WOMENS-HEALTH Messages for April, 1998: Re: 4th degree episiotomy

Re: 4th degree episiotomy

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Thu, 9 Apr 1998 21:50:29 -0500 (CDT)

Messages sorted by: [ date ][ thread ][ subject ][ author ]
Next message: Jenn: "Any Dr. input on ovulation prediction tests??"
Previous message: Annie: "SUTURES,ADHESIONS, & POSSIBLE HEMANGIOMA"
In reply to: Jamie Iselborn: "4th degree episiotomy"

A fourth degree episiotomy is when the tear through the vagina extends through the rectal sphincter and into the actual rectal tissue. Contrary to popular belief, cutting an episiotomy actually increases the risk of this (think about how much easier it is to get paper to tear after you cut it a little, vs trying to tear it without a starter cut). It is also a myth that these tears can always be prevented. Childbirth is a risky business, and sometimes 3rd and 4th degree tears occur despite the best efforts by the OB or midwife.

A 4th degree tear is sewn in layers, starting with the rectum. They can be quite painful, and ice, painkillers, and sitz baths will help. In unusual situations they may "break down" and open up, probably due to swelling and tension on the stitches. This cannot always be prevented. When this occurs, a fistula may develop, which is a hole between the rectum and vagina. Patients may pass gas through the vagina, or even have a bowel movement that passes partially through the rectum and partially through the vagina. This may lead to vaginal infections, but more commonly, leads to embarassment due to accidental gas release or passage of liquid stool throught the vagina. Obviously, this creates self-image problems and adversely effects one's sex life. If the sphincter comes apart, as in your situation, it may lead to rectal incontinence.

Treatment is pretty straightforward. It is critical to wait for healing of the tissue before attempting a repair. Patient always want the problem fixed immediately, and it's hard to get them to wait for 4-6 months for the area to heal and for the swelling to go away. The patient is put under anesthesia, and the area is reopened, the tissue is cleaned carefully, and layer upon layer of suture is used to reattach the sphincter, or close the fistula. It is usually very effective, but requires careful attention to hygeine and diet (ie no constipation) for weeks afterwards. In rare occasions, a colostomy is required (an opening in the abdomen where feces passes into a bag) for a few months to let the area heal. This is not very common. Many gynecologists, and all gynecologic oncologists, are trained to repair these problems. I imagine that colorectal surgeons receive similar training, but I'm not sure.

Good luck with your surgery. I'll keep my fingers crossed that everything works out well.

-- Ashley Hill David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL http://www.gate.net/~dahmd

I apologize, but I am unable to answer personal e-mail due to time constraints.

Next message: Jenn: "Any Dr. input on ovulation prediction tests??"
Previous message: Annie: "SUTURES,ADHESIONS, & POSSIBLE HEMANGIOMA"
In reply to: Jamie Iselborn: "4th degree episiotomy"

Women's Insurance Checklist from Auto Insurance Quote

use when must restrict search to only the women's health forum...
Enter search keywords:
	Returns per screen: Require all keywords: