Is there anyone that can tell me about their experience with pregnancy after a sphincteroplasty? Has your continence worsened as a result of the pregnancy? All the research I have done on this, combined with Dr opinions, says that you may get worse, you may be ok. Either way continence after a sphincteroplasty is degenerative, but I am curious if anyone has any first hand experience to share. We are trying to decide whether to have another or just enjoy our one.
I am due for a sphincteroplasty due to a bad repair after a 4th degree tear 4 years ago. I've since my first birth been pregnant again and had a c-section. I am also planning on getting pregnant again after my sphincteroplasty. Yes, my continence got slightly worse during pregnancy, but much less than I was afraid of. About 3 months after pregnancy I felt that things were back normal again, actually even better than before the 2nd pregnancy. I must add that I have been doing kegels for 4 years and did kegels every day during my pregnancy and afterwards (started again 6 weeks after c-section). Kegels have improved my symptoms tremendously and are probably the reason why I'm doing so well after pregnancy no. 2. After my sphincteroplasty I'm going to continue to do kegels for all they're worth and I'm absolutely positive that another pregnancy will be fine, as long as I have a c-section and do my kegels
Last edited by Babygirl43; 06-09-2010 at 12:27 PM.
Thank you for your input! I am desperately trying to find women in the same boat that I find myself. I have worked so hard to normalize my life after my complications and am afraid to make things worse. Do you mind me asking you if you tore your internal & external sphincter all the way through? Did you experience nerve damage from your 4th degree tear? I know it is none of my business, I am just wondering if we had similar injuries. Any degree of this injury is awful. I have started working on my kegels again. The last few years I have worked a lot on diet & normalizing my bm schedule so that I had some predictability to my day. It sounds like you have succeeded with your kegel regimen. any advice? do you do sets at different times throughout the day?
Yes, I tore everything, all the way. I don't have nerve damage. My main issue is urgency, which has become much better because of kegels. I have no passive leaking. Did you tear both sphincters and do you have nerve damage? Which problems do you notice?
I do 15 sets of kegels a day in one go, and hold for 20 seconds each. Alternatively you can do 30 sets of 10 seconds. I do them in the evening, although now that I have a baby I do them during the day during one of his naps.
Yes, I tore both the internal & external all the way through, but there was so much scar tissue, they couldn't determine that until the surgery (sphincteroplasty). I have some nerve damage that they were hoping may come back a bit as time passes. I just saw a new OB/gyn three days ago, and he reminded me that pregnancy can cause nerve damage. I guess that is part of the reason I am concerned about another pregnancy post-sphincteroplasty. Obviously, this is a degenerative condition with age, and I really want to postpone any serious problems as I age. My surgery was 3 & 1/2 years ago. It helped me. I still cannot hold gas. Loose stool is usually a big problem. But, like you, urgency is my biggest issue. I have started working diligently on my kegels again. I am hoping that will help me at least maintain where I am. Biofeedback helped me if your doctor has that available. They teach you how to isolate the muscles for kegels work & they teach you a lot about diet/fiber/things to help you "regulate" your body so you are not caught in a difficult position. It sounds like you are doing very well for not having a repair yet! Sounds like kegels are the key. Did you have your c-section at 40 weeks or did they do it a little early? My colo-rectal surgeon advised me to have the c-section as soon as the baby is full term(37 weeks).
I'm sorry to read that you still have issues even after having sphincteroplasty. Did they not see the extent of your damage on an ultrasound before surgery? My goal is to become as normal as possible after surgery, although I might be a bit too optimistic there, I don't know...
I really wouldn't worry about getting nerve damage during pregnancy. I don't even know if it is true what your OB/gyn said. I read on an informative website about sphincter tears that you can only get nerve damage if you give birth vaginally, not if you have a c-section. Which would make me think that a pregnancy wouldn't really affect the nerves. What pregnancy did to me was temporarily weaken the internal sphincter since this is soft muscle tissue just like the uterus. The uterus needs to stretch, thus all soft muscles in the body weaken. That is also why you always need to pee in the first trimester, the urethral sphincter is also made of soft muscle and gets weaker. 3 months after pregnancy I felt that the internal sphincter was back to normal again.
Also pregnancy weakens your pelvic floor muscles in the last trimester due to the weight of the baby. But this also got better after the baby got out. I actually got better after pregnancy than before pregnancy. Maybe because doing kegels with extra pressure from baby actually strengthened my muscles, as I did many kegels standing. I feel in no way that my pregnancy worsened my problems and I am definitely going to have a third child after my sphincteroplasty, maybe around 2 years after surgery.
If I were you I would talk to a CR dr. and ask his opinion on nerve damage from pregnancy (without a vaginal birth). Maybe his answer will be different from your OB/GYN's? I feel that I can with all my heart say to you, if you want a baby, go for it. I really don't think that you will get any worse in the long run, as long as you do your kegels. For us, kegels will have to be a life long habit. I hate doing them but will do them until the day I get so demented that I don't know who I am
Thank you for the words of encouragement. I think that you & I have similar ways of handling the situation by being proactive in our improvement. When I fist started going through this 4 years ago, I spoke to many women who were very defeated. So, I appreciate your point of view. So, to answer your questions: 1) From the ultrasounds ( I had several as I got several opinions), they could tell I had torn my external sphincter. But, the scar tissue around the area was so bad, that they couldn't tell exactly where the tearing stopped. When the CR surgeon performed the surgery, she said it was much worse than they thought from the US. I had completely torn my internal & external sphincter. The terrible OB who delivered my baby didn't repair either while she was sewing me back up-so there was no repair done at the time of labor. This put me at a disadvantage, obviously. 2) The recovery takes a while from the surgery. So, it took awhile to feel too improved. But, I am 100% glad I did it. It makes sense that if you have muscles that are supposed to be connected in a circle, you want them to be put back together to give you the best chance at normalcy. I feel that I had improvement. How extensive is hard to say because I feel like it got better over time. Obviously, it is major surgery and it took a while to completely heal. The improvement is probably 25-50%. But, this is a great time to find the best surgeon you can. I do believe that my surgeon is a reson why I improved. She was VERY good. You do hear a couple of bad stories about the surgery, but I think if you go to a good surgeon & you follow the recovery protacal to a tee, you will be great. With the way you have handled your injury to this point, I am sure you will have a successful surgery.I am sure if I had not had the surgery that I would be in much worse shape today.
That is just so bad, your OB didn't even attempt to repair the sphincter muscles! I thought this is one thing that an OB should know! My OB only repaired part of the external muscle and didn't repair the internal one at all. Apparently in many of the OB books they only teach how to repair the external muscle and that the internal one isn't so important. It makes me so angry. This is probably why she didn't repair it.
My surgeon will repair the internal muscle and the entire external one (which is only half repaired). My CR dr. has specialized in the secondary repair of obstetric injuries, so I really do hope that I have found a good doctor. He will operate in October hopefully.
It's good that you had yours repaired, you wouldn't have had a fighting chance to get better without it. I hope that my surgery will make me even better, but I'm scared to death that it will become worse instead. I also dread the months of maybe not being able to hold it in again after surgery. It took me 4 years to get where I am now, so I don't feel like starting from scratch again. But I'm willing to do that too, just in order to get as good as I can get!
It is really good that your OB repaired your ext. sph. right after your injury at labor. There is overwhelming research that shows that being repaired right after labor produces the best results. Not repairing the internal sphincter is blasphemy. The research is sub-par on this whole issue and I feel there is a big lapse in information on this topic for OBs-especially in the US. Our medical system does not focus much on the issue. All the research I read when I was going through this had very decisive conclusions. They do much more for women after labor & relating to tears, etc in Europe. My doctor left for vacation & swore I was so far from going into labor that she would be back in time to deliver my baby (not her fault, but in light of the events-very disappointing). I went into labor the next day and had a terrible series of events-concluded with the quack that delivered my daughter, who lied to me about my injury and falsified my records. (afraid of a lawsuit, I suppose) I have worked hard to get over the anger and to just be as healthy as I can be. I am sure that your surgeon is excellent & that you will improve post-surgery. Working from such a strong position should help you. It seems to me that the post-surgery follow-up is very important. Just follow the post-surgery home care that they give you and do not do too much too soon. I know this is hard when you are a mom-but, I feel it is important not to stress the muscles post-surgery too soon by doing too much. You are going to be great. I am happy to discuss any details of the surgery/follow-up with you. they can be strange & embarrassing. I know I didn't really want to discuss them with my husband too much because it is hard to understand if you aren't going through it yourself.
I can totally understand your negative feelings towards your OB and also your need to get on with your life. It's like they don't undertand the impact their actions have on the rest of our lives...
I would appreciate any information and experiences you have post-sphincteroplasty. I am prepared for worsened continence right after surgery, but I would appreciate if you would describe to me the embarrassing side-effects you experienced. I would really like to know what to expect, especially in the "holding it in department" Also how long it took to feel an improvement. Thank you so much for your support!
I am happy to tell you whatever I can remember form the surgery. There are probably differences in the way our surgeons handle the surgery. First of all...there is no delicate way to ask-which way is your surgeon going to do the surgery? I think you said you were going to a CR, which should mean that the surgeon will go through your rectum. This is what makes the surgery risky, as obviously, there is bacteria in this area. So, the whole balancing act of the surgery is following protocol by keeping the area clean & managing excretion so there is no unnecessary pressure on the repaired area.
So, obviously, the pre-surgery involves the cleaning of the bowels-same thing you would do for a colonoscopy. Drinking lots of gross stuff that will help clean you out-not fun, but no big deal. Then, you will probably stay in the hospital for a few days after the surgery. They had me stay until I had a bowel movement. This takes a while because of pain meds, etc. those first few days are painful, but you are so drugged, you won't remember much. the worst part was when the nurse (who was a saint!) made me get up & walk & go to the sitz bath to clean up. It is difficult to get up & moving because you have been laying in bed on strong meds for 24hrs. Obviously, the first BM is no fun. Then, you go home and the recovery is strange because there is stuff to do, and I didn't want my husband or my mom doing it because it involves your bottom. You may feel more comfortable getting help from others. Everyone has different comfort levels. My surgeon made me give myself a water enema with a plastic catheter everyday... I think she had me do it a few times a day. It is by far the worst part-one day, I accidentally stuck the tube into my wound instead of my rectum. It is hard to find the right place to execute the whole thing. It isn't necessarily painful-just challenging, as you can't see what you are doing & you are trying to keep from worsening your wound. I was fortunate that my Mom came to stay with us for a few weeks to help with my daughter, etc. That was really helpful, as my daughter was so little & didn't understand why I couldn't carry her, etc. It is difficult to not lift your children, but it you are going to go through the pain and time of the surgery, you want it to work. You really need help so that you will not have to do any lifting or you can blow out the repair. I know you are anxious to know how quickly I felt more continent, but I don't have a straight answer. It was gradual. It is serious surgery and so, takes a while to even heal. I think it took a good 6 months before I felt stronger than before. But the good news is, every month I felt stronger & better. It is major surgery, but worth the risk with a good surgeon. You will be great. I would be happy to chat back & forth with you as you go through the process if your have questions or just need support. I felt very alone, because no one knew what I was going through as I recovered. My husband was great, but understandably, didn't know what to say to me. He knew I was going through a tough recovery and I think it made him feel pretty helpless. Either way, know that there are people out here who you can talk to & who have gone through the same thing. You sound like a strong person, and I am sure you will be great. What am I leaving out?
Thanks for all the details! They don't tell you about this part when scheduling the surgery. I am like you, and I don't feel comfortable with other people helping me in "that region". I think I will even have problems with a nurse dressing my wound, so my husband is out of the question! The enemas sound like a hassle. But I'll do anything to get better.
I'm so unsure if I will be able to go back to work after 2 months, and do other normal things like going to the shops, or if I'll still have issues holding it in. 6 months is long time to feel improvement. I will at least do my kegels religiously.
My CR surgeon is also going to do a perineoplasty, so I think he'll be going in from above, not through the rectum. Who was your surgeon, was it a OB/GYN or a CR surgeon?
A colorectal surgeon performed my surgery rectally. I did see a uro-gynecological surgeon who wanted to do the surgery vaginally, but he turned out to be much less experienced than my surgeon.
What do they do in a perineoplasty...make your perinium bigger? How do they determine if that would be a helpful surgery? I haven't heard of it.
You will be fine to go back to work. I think I was only off for 1 month before going back to work. I am in sales, so I am not even in an office, and I was fine. You may want to ask about biofeedback from your CR surgeon. My surgeon had a biofeedback nurse in the office who helped me a lot. They teach you a lot about altering your lifestyle to make living with continence issues easier.
The perineoplasty is to make the perineum bigger yes. It is much shorter than earlier, and it's being done because 1. it bothers me 2. building it up *can* help the outcome of the surgery by giving more bulk to the area. So I assume he'll just cut open the whole scar and sew it back together again.
I really do hope that a month off work will be enough. I'm not telling them what my surgery is for, I feel it's too personal. Did you tell your work?
Right now I am so impatient and just want this over with so I can recover. I'm tired of my problems and want to be normal again. But will I ever be??