WOMENS-HEALTH Messages for January, 1998: Re: 4th Degree Tear

Re: 4th Degree Tear

From: Lori (anonymous@obgyn.net)
Wed, 28 Jan 1998 10:22:53 -0600 (CST)

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Reply: Harvey S. Marchbein, M.D.: "Re: 4th Degree Tear"

At Thu, 27 Mar 1997, R.Daniel Braun, MD FACOG wrote: >
>At Thu, 27 Mar 1997, Mrs. wrote:
>>
>>I gave birth vaginally 8 months ago and experienced a 4th degree tear. I
>>now have a rectovaginal fistula (as explained by the colo-rectal
>>specialist I went to see), which is getting smaller, but which still
>>allows communication of bowel movements into my vagina on occasion. The
>>rectal specialist recommends that I repair the fistula and opt for a
>>c-section for my next delivery. My ob-gyn feels I should deliver
>>vaginally again and then repair the tears after my childbearing years.
>>I am thinking of having another baby and would like to hear about
>>similar cases. Is it wiser to opt for the c-section to avoid possible
>>worse tearing or would a vaginal birth still be the norm in such a
>>situation? What is the chance that the tearing would be even greater
>>with another child and could it be repairable after?
>>
>>--
>>Sanja Pozar
>>
>How soon are you planning to get pregnant?
>If it is real soon, I would get pregnant, deliver vaginally and see what
>happens.
>If the fistula persists or gets bigger then get it repaired after that
>delivery.(at least 3 months and preferably6months after the delivery)
>If you plan to wait another 1-3 years, I would recommend waiting another
>6-8 months hoping the fistula will continue to close on its own. Many
>of them will. If it doesn't, then have it repaired, get pregnant and
>either have a Cesarean or vaginal delivery depending on how you feel
>about the risk of having a recurrence. The risk is fairly small (around
>10% I think) but if that is too high then have a cesarean.
>As you can see, there is no simple straight forward across the board
>answer to your question. If either of your physicians recommends a
>course of action, ask them why and what are the alternatives and risks
>and benefits. If they won't discuss it with you, get a physician who
>will.
>
>--
>R.Daniel Braun, MD
>
> "Heisenberg might have slept here"
> Unknown or possibly Indecisve
>

--
I have already had a fistula repaired that was not very far in to my vagina.  But now I have another that was only found through my rectum.  It is very far up and my physician is recommending a surgery in New Orleans where they will go through the rectum and pull a muscle down over the fistula. Are you familiar with this procedure?  Do you know what the long term success rate may be?  I gave birth almost 2 years ago and tor very badly.  Should this procedure be permanent?

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