Vaginal Laceration & Postpartum Fecal Incontinence: A Doctor's Perspective

Question
Hello Dr. Rappaport,

I have TOPICS to ask you about:  

1.  I have a 3rd degree vaginal laceration in the external rectal sphincter that no one repaired after I gave birth to a 9lb baby 4 years ago.  I now am fecally incontinent.  From your experience,  how is this discovered after a baby is delivered?  Isn't this something that is
noticeable?  I was told a repair now would be less that 50% effective-what are your thougths?

2.  For a person in their early 40's, having pre-menopausal symptoms (increased facial hair, scalp hair loss, mood swings, occasional sleep problems, memory issues, urge and bladder leaks once or twice weekly, low sex drive), and a 32 estradiol on day 1 (range is 20-? with below 20 menopausal) is it recommended to    try estradiol therapy to get rid of symptoms and preserve bone and help memory and quick aging?

Thanks for your help,

Annie


Answer
After the baby is born , it is prudent to check any tears or lacerations. I always place my finger in  the rectum to see if there is a 1st, 2nd, or 3rd laceration. If you have injury to your rectum, it can still be repaird, although difficult. If it is found at the time of delivery, sometimes we will wait 6 months and then repair it. If you have premenopausal symptoms (flushes, flashes, sweating, memmory loss, etc) perhaps estrogen therapy will help. Discuss it with your gynecologist.