I incurred an internal and external anal sphincter fissure during labour. It is hard to say for sure but I think there were a variety of factors; baby was 9 pounds 2, the placenta was on the 90th centile, I had an epidural, it was my first birth, from 4 centimetres dilated to baby being delivered was about 12 hours with about 2 hours pushing (is this long or short??!), I was two weeks over due (although the dating scan never made sense with when I thought I conceived while charting my ovulation), my waters were broken artificially (again not sure whether this would have contributed).
I was in pain after birth but it took about 6 months to get a clear diagnosis of a fissure. I went through various treatment options. The last, and I hope the final, was a fissurectomy and anal flap when my son was 15 months old.
My question is, what can I do to prevent a fissure next time? Would you recommend a c-section or are the risk far greater than the fissurectomy I eventually had to have?
Anal Fissures are more common in pregnancy , particularly in the last three months. The main cause is constipation rather than a difficult or long labour. It is not particularly associated with vaginal birth and not an indication for a C section next time.
Although there is a slight chance of recurrence, the best advice is to try and avoid hard stools that can tear the rectal mucosa. So lots of fibre ,bran, vegetables fruit fluids and all the usual advice is the best way forward.
4cms to fully in 12 hours is a little slow but not unusual in a first labour. Same comments for the two hour second stage. Next time you can expect a quicker and easier birth. Average 6 hours max and no more than 30 minutes pushing.
The above advice is from the Doctor, I would however like to add that I had awful constipation and found that my diet and water consumption made no difference. The only thing that helped was Fybogel, which is a natural plant extract that helps with constipation. You can get this free of charge from your chemist if you get a prescription from your GP.