appeasiotomy

I had my baby girl 7months ago and had to have an appeasiotomy as forcepts were needed. Everything was fine untill 1week later I was very sore and slightly open! My midwife looked at it and said it was fine, I should expect some discomfort. Then just a few days later I had a strong discharge so went to see my GP who was horrified, I had an infection and also poo in there. I had to goto the hospital, where they removed my stitches and gave me antibiotics to clear the infection, in the hope that once the infection was gone I could be re-souchered. This went on for weeks, as everytime I went back the site was still infected. When eventually the head of Gynecology told me I couldn't be re-souchered as the skin had already started to heal and as it was open like a v shape the stitches would just pull..... over time this did work, and then at around 4months post labour, the healing stopped. He courterised and re-souchered 5 times to date and I am still not healed, or even closed fully, the last time this was done (5weeks ago) he used removable stitches on the outside, I had a check up 3weeks later and he said he wouldn't remove them as he feared i would 'pull open' again.... Is what being done right for me? I have a check-up on Wed and I fear he will just say we'll quartarise and re-soucher again? My recovery seems so long-winded and I can't find any case of this anywhere, do I have any other options? you're advice would be most welcome! Sam

[Elaine Brown, MD]

HI!
Oh my goodness!  I'm not really too sure where I would begin with you as my patient,
I think the first thing to do would be a very thorough examination (possibly under anesthesia ) to be certain that there is no fistula.  (A fistula is a communication between the rectum and the vagina).  Given your story, I would be VERY worried that this is the case.  IF SO, it might be necessary to perform a diverting colostomy to devert the flow of feces away from your bottom so that it could heal. A colostomy is usually only necessary for 3-4 months and then can be taken down again.
Once the infection was completely cleared, I would then operate with the assistance of a specialist (gynecologic oncologist) to repair your bottom and close the fistula.
You would probably need to have all of the scar tissue removed and repaired, so it might be a fairly large operation.  When your bottom had healed I would double check for the fistula and then take down the colostomy.
IF there is no fistula, I would do all of the same things EXCEPT the colostomy.
I think you are going to need to demand a specialist in gyn-concology.
FINALLY--I would recommend that you have all the rest of your children by C-section so that this never happened again.
I DONT think your case is being handled well, and if you have any resources to do so, get another opinion!
Good luck!
Dr B