Is there a homeopath near you? If you want I'll get in contact with her again to ask for the remidy names again. I acutally found out that I don't have a fistula so that is one thing less to worry about.

My tear was always "only" a third degree. And it did hurt a lot getting repaired! And it took forever. It really wasn't a pleasant experience.

Judas Mom- Thanks for posting about your experience. I hope you heal quickly. It sounds like you had it bad and I really hope the incontinuce stops. Has anyone mentioned trying biofeed back once you heal as an added messure?

I acutally saw the doctor today to get the results of everything. Basically he said the perinium space is very thin and I"m a good canidate for the repair. Told me that 65% of people see a great improvement, another 20% see some improvement and the rest have none (but it doesn't get worse.) He said the total time off from 'work' is at least 4 weeks. two days in the hospital, then home on a liquid diet and I wouldn't be able to sit on both butt cheeks for a while nor lift anything over 20 pounds. Has this pretty much been your experience?

I"ve decided to wait until I have another baby. I can handle the problem until then. I just hope it won't become much, much worse after the next delivery. I"ll have to wait at least 6 months to have the operation. I do have some anxiety about it all still but I have decided my desire for another vaginal birth trumps the anxiety. Plus I just don't feel like my problem is bad enough yet to have such a big surgery.

We should try to keep this thread up-dated with how we are doing. Goodness knows we can use lots of support for such a private, hush-hush problem!

Thanks,
Dawn
Sungold17 is offline  
#7 of 16 Old 04-20-2006, 11:33 AM - Thread Starter
 
Sungold17's Avatar
 
Join Date: Jan 2004
Location: Harford Co, Maryland
Posts: 270
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Oh yeah... what about sex? How long did the doctor say it would take until you are ready for that? Sex hurt for about a year after my tear. I can't imagine what will happen after surgery??
Sungold17 is offline  
#8 of 16 Old 04-21-2006, 02:33 PM
 
Judes Mama's Avatar
 
Join Date: Apr 2006
Location: Maine
Posts: 11
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
My OB said that we can't have sex for 4 to 6 months or at least end of summer or fall . It was absolutely excruiating when we tried around 4-5 months after delivery. My doc had to remove granulomas (several times) which had formed over the stitches from the original repair at the time of delivery. After the last removal (who knew they were soooo painful), we were successfully able to have sex once before the surgery (around 7 months post delivery). I think that the presence of the granulomas that kept forming were more the cause of the pain instead of the actual repair.
Judes Mama is offline  
#9 of 16 Old 04-21-2006, 02:40 PM
 
Judes Mama's Avatar
 
Join Date: Apr 2006
Location: Maine
Posts: 11
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Sungold---I would be very interested to know what homeopathic remedies are recommended for this type of repair. I have been actively trying to find a homeopathic physician in my area for quite some time now.
Judes Mama is offline  
#10 of 16 Old 04-21-2006, 02:50 PM - Thread Starter
 
Sungold17's Avatar
 
Join Date: Jan 2004
Location: Harford Co, Maryland
Posts: 270
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I'll email the lady. She was talking about fistulas.

4 to 6 months on the sex is a long time!
Sungold17 is offline  
#11 of 16 Old 05-03-2006, 02:50 PM
 
moonmama22's Avatar
 
Join Date: Mar 2005
Location: CT
Posts: 549
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Thank you to everyone for all the info!! I'm anxiously awaiting the homeopathy info!
I actually had to change my dr. appt b/c my insurance wasn't effective yet, so I'll be glad to have as much as possible to share with dr. when I go... Thanks also for all the support and positive feedback - this is so hard...

Erika, mama to Sawyer 6/04 joy.gifand Gracie 7/10energy.gif  :, dw Amy:

treehugger.gifsaynovax.gifbfinfant.giffamilybed2.gifRainbow.gif

moonmama22 is offline  
#12 of 16 Old 05-04-2006, 08:21 AM - Thread Starter
 
Sungold17's Avatar
 
Join Date: Jan 2004
Location: Harford Co, Maryland
Posts: 270
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Thanks also for all the support and positive feedback - this is so hard...
It is hard! And it can be difficult to talk about to people in-person.

Ok, here is the info from my friend...

Quote:
Silica

there are others but that seemed to be the strongest indicator.
I would see a homeopath, tell them what you know, and see what they can try. I hope this helps a bit.
Sungold17 is offline  
#13 of 16 Old 05-11-2006, 02:27 PM
 
moonmama22's Avatar
 
Join Date: Mar 2005
Location: CT
Posts: 549
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Sungold,
Thank you for the information. I have an appointment with my pcp next month, and will ask her to refer me to a naturopath (my insurance requires precertification for naturopaths.) I hope that sugery will be an option for me, although I have a low, low tolerance for pain, because I think the fistula is getting worse... But, I will certainly try the homeopathy first! And I will remember the name Silica...
THanks again! Anyone know of any support group/threads anywhere else dealing with this? I am the kind of person who could use all the information I could get before going into this...
Thanks!

Erika, mama to Sawyer 6/04 joy.gifand Gracie 7/10energy.gif  :, dw Amy:

treehugger.gifsaynovax.gifbfinfant.giffamilybed2.gifRainbow.gif

moonmama22 is offline  
#14 of 16 Old 07-25-2008, 03:52 AM
 
Narn's Avatar
 
Join Date: Nov 2007
Location: Philadelphia
Posts: 458
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I am bumping this two-year-old thread, because I am having similar problems as the original poster and am wondering if anyone can share their experience with this.

Anyone?

Brianna, mom to my always naked and singing Faye (9/07) and my chubby baby Bronwen (10/10).
Narn is offline  
#15 of 16 Old 07-25-2008, 11:10 PM
 
moonmama22's Avatar
 
Join Date: Mar 2005
Location: CT
Posts: 549
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I had forgotten about this thread - here's an update from my last post. I never went to a naturopath (no money here!) but did see the OB I had when pregnant with ds. I liked him b/c he was a very "hands-off" OB who discouraged any medical interventions. He checked me out, and did not find the fistula, but agreed I did have one, based on my symptoms. He said surgery was an option, but not a guaranteed solution, and that if it wasn't causing any infection or fecal incontinence, he would suggest just leaving it, from a medical perspective. However, he did tell me that if it was causing me to much emotional distress, he would refer me to a good surgeon, b/c he had done some repairs in the past, but it had been a while, and he wanted to refer me to someone with more experience. I really appreciated his honesty, and have taken his advice and just left the fistula as is. It's gotten to the point that I don't think about it much anymore, until I start thinking about having another baby.
I would love to hear updates from anyone else...

Erika, mama to Sawyer 6/04 joy.gifand Gracie 7/10energy.gif  :, dw Amy:

treehugger.gifsaynovax.gifbfinfant.giffamilybed2.gifRainbow.gif

moonmama22 is offline  
#16 of 16 Old 07-26-2008, 11:43 PM
 
Narn's Avatar
 
Join Date: Nov 2007
Location: Philadelphia
Posts: 458
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I wish I had a nice OB like that. When I talked to mine about my problem, she said that she had never heard of a woman having fecal incontinence after labor. I know she has been practicing for a while. Can I really be the only one? She said she would refer me to a specialist, but would need to look one up, because she didn't know anyone to refer me to right now. I should have stopped seeing her during my prenatal visits when it was clear that she wasn't the OB I wanted. Even my DH doesn't like her.

Brianna, mom to my always naked and singing Faye (9/07) and my chubby baby Bronwen (10/10).
Narn is offline  
Reply

Quick Reply
Message:
Drag and Drop File Upload
Drag files here to attach!
Upload Progress: 0
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off