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Old 01-12-2011, 09:57 AM   #91
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Re: Sphincteroplasty after 4th degree tear

Hi Lilypetunia. No problem, I can understand why you thought Canada. Most European countries have universal health care too.

Sorry, I was confused about the PTNS. I was offered sacral nerve stimulation, I thought that was the same as PTNS. I doubt PTSN is available here yet, but will probably come in a few years.

Otherwise yes, it sounds like we're experiencing a similar recovery. About the things coming out, sometimes it's only a little hemorroid coming out when the feces push down, otherwise, when the urge is really big, I've felt with my hand and a little bit of feces is at the opening. It is much less than before but would like it to go away though!

Take care!

 
Old 01-12-2011, 01:56 PM   #92
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Re: Sphincteroplasty after 4th degree tear

My surgeon said PTNS is currently only available in Europe for fecal incontinence. Wikipedia also lists it as available in Europe but apparently it is still under review in the UK. So I guess not all of Europe. I think the procedure is relatively new. It is minimally invasive and seems to have really good results. You should ask your surgeon about it.

 
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Old 01-12-2011, 02:54 PM   #93
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Re: Sphincteroplasty after 4th degree tear

Thanks girls for the replies. I am glad that you both have better control. Wow, 30 minute wait...that is incredible. I would never be able to do that. Even with the better consistency with my 'bulking' measures I still have to move quickly to the bathroom but now I can at least make it there. Lillypetunia, I had to LOL at your squatting over the mirror to 'see'. I have so many 'photos' with my camera set up on a tripod to 'see' my wound healing progress... LOL Just so you all know, my diabetes is newly diagnosed in August. Right before my surgery. I have gained quite a bit of weight from not being able to exercise. I believe it was a fluke that my sugars were high at that time also because I have not had any trouble keeping my blood sugars stable even without medication. Although, right after surgery I aimed at keeping my blood sugars below 80 to aid in my healing. The doc put me on the metformin and said "It will help you to loose the weight". Well, I have not lost a pound while taking it. My problem is with lack of exercise because of the soiling issues. I have started walking this week with my 'better control'. Although, this afternoon was not so great but the 'positive' is that I made it to the bathroom. This is improvement. I still believe that the kegels are the key since most of my improvement seems to come from that...it may just be 'retraining' the mind and the body to work together?

 
Old 01-12-2011, 03:00 PM   #94
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Re: Sphincteroplasty after 4th degree tear

Quote:
Originally Posted by lilypetunia View Post
My surgeon said PTNS is currently only available in Europe for fecal incontinence. Wikipedia also lists it as available in Europe but apparently it is still under review in the UK. So I guess not all of Europe. I think the procedure is relatively new. It is minimally invasive and seems to have really good results. You should ask your surgeon about it.
Lilypetunia...funny after all of these posts on the PTNS this past Sunday my community news paper had it mentioned as a treatment for urinary incontinence and found that it also improved fecal incontinence as an "added bonus". The doctor being 'interviewed' about it made it sound like it was already available but at the end of the article it stated that it was "widely available in Europe but not yet approved by the FDA in the US." So I imagine it is on the horizon although I doubt insurance companies will 'cover it' for many years.

 
Old 01-12-2011, 05:05 PM   #95
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Re: Sphincteroplasty after 4th degree tear

Yes you are right, it is available in the US and approved by the FDA for urinary incontinence, and insurance will cover the treatment for urinary incontinence only. However, it is not yet approved for fecal incontinence by the FDA. They are still going through the review process which has unfortunately been stalled by some problem with the facility making the device. Hopefully it will resolve soon. As soon as it gets FDA approval insurance should cover the treatment. It is a much more affordable treatment than sphincteroplasty and sacral nerve stimulation so the insurance companies will probably prefer it.

 
Old 01-12-2011, 06:53 PM   #96
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Re: Sphincteroplasty after 4th degree tear

flsunshine, I am glad you have been able to start walking again. I also do a walk-at-home program. Leslie Sansone does a ton of them, there are dvd's and also available on-demand. It works well for me because I can get exercise without leaving the house.

 
Old 01-13-2011, 10:57 AM   #97
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Re: Sphincteroplasty after 4th degree tear

The PTNS sounds interesting, I will look it up for details.

I'm feeling slightly down today, I had to go to the bathroom 4 times today, making me much more dependent on bathrooms than I want to. I feel like I'm not improving at the moment. I still have to go 2-4 times a day and hope for 1-2 times.

Yes, the 30 minute wait sounds great, but that's not when a proper urge hits, then I still have to hurry. But, I can sometimes feel the bowel getting full and could technically go to the bathroom if I wanted to, but don't. But there are no urges then. When a proper urge hits, it still starts to come out a little bit.

I'm afraid this will never go away. My surgeon didn't repair the internal muscle separately, he just stitched up the external muscle and said the internal one is usually stuck to the external one with scar tissue and there is no point in stitching them separately, the internal one will just be stitched up at the same time. I got quite disappointed by this and really hope that the internal muscle was stitched back up with the external one making a whole ring. I have the feeling there is still a gap in the internal muscle, causing these problems.

I'm glad things are getting better for you sunshine. I don't remember if you'd done an internal ultrasound of the anal muscles after surgery, did you? Just to know the extent of the current damage.

Last edited by Babygirl43; 01-13-2011 at 01:37 PM.

 
Old 01-14-2011, 12:03 AM   #98
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Re: Sphincteroplasty after 4th degree tear

Babygirl it seems to me that the internal sphincter is notoriously repaired at the same time and not separate and the 'failure' of the internal repair is also something that happens often. With that said, maybe it doesn't mean that it is a failure of the repair but instead part of the natural healing? I know that since I have more control of the 'consistency' of my poo I have more 'control'. I still go to the bathroom at the least 5 times a day. Perhaps the scar tissue or thickening of the muscle as time goes by will facilitate more control? Don't loose hope. You are still healing. My surgeon told me that it takes at least six months to fully recover. Take heart and stay positive. Stress/worry is not good for the repair of the body.
Yes, I did have the ultra sound tests done post op and that is when he told me that a follow-up surgery would help me. Ugh... First thing though, I need to get this diarrhea under 100% control....which is is better but not even 50% under control. I still have 'break through' and therefore FEAR of accidents.

 
Old 01-14-2011, 02:48 AM   #99
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Re: Sphincteroplasty after 4th degree tear

Thanks for the encouraging words Flsunshine! I feel a bit better today again. This might also have to do with the fact that I had quite a strong urge and it didn't come out, I just ignored it and it went away. This happened about 5 times in about 10 minutes before I went to the bathroom. It feels like a significant improvement from before the surgery. You're right, I'm still healing and this will most likely get even better. I guess I cling to the hope of becoming 100% normal some day and yesterday I lost any hope of this happening. Today I'm a bit more positive.

I really hope you get control of your diarrhea, it really complicates everything for us who have this problem. And I totally relate to the fear of accidents, it complicates everything.

 
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Old 01-14-2011, 11:16 AM   #100
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Re: Sphincteroplasty after 4th degree tear

Hey babygirl, I totally feel your pain! I have been going several times in the past few days too (I think because I have been messing with fiber supplements to get good consistency) and it feels depressing, like things are regressing. I had a whole 2 week period where I only went to the bathroom once per day just like before childbirth. My big issue is that the wound gets poop in it every time I go, so then there is a whole procedure to clean it out which involves q-tips and a mirror. It was so much easier when I could do it just once a day. My daughter is still a baby and doesn't understand that I have to take time to do this and she will start crying etc. Also, I feel like I never will heal, I still have an inch opening in the perineum, it looks really gross. It seems to me it has not healed much in the past month so I am not sure if this is permanent and I will need some type of second surgery to close it up?
I guess we have to wait and see for results, I have heard it takes up to 1 year to get optimal results from the surgery.
I started taking flax seeds today so I will see if it will make a difference to the consistency.
I am not sure if my internal sphincter was repaired separately, I will ask next time, all I know is that both sphincters were repaired and the surgeon was very hopeful about the outcome because all parts were there and I have no nerve damage. So we shall see.
hugs to all of you and have a great weekend!

 
Old 01-14-2011, 11:28 AM   #101
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Re: Sphincteroplasty after 4th degree tear

Lilypetunia, It took my wound three months to completely close. I wonder why they have you using q tips to clean it? Please call and ask about the possibility of getting a peri bottle. My surgeon had me mixing a quarter of a peri bottle of hydrogen peroxide and water to clean with after going to the bathroom. I would let it 'sit' for a minute and then rinse with pure water. I did not get a secondary infection and he seemed very surprised at this. The last bit of healing did seem to take a long time. I also want to be a 'proponent' of a hand held shower with a valve that has a 'flow control' dial. With my diarrhea issues this was a 'life saver/time saver' for me because I could get into the shower and clean up from the waist down and it was quicker and more convenient at times. I truly believe that the hydrogen peroxide and water 'therapy' was the key to no infection for me. One person I talked to did this same thing but with a 'spray bottle' that she carried with her in her purse. So I believe my surgeon is not the only one to prescribe this but please talk to your doctor before doing this. Too much peroxide is not good...peroxide can be caustic to tissues if used full strength. A delicate balance I believe... I am saying prayers for us all!
I should have read what I posted before sending...that was a quarter hydrogen peroxide and three quarters water.

Last edited by flsunshine; 01-14-2011 at 11:29 AM.

 
Old 01-14-2011, 11:47 AM   #102
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Re: Sphincteroplasty after 4th degree tear

thanks I might try the peroxide, however I don't currently have an infection so I don't know if it will do any good? I am now 4 months post-op and still have a one inch hole. The reason for this was that I got an infection 1 week post-op. Maybe if I'd used peroxide I wouldn't have gotten one? Anyways, I do use a peri-bottle but it doesn't do the job completely so after squirting with it (and I have to do 2 or 3 rounds of them) I have to finish the job by cleaning with a q-tip. I seem to have a lot of crevices down there since the surgery and stuff gets stuck in it so the peri-bottle is not enough. I also do the sitz bath but that is usually not enough either to get everything out. I have found that sitting over a mirror with a q-tip is the only thing that really gets all the stuff out. I am hoping once the wound closes I can go back to just using the peri bottle.

 
Old 01-14-2011, 12:03 PM   #103
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Re: Sphincteroplasty after 4th degree tear

Just make sure you 'rinse' the peroxide off after it has foamed so to not let it damage good tissue. It seems the q tip might be debriding tissue also...which is not in itself bad because all wounds get dead tissue with the formation of new tissue. Please call your doctor and ask before using because there may be a reason why they did not recommend it. I will say that the third plasty I had that the wound opened he had me using the same method but with sterile water that I got from the pharmacy (expensive for as many times I go to the bathroom). On the same token I was on 'well water' not city water at the time so that may have been the reason for the sterile water. I did not get an infection that time either. How often do you go for follow-up appointments? Are they debriding your wound when you go in? Each time I went in they would debride my wound...which is not comfortable but that seemed to facilitate more 'healing' the following week. My incision was a horse shoe shape on my perineim and once the stitches dehicsed they had to completely remove that 'flap' of skin which left a 'crater' the size of a half US dollar (two inches) and quite deep. Little by little it did close albeit I do have a LOT of hard tissue. So hard in fact that it actually 'pulls' and stings when I sit on the toilet or squat for which I do not do very often and when I do 'catch' myself doing I quicky right myself because it truly hurts. THAT too is why I was a proponent of the message of the tissue to make sure adhesions do not form and therefore hard tissue. I wish we all had a doctor on here to give us suggestions instead of having to go back and forth with our personal doctors. But as we all know THAT will never happen. LOL

 
Old 01-14-2011, 02:29 PM   #104
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Re: Sphincteroplasty after 4th degree tear

Hi In my opinion one of those shower heads on hoses might be useful to squirt with and lessen time followed by a light dab to dry with sterile gauze going from clean areas to dirty, a towel where there is no open wounded area and a hairdryer on cool. If no shower head can be used because of rental a water pour might be useful. A hand in a sandwich bag the (type with the fold top not the plastic zipper) might help keep poop off wounded area in my opinion being careful how poop falls and where it goes. The idea is to help keep the wound separate from the poop by keeping the poop away in the first place. It should not be held hard in case infection is present. A person would not want to push the infection literally to other places. A box of the bags can be kept in a handy place where they will not fall in the toilet but where they can be easily reached at a moments notice. A trashbucket can be kept nearby for used bags. As usual everyone makes their own decisions. Hope this helps someone. :grin:

Last edited by sjb; 01-14-2011 at 02:31 PM. Reason: typo at post, addtion made

 
Old 01-14-2011, 05:46 PM   #105
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Re: Sphincteroplasty after 4th degree tear

Thanks everyone for your advise. Flsunshine, I have been going every 2-3 weeks for follow-ups but next is not until 6 weeks, they did debride the wound twice. Hopefully, I will see some improvement soon.

SJB, thanks I will try the bag trick, it might just work!

Another thing I started this past week is using a warm gel pack on the area to encourage blood flow. I know the sitz bath is helpful to increase blood flow because of the heat but I don't always have time to do one, so I started using a warm pack instead and it feels very soothing.
I also started using a zinc oxide ointment on the wound since zinc helps in wound healing and I am also hoping the ointment will provide a barrier from moist and dirt.
I am hoping the hard work will pay off soon!

 
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