Anyone had issues with a perineal tear?

[daisyd]

So, I'm nearly 10 weeks postpartum and I had a third degree perineal tear that is not healing well. I'm told that there is excessive granulation tissue at the site of the tear. This is causing intermittent pain and tends to bleed (on examination). I'm told that this is a minor issue and that I'll need to be operated on if it doesn't go away by itself in 3 months. Has anyone else had similar problems?

I really don't want a repeat stint in the hospital. DH just cant afford to be away from work right now to take care of DC and me. And, I don't want surgery if I can possibly get away without it. There is no guarantee that it wont recur after surgery as per what I've read. It would help for me to hear about your experience/ suggestions.

TIA!

[Jenny_A]

I haven't had the experience you're having with the bleeding, etc... But, I tore pretty badly with DD. I remember the doctor commented on it after she was delivered and I received LOTS of stiches. It took at LEAST a year for that area to heal totally! I had a lot of numbness in that area and I honestly began to think it would be that way forever. It's finally all healed and now I'm delivering baby #2 soon! That's the part of delivery I am most concerned about, simply because it took so long to heal before.

Anyway, no advice but just know the healing process is slow!

HTH,

Jenny

[DrSally]

I had a 4th degree tear with DS, but didn't have issues with healing other than it took a long time and wasn't fun. I have read past posts about people who have had pain in that area following healing. I would really dread a surgery. I hope it heals up.

[Momof3Labs]

I had granulation tissue removed from my tear following DS1. The actual removal was horrible - my OB did it in her office using either no or a bit of local anesthetic. It was awful, but didn't involve any kind of hospital stay. But she only had to do it once, and I was fine after that. I tore with DS2 also (though not quite as much) and that tear healed just fine.

I can't imagine that you'd have to stay in the hospital for something like this for more than a day, if even that (could be outpatient). What did your OB tell you? If you need to do it, then your DH just needs to be there for you. I know how painful it is, and you can't ignore it just because he's busy at work.

[BeachBum]

I had a 3rd degree tear too (and an episiotomy). But I didn't have granulation issues (sorry I don't even know what that is). It is not fun. But you've got to take care of yourself. I know it may seem stressful now for DH to be out of work for a bit, but how will it feel in a few years if you are still having complications from this? I know I would do everything in my power to get it fixed! Sex was an absolute joke (and very painful) until my issues were totally resolved.

But, I agree with another poster that it took a long time for that area to feel normal. I continued to use stool softeners for several months (just a softener, not one that makes you go). On the advice of my Dr. every chance I got I would spray myself with the hand held shower instead of wiping (for #1 too). I honestly don't remember how long I did that though...several weeks at least.

Good luck. I hope you make a full recovery!

[jd11365]

Yes, I did, and had granulation issues as well. They cauterized it right in the office. I will tell you it took years for it to feel normal again, if normal is the word, but no pain or bleeding.
I was told not to do surgery until after I was done having children. It tore, they fixed it. If they do surgery, they will tear it again, then fix it. Then if you have more children, you could tear again, putting too strain on the area, and adding too much much scar tissue. If you wait until you're done having children, you fix it and you're done.
I ended up not needing surgery after my second child. I didn't tear much with him and it healed well enough on its own.
HTH!

[shilo]

yup. big hugs to you. it is a uniquely miserable situation and largely responsible for why it took me almost 2 years to decide i could brave trying again. there's just no describing the head-job that comes with having it sting and burn to pee for 3 months straight while dealing with all the other newborn stress. be gentle with yourself.

anyway, i had multiple 2nd deg. tears with DS1, and ended up with 2 that were prolonged/non-healing after some of the stitches tore out a few days after delivery. one of the two had slightly excessive granulation, the other had normal granulation. the one with the 'excessive' granulation finally closed at about 12 weeks, the other one with 'normal' granulation not until 14 weeks, iirc. i say 'closed' not healed b/c the area continued to be uncomfortable with intercourse until at least 6-8 mos. pp and then just numb for close to a year after that.

the thing that finally 'turned the corner' in getting them to start to heal (this was at about 6wks pp) was when the NP in the office had me start doing sitz baths 2-3x per day and blowing the area dry with the hair dryer on low after each. she also encouraged sitting on a heating pad and lots of kegels to try and increase circulation to the area. it took a solid week for this to start to help, but they went from non-healing to finally making progress that week. before that, i was just doing the peri bottle or shower to rinse after every trip to the bathroom and patting dry with tissue. we did talk about cauterizing them, but she felt that as long as they continued to heal, albeit slowly, i'd be happier with the long term result in letting nature take it's course. had the regimen with the sitz baths, blow dryer and heating pad not pushed them from non-healing into prolonged (slow) healing, i would have had to have them cauterized. in the end, letting them heal on their own did lead to a good long term result - but it wasn't always easy (to keep up the regimen as well as the extra time i spent dealing with the uncomfortable side effects).

so, the 'bad' news - i had a V shaped notch with scar tissue at the introitus (opening) for the 3.5 years between kiddos. the 'good' news - i tore again (another 2nd degree, but 'minimal' according to my OB) at the scar tissue with DS2 and my OB was able to do a great repair and i am mostly healed at this point (one darn stitch that won't resorb). no more V, most of the scar tissue is gone and very minimal discomfort at this point (i'm 4wks pp after DS2 right now).

more hugs, good luck!

[daisyd]

Thanks all of you for taking the time to reply and a big thanks for your support!
My OB suggested excision under general anesthesia as the granulation tissue was very vascular (lot of blood vessels). She was not keen on doing an office procedure. We didn't discuss it in detail. She didn't seem confident about what she was doing (just my read). When I asked "whats the harm in just leaving it be, why should it be removed?", the best answer I could get was, "because, it has no business being there". She suggested applying bactroban cream inside the vagina "to dry it(gran tiss) up" for a few weeks. When I read the product info on the cream it says "not intended for use on mucosal surfaces" (and the vagina has a mucosal surface). I developed burning while using the cream and so I have discontinued it. Her colleague (from whom she asked a second opinion) suggested physical therapy to strengthen the area and may be an ultrasound to rule out a fistula (though they didn't feel one on their examination). I haven't been able to get through to physical therapy for an appointment for a week now. They were busy because of the holidays I guess.

I feel insecure because I'm not getting good answers from my OB and she doesnt seem confident about what she's doing. I'll be getting in touch with her tomorrow after she returns from a week long vacation.

Lori, a special thanks to you for taking the time to write about your experience in detail. It was very reassuring to hear that it does get better. Thanks for your suggestions. Hugs.

Daisy

[misshollygolightly]

Hi there...and more :grouphug: to you! I had a 4th degree tear this past summer with my first baby, though I fortunately didn't have the specific granulation issue you mentioned. I would never wish a 4th degree tear on anyone, and I can only imagine what the added complications do to you! These may be things that don't help the granulation or that you're already doing, but just in case, I thought I'd mention them as they definitely helped me:
sitz bath several times a day (really, as often as possible, and with the hottest water you can comfortably use! I even figured out how to nurse DS while sitting naked on the sitz bath, using a boppy to support him); witch hazel wipes (aka Tucks pads) to help keep the area clean and slightly numbed; hot showers and spraying the area directly with the handheld shower head; stool softeners for about a month; and sitting on a hemorrhoid pillow (those rubber inflatable ring-shaped things) as needed for the first 3-4 weeks; using a peri bottle of warm water to rinse "down there" after pottying. The sitz bath and peri bottle were absolute lifesavers for me! Physically and psychologically, a bad tear can really get you down during those chaotic newborn days...do not feel guilty if you sometimes feel that all you can do is feed your baby and then try to take care of yourself! This is a good time to rely on DH, friends, and relatives to do some of the diaper changing, baby-cuddling, and housework while you do what you need to stay comfortable and heal! Hth!