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Zen Teachings Number 3

16 November, 2011

3rd and 4th degree tear

I am on the end of a long trail of funny joke emails. My Mum sends them to me; her friend sends them to her and her friend’s daughter sends them to her ….and so on. I like getting joke emails – because in the middle of a chaotic day of working hard with patients, rushing to the shops/gym/and other places –  you know what it’s like – I like having the opportunity to have a random ‘laugh out loud’.

One of the funniest recently – from Mum via her friend Peg and her daughter Kym- was one called Zen teachings -and I thought of it today when I was attending the first two workshops of the Continence Foundation of Australia’s National Conference in Melbourne. The first three-hour workshop was on Obstetric Anal Sphincter Injury and the afternoon one was on Faecal Incontinence in Adults.

Third on the list of the Zen Teachings was very relevent to the topics today.

No-one is listening until you pass wind”

As funny as that one liner is – it’s not too funny if you are suffering gas incontinence following the birth of your baby or worse still loss of stool. Dr Alison De Souza told us that since the advent of 3D anal ultrasounds there has been an increase in finding anal sphincter tears to 30%  – these are occult tears meaning at present, they may not be symptomatic for the woman. But if they are picked up early then the outcomes can be better for the patients in the future. When the 3rd or 4th degree tear is repaired after the birth, Alison emphasized the importance of early clever management of the injury – such as you would in any acute injury.

  • Ice for the first immediate 24-48hour period
  • Rest in the horizontal position as much as possible in the first 24-48 hours (no you don’t receive visitor after visitor sitting for hours on end in bed!)
  • Strict analgesia
  • Trial of void after removal of the catheter which is necessary following the repair
  • Gentle pelvic floor exercises after 72 hours
  • Bowel care to avoid straining
  • See the GP at three weeks
  • Regular review by a Continence and Women’s Health Physiotherapist
  • Review by a Colo-rectal surgeon at 6 weeks if any faecal incontinence.

What is crucial is good education of the patient to maximise the potential recovery of muscle strength and minimise damage from inappropriate straining at stool.

They were both great workshops and you are able, I understand, to access the CFA  website to see the full powerpoints.

Next time I may expand on Zen teaching number 2:

‘Sex is like air. It’s not that important unless you aren’t getting any’.

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One Comment
  1. Katie permalink

    It is awkwardly true re zen teaching three: no one is listening until you pass wind… But yes, not very funny if you are suffering from issues you mentioned. Thanks for your wonderful, continued information – mostly awkward, but so important to be aware of.

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