Mitzee,
My Dr. did say it might affect my recovery, however he didn't seem that it would matter much in the beginning. It may affect later in life.. As far as help at home, my husband can only do so much. My mother in law is coming to help out (I can only handle for so long even though she is great), then my mom is coming to help out. I should have it covered. I really think it will be the hardest on my 5 year old. My 8 year old will understand the Mom needs her rest, but I fear it will be hardest both of us for my 5 year old. He has a great relationship with his Dad, however he is very attached to me.
Kelley,
You had nerve damage also, being as you have had your surgery and the great outcome you have had, what did you Dr. say regarding the nerve damage?
Linds,
If they are fixing your perineal area, then you are more than likely having the perinealoplasty. From what I understand, mine perineal wall was very thin, almost nonexistent, therefore they are going to build that wall up with muscle to help the sphincter.
Kelley and JJ, you both had the perinealoplasty, is what I am saying correct since you have already had the surgery?
I had severe nerve damage on one side (1 pudendal nerve) I was told that this could not be repaired, and could decrease the quality of the repair. I feel like the repair has been great--no problems at all. The place that I attribute having nerve difficulty in is in pushing and contracting to have a BM. I can definitly tell that my muscles contract better on the side without the damage. This is where my toilet gymnastics have come in to help me on that side with the damage. I sometimes have to put pressure down on one cheek, sit sideways to put more pressure on that side, and do all sorts of weird things to help get it out. I am getting more experienced and I feel like I finally have found what works for me most of the time. I also still have to be careful and make sure I evacuate completely.
The perinealplasty is when the the perineal muscles are used to bulk up the perineal wall. My perineum was also non-existent--but I am told I have a very nice one now!
Linds,
It sounds like you definitely should have the surgery to fix your tear. It will probably only get worse with time. In the last 6 months before my surgery, I became so much worse. The final straw for me was trying to take a nice warm relaxing jacuzzi bath at my parent's house and finding out I had leaked all over without even noticing--talk about humiliating! My surgeon had me on 2 weeks of a clear liquid diet, and then 1 1/2 weeks on full liquid, then high fiber diet. I think I am the only one who had such crazy diet instructions. It did help holding off the BM's which is what the dr. wanted. He finally induced a BM on day 9 because he didn't want me developing an ileus. Everyone has had different experiences. My surgeon felt very strongly about the diet, NO stool softeners, and no lifting anything over 5 pounds for 5 weeks. He also felt strongly about the bed rest. My work was delayed for 9 weeks mainly because I stand at incubators all shift, and the pressure of standing was sore on my bottom. I also stayed out longer because of the dehiscance. If you can avoid ripping your stitches out, you should be fine. Unfortunately, my surgeon said to expect that the wound would open up. It did while I was still pretty much on bed rest. I felt a lot better at 3 weeks and really good at 5. You will have to be careful working in the ER--you will be on lifting restrictions and it is suprising how every movement seems to tug at your bottom in one way or another. Do you work 12 hour shifts? In regards to my 4th degree tear--it was my own fault. I deliverd naturally with no epidural, and when my daughter was crowning, the dr. said "stop pushing"....I got a huge contraction and couldn't help pushing, and I pushed really hard and she flew out--ripping me. It's hard to control the urge with no epidural. Working in the NICU, I attend deliveries all the time, and I also worked L&D and post partum for a while--I have seen a lot of 4th degree tears. Sometimes it is because the dr.s don't let the perineum stretch long enough (too busy and in a hurry) and sometimes it is because of a big baby, or a small mom with a very little perineum to begin with. I have also seen a lot of bad deliveries with just plain bad practices---suction, forceps, interns delivering that don't have a clue what they are doing and of course emergency situations where the babies safety is #1. It can be prevented sometimes, but not always. You can also have a torn sphincter from pressure alone, and no perineal tear. Hopefully everything will go smoothly for you, and you can get back to normal and enjoy that beautiful baby. My 3 were well worth it! Take care Oops--About the Gas X--I have not tried it. I worked last night and found myself running away from gas a few times hoping no-one would notice. I work in a tight-knit unit so that is hard. I will try to use the restroom if I am having a bad day. My gas usually revolves around my BM's so if I can take care of the BM, I am usually ok. My issue is more of a loudness than odor thing-but I deal with both at times. I am going to purchase that Tannilbit and try it. I need to ask my Dr. if It is ok to take with all my other meds. I have an autoimmune connective tissue disorder and am on steroids, anti-malarials, and other things so I have to be careful. Take care
Kelley
Kelley
Linds, since you have no pudendal nerve damage, you should have a good surgical outcome. My understanding is that pudendal nerve damage decreases the likelihood of a successful outcome, but doesn’t make it impossible. I had/have no nerve function on one side and delayed nerve function on the other. Perhaps this is why I continue with my leaking?? My dr thought that I would benefit from the surgery since my sphincter defect was severe, the perineum was very thin, and there was still some nerve function. The repair of your perineum is the perinealplasty, and I am sorry to tell you that this is what was the most painful for me. However, the worst of the pain is over within a week or 2. Although the soreness and aches do last much longer, they are bearable. The bulked up perineum is supposed to help the sphincter function better. My diet was nothing by mouth for 3-4 days, clear liquid x1, full liquid x1, then soft diet, gradually progressing to high fiber. I thought it would be hard to go without food, but it was easy, just like Mitzee said, I wasn’t hungry. Like Kelley, my wound opened while I was on bed rest. But you should still be very careful about how you move, even turning over in bed, to try to prevent any strain on the incision. Do not sit upright until the incision has begun to knit together. My tear happened 10 years ago with the birth of my 1st child. I don’t know why it happened. My ob didn’t use forceps or suction, and the baby wasn’t huge (almost 8#). However, I had an epidural so I couldn’t feel anything, and I am pretty small. I delivered after 30-40 minutes of pushing. After the delivery, my ob stitched me for almost an hour, and I didn’t realize that I wasn’t working right for a while. I just kept telling myself that the problem would get better, but it never did. I have never used Gas X, but I am quite willing to try. Do you take it once a day? With every meal? How effective is it? And does it cause any change in the frequency or consistency of bm’s? Good luck to you as you make your preparations.
Take care everyone. Lisa, thinking of you and hoping your recovery is going well.
Linds,
As far as my delivery (8 years ago), I was a 10 at 7am and didn't get him out until 1:45. So I was in the "pushing stage" for quite awhile. I should have had a c-section. I am very small and his head would not fit through the birth canal.. I tore and they used everything from forceps to the suction cup to get him out. It was well worth it, having my son okay, however I should have never gone through all of that trauma. I am hoping that since I do have the nerve damage, I will have success. I can only pray and hope that it will be better than it is today. It is only going to get worse, so I have nothing to lose.
Hey all,
I have made it to my third week post op. I think I am going crazy staying home and resting so much. My two year old has defintly not been happy about me not lifting him. He refused to hug me for a few days. I expected that though. I am still so incredibly sore and on pain meds. My stitches have opened up all the way now. It is not fun. I use tons of gauze everyday. I am having a hard time believing i will ever heal. I have a large amount of mucus now and started bleeding some this week due to the opening.
Kelley,
when did you start your cautherizing to help healing? I have opened up from opening to opening. I am a little scared about it healing anytime soon.
Linds,
Welcome to this board. I am sorry you are having these issues, but we are not alone. I don't want to scare you, but I want to warn you that if you plan on having anymore children, you need to talk to your Dr about the realization of that and the possiblity. I was told before my surgery, more children were possible with a C-section. After my surgery, I was told more children would cause me to have a colostomy bag and severe damage. He said I would be able to have more children (with help from a specialist because I also suffer from endo), but that my body would not be able to carry it due to the extensive work he had to do. We have decided not to have anymore children now. It was a hard decision, but my health is most important. I do not want to chance a colostomy bag. He said my internal sphincter was very close to my something (not sure) and carrying a baby would cause damage. I am only 5 foot and 115 lbs so maybe my size has something to do with it. Just be cautious if you plan on having more children.
My surgery was only a sphincteroplasty to both my internal and external sphincters. But my Dr talked about building up my perineal, so i am not sure if i had a perinealplasty. I was in the hospital for 6 days on morphine for 4 days. I opened up when I was realeased from the hospital. That was not fun. I have my mom here staying with us to help and I don't know how others get by with out that constant help. I am not supposed to lift anything for 6 weeks. I was put on a low fiber diet when I was released. I see my Dr next week so I am not sure if I will go on a high fiber diet now? You will need to buy a lot of gauze too. I go through so much gauze in one day. I think the hardest thing for me is relaxing this long. I know I need it, but i have been resting and not doing anythign now for three weeks. I still have three more weeks to go. I am going to attempt to drive this weekend. I won't have my mother after this week so i need to be able to take my son to daycare and start working from home. I am scared of how much I have opened and being out of work so long. But rest rest rest is the most important. I think all my questions have been answered on this thread and it has been a wonderful group. so take the time to read everyones story. My thoughts and prayers go out to you. You will get through this.....
My two year old has also decided to potty train himself this week. Daycare has informed me he is completly potty trained at school now. Of course, the one time i can't pick him up or move well he decides to potty train. So i know i have opened up from straining and bending over. I have been pretty down lately because I feel like I am missing this time with him. But I have to keep in mind he won't remember this time and I want him to remember me not running to the bathroom all the time.
Lisa, That’s too bad that your wound has opened. I know that it is scary looking and painful and oozy. But, it will heal! Really. My wound was so scary and deep and gaping all the way from my vagina to anus, and it did heal. You will too. Just hang in there. Continue with your gauze, sitz baths, etc. There will still be lots of mucous and goo until the skin closes. Ask your dr about the underlying musculature so that you have reassurance that it is intact. I am so sorry that you had to face such a hard decision about increasing your family. My heart really goes out to you; I hope your spirits are a little higher soon. Take care,
JJ
Lisa, I'm so sorry your stitches have opened up. That sounds like a very, very common - but not welcome - event following surgery, even when one doesn't move around a lot and "cause" it to happen. I think mine have opened in a few teensy places and will see the surgeon Thursday. But most of the incision seems intact. I am so sorry for those on this board that have had such an opening, but thank goodness we can support each other no matter what!
Congrats to your son for potty training himself just when you need him to. Smart kid! This will make it easier for you in the weeks to come.
Here's to an extra nap for all of us,
Mary
I am so sorry! I called my Dr. almost everyday after my stitches opened up scared to death. The poor nurse reassured me every day that it was ok, and expected, and it would heal...she was right. For me, it was a very long road to complete healing and guess what?--after many days of continued soreness, and slight bleeding with BM's I did the mirror check to find that relentless little spot of mine opened up again!!!!!!!! NO wonder I have been sore. On the 18th of June it will be 5 months post op for me. I will probably just leave it alone--I am tired of Dr.s and concentrating on getting my other health issues under control now. The hole will heal. The gauze is important for pulling away the dead tissue, and the sitz baths really promote healing also. All the sudden, tou will notice it starting to heal up and granulate. My bottom was completely unrecognizable after surgery. It didn't even look like I had a rectum at all--rest assured I look normal now except for a lot of visible scars--but who's looking ...right??? My cauterizing was done a couple times in the first 8-12 weeks, and then every 2 weeks from 3 1/2 months on. It did help--but they won't do it when you are really raw and sore. They wait until the healing almost "stalls" and the cauterizing boosts the rate of healing back up again. Hang in there....It will get better. Remember to sit on the cheeks on a soft pillow--Don't stress your incision anymore. Take care.
Kelley
Thanks for your insight. My doctor never mentioned the possibility of not being able to have other children after this surgery. He did mention that I'd have to have a c-section. I am definitely going to contact him first thing in the morning because we want to have at least one more child. I'd certainly postpone my surgery until after I was finished having children.
Mindy/Jou Jou/Kelley/Mary-
Do you guys recommend waiting until I'm finished having children to have this surgery? I am unsure at this point what I want to do. Gas is my biggest issue and from what I hear that isn't going to change after surgery anyway. I know that I need the surgery--but if it puts me at risk to not being able to have more children--I might have to hold off for now.
Please send me your comments on this. Lisa, thanks and I am sorry. Did your surgeon mention this to you as a possible risk?
Linds,
If I were you, I think I would wait to have the surgery until you are done having children. If you definitely want another one, then I would wait. I have two boys (8 and 5) and am done having any more. I would think with the surgery being what it is (recovery and all) I would hate for you to indure that then have more children, and possibly do more damage or much worse. If you can live with it until after you have more and you know you want more children I would hold off. I have lived with this for about 5-6 years, but knowing we don't want anymore children, I know I need to get this taken care of now, even though I am scared to death. I know you will make the right decision for yourself and your family, but having a precious baby will make the wait worth it
Lisa,
It is good to hear from you. I think that is my biggest fear as far as the surgery is having the incision open up. I know you will be just fine, and remember to take it easy. I can't imagine having a little one to care for, at least my 8 and 5 year are self sufficient, but I am sure they will want to be with Mommy while she is in bed. Just remember, you are already 3 weeks post surgery and everyday that passes is another day of recovery. Hang in there, you are doing great! I honestly don't know if I will be able to take a mirror and look at my incision when I have the surgery. It might freak me out too much. I don't do good with stuff like that
I have a appt. with my Dr. in 2 weeks to pin down a date for surgery. The last day of school was yesterday, so summer has begun. I am sure it will fly by and before you know it will be time for surgery..
Linds,
My surgey is also scheduled for the 15th. Let's hope it's our lucky day and every thing goes with out a hitch!! Exactly 2 days after my son turns one year old. What a crazy year!! My first repair was an end to end done by an obgyn 2 months post delivery but it didn't hold. So...here we go again--round number two. This one is being done by a colo-rectal guy--overlapping repair but now my fear is--what if it's too SMALL when he's done???
I never thought I had gas before (although I did feel bloated often) but after wards I had gas all the time!! Very embarrasing at work, to say the least. But my dr. did a stool sample and found candida and high bacterial levels so she gave me Tanaltib ( a natural antifungal ) and this made a world of difference!! It actually made me think that maybe I could get away with out having the surgery. She said it help in about 80% of people who have gas and bloating issues. She also put me on oral nystatin for a month to kill the yeast. The Tanalbit is a supplement so you don't need a script for it. Look back in the links--someone found a place on the internet to buy it cheaper than I get mine. I'll be interested to hear if it helps others on this site as much as it has helped me.
Good luck! I'll be interested to hear about your progress after surgery!
Robin
Lindsay, You are, of course, the only one to decide what is right for you. But, for me, it was important to complete my family before having this surgery. For one, you aren’t having full blown accidents, and while the gas and leaking is not an insignificant problem, it seems like something that could be tolerated in the interests of having more children. Especially if something like the gas-x or tanalbit or chlorphyl could help. Secondly, additional pregnancies/deliveries could cause the same or additional damage. If you wait, you could, hopefully, have surgery to fix the problem without chancing more damage. My damage came with my 1st child. Afterward, my ob/gyn told me to wait until I was done having children before pursuing a remedy. When I began to see surgeons, many years later, the 1st one I saw told me that some women can get damage to the muscles and/or nerves just from the pressures and physical stress of pregnancy, even if the delivery is by c-section. This is just my opinion. You should talk to as many people as possible before you decide either way. It is hard to live with this crappy problem, but I am glad I waited. Also, interestingly, during my 2 subsequent pregnancies, I never experienced any leakage or incontinence of gas! It must have been something to do with the pressure of the baby, I don’t really know, but it was wonderful! I was very regular, with complete, easy bm’s. Good luck to you.
JJ
My doctor also did say that it would be better to be done having children before having this surgery. I would have to have a c-section with any subsequent births, but the main risk is of pressure during the actual pregnancy on the pelvic floor. This is not to say that you couldn't have more children, but I didn't want to risk it. Also, tears in the sphincter can and do occur without vaginal deliveries. I know it is a hard decision to make. I did not have the good fortune that Jou Jou had during her subsequent pregnancies. My leaking became a horrible issue while pregnant with my other 2 children. I also had urinary problems, so if I wasn't peeing all over myself, I was leaking stool all the time! I have heard that recovering from c-sections is so much harder than a vaginal delivery that I was not very excited to have that be my option either. I would talk to your dr. more extensively about it. Maybe he or she can offer more insight into it. If you are only having the gas issues, maybe try that supplement, and see if that helps in the mean time. Either way, you definitely deserve to not be miserable. Take care,
Kelley
So my surgery is a week from tomorrow. I've been buying herbal baths and homeopathy remedies all with the hopes of speeding healing and minimizing the chances of infection. I think I'm ready (mentally) to do this. I'm so excited to live a normal life, go to yoga classes again, run with other people and be rid of the constant fear of embarrassment. But the question I'm afraid to ask is... what if the second time fails too? Then what do I do?
Pray hard right now, I guess.
Robin
Hi Robin... sounds like you're ready! Please keep us posted on your progress. My experience was different from some others on this thread in that I am 4 wks post-op now and my incision has not opened, in fact has healed nicely. I am almost back to normal with my BMs and look forward to getting the bottle of Tanalbit I ordered, to be sure I don't have too much candida in my intestine. I managed to get throuth a UTI, an impaction (remember the mag citrate???) and an external yeast infection, so I think I'm in the home stretch now. I just want to reassure you that some of us do have fairly quick healing and I hope you'll be one of us. It's a good thing your repair now is overlapping, not end-to-end. I'm not sure about the herbal baths, if they might be irritating. I've just used plain warm water in the tub twice a day and that seemed to do fine. It sounds like your main problem is gas, right? I have much less gas since the surgery; less trapped stool and less fermenting. I hope the same goes for you. How long will you be in the hospital?
If the "second time fails" then you'll just deal with it. You have more strength than you realize.
At this point, you have done all you can do. It is time to relax, pray, and have a lot of positive thinking that this surgery will be successful for you. I know there are a lot of "what ifs," and I was scared to death having the surgery..but keep a positive attitude-it really does help. Please keep us posted on your recovery when you can. What kind of post op directions have you had so far (length of stay, diet, restrictions??) I will be thinking of you.
Kelley
Like Mary, I have healed exceedingly well. Had no impaction, no wound opening, yeast infection, or UTIs. I used my sitz bath (that the hospital supplied) 3 times daily, especially after BMs. My doc also had me using a cream on the incision that had "caine" in the name, usually used for hemorroids (sp). You can buy it over the counter. I also used gauze for the first couple of weeks, but just used pads after that for drainage. Only had 2 days that I had any bleeding, and it was a very small amount. I couldn't sit straight up for several weeks, but that passed quickly. I'm 7 weeks post op and am getting some energy back. Had a flair with my chronic fatigue/fibromyalgia, but that is better now. So, all in all, I've had it much easier than some of the people on the board. I do have problems retaining gas, as I have mentioned many times on the board. I am no longer having panic attacks about it and I keep telling myself I am getting better everyday. I'm doing the Kegel exercises 3 times daily, but they take about 3 - 6 mos. to show improvement. I've only been doing them 4 weeks, but I do think I see a little improvement. I have my BMs in the morning, usually 4-5 still. I'm taking stool softners and am using 1 tsp. of Benefiber each night in a can of V-8 juice. It has kept my stools soft, but I don't go a lot at a time, which is why I'm having so many of them. My digestive system has not caught up with the changes yet. However, I'm mostly free of gas in the afternoon. So I schedule everything around that right now. I don't work outside the home, so I can manage my time and BMs OK. The urgency has decreased, so I can hold it for longer periods of time. That has been a major concern about not leaving the house before my BMs stop about 11:30. I think I could make it to a public bathroom now if I needed to. I wear pads when I am out, just in case I have an accident, which hasn't happened. But, good insurance. I also have not had any leakage of BM in a couple of weeks.
The healing process will take time and is different for everyone. I was pretty ignorant about this whole process before the surgery. Found out so much by being part of this message board and the support is wonderful. I wasn't scared about the surgery beforehand because I didn't know enough to be scared about. Try to relax, and as Kelly said, you have done everything you can in preparation. Now it's just having the surgery, being patient with yourself with the healing and knowing it will take time. My thoughts and prayers are with you.
Hi Suzan... my surgeon had me eliminate stool softeners and reduce fibers so that I'd have fewer BMs. He also Rx'd Lomotil (generic = Lomox) which works like anti-diarrheals like Immodium only faster, to slow the action of the colon. It has helped a lot and for the last 3 days I've only had one or two BMs each morning, around breakfast. I was concerned about getting constipated or forming an impaction, but that hasn't happened. About 5 yrs before this surgery I was diagnosed with "rapid transit" which resulted in 5-6 BMs per day so my colon wasn't absorbing nutrients, plus I had the problems of not being able to hold it due to the sphincter defects and rectocele. So perhaps you might try slowly cutting back on the stool softeners...? It worked for me.
I started Tabalbit 2 days ago, just two caps before lunch. Hmmm... I'm sniffling & blowing my nose several times each afternoon. Maybe I'm allergic to the plant tannins? Anyone else had this experience?
I also still have to be careful and make sure I evacuate completely. 
Working in the NICU, I attend deliveries all the time, and I also worked L&D and post partum for a while--I have seen a lot of 4th degree tears. Sometimes it is because the dr.s don't let the perineum stretch long enough (too busy and in a hurry) and sometimes it is because of a big baby, or a small mom with a very little perineum to begin with. I have also seen a lot of bad deliveries with just plain bad practices---suction, forceps, interns delivering that don't have a clue what they are doing and of course emergency situations where the babies safety is #1. It can be prevented sometimes, but not always. You can also have a torn sphincter from pressure alone, and no perineal tear. Hopefully everything will go smoothly for you, and you can get back to normal and enjoy that beautiful baby. My 3 were well worth it! 
