Urogynecology Expert Forum
4th Degree Tear during Childbirth Years/Incontinence
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Questions in the Urogynecology forum are answered by Bruce Crawford, MD, J. Kyle Mathews, MD, and other medical professionals and experts. Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.

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4th Degree Tear during Childbirth Years/Incontinence

I am the mother of four boys. First i had via csection.  Second 12 years ago vaginally which left me with a 4th degree tear.  At that time i was young, naive, and no one told me.  I just knew i was never the same.  When i got pregnant with my third baby the dr. brought it up saying he saw it in my file, poor girl.  Did i have trouble with incontinence and holding my stool.  In embarrassment, as i always knew something was wrong, and the messiness of it, i said Oh no...not at all.  Lieing but embarrassed.  Well the two babies after, made it only worse.  I have trouble leaking, heaven forbid i get diahrea, i cant make it.  I try to watch my diet, but that help some what.  I got the courage up after a messy accident on the way home from a dinner with friends to talk to my practitioner.  She said there was nothing that can really be done to help me.  Is she wrong?

I cant stand this anymore.  It has taken what vibrant life i used to have away.  I am simply afraid to go anywhere there is no bathroom.  I dont walk anymore, i dont do things with my kids.  Its just sad.  I am a victim of a toilet!  Its somewhat pschological now, i had an accident in Canadian tire once now i walk in that place and feel the panic as there is only one bathroom.  Gosh i just dont know what to do.  If i have any options.  Help

L
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Is this fecal incontinence? If so, a disrupted anal sphincter (sustained in childbirth) can sometimes be a cause.  The repair of the disrupted sphincter can be performed by a urogynecologist or colorectal surgeon, and is  50% - 60% effective in curing the problem. It does takes a while to heal completely. Other therapies include sacral neuromodulation (AKA Interstim), which works very well for fecal issues, but this is not yet FDA approved for fecal issues (it is approved for urinary urgency and urge incontinence). So, there are solutions to the problem that you have.

Many providers would first recommend diet modifications to solidify the stool, which makes it easier to hold on to.

Find the nearest hospital affiliated with a medical school, and ask if they have a trained urogynecologist or colorectal surgeon. Ask for an evaluation by either one. They should give you correct answere to help with your problem.
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J. Kyle Mathews, MD, DVMBlank
Plano Urogynecology Associates
Plano, TX
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