Consequences of a rupture during childbirth
Third- and fourth-degree perineal tears affect the pelvic floor muscles and anal sphincter. If the sutures during childbirth are placed inaccurately or come apart, a scar deformation is formed: gaping of the genital slit, prolapse of the vaginal walls, discomfort in sexual activity, and if the sphincter is damaged, incontinence of gases and feces. Many women do not address these complaints for years, considering them an inevitable consequence of childbirth. The operation removes scar tissue, restores the levator muscles and, if necessary, the integrity of the sphincter. The optimal period is no earlier than 6 months after childbirth, when the tissues have completely healed, and after completion of breastfeeding.
When is reconstructive surgery needed?
Childbirth, especially with perineal ruptures and a large fetus, and age-related changes lead to stretching and damage to the muscles and ligaments of the pelvic floor. Prolapse of the walls of the vagina, uterus and bladder develops, a feeling of a foreign body, urinary incontinence, impaired bowel movements and discomfort in sexual life appear.
Conservative methods - Kegel exercises, pessaries - are effective in the early stages. In case of pronounced prolapse and formed defects, the anatomy can only be restored surgically.
Principles of reconstruction
- restoration of anatomy using the patient’s own tissues
- bringing the levator muscles together to form support for the pelvic floor
- excision of scar tissue that is unable to bear the load
- if necessary, a combination of several stages in one operation
Recovery
The key condition for success is adherence to the regime: sexual rest for 6–8 weeks, avoiding heavy lifting and preventing constipation. An increase in intra-abdominal pressure in the early period is the main cause of suture dehiscence and relapse of prolapse.