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Colostomy After Poorly Repaired 4th Degree Tear

Colostomy After Poorly Repaired 4th Degree Tear

After a mismanaged labour and a poorly repaired 4th degree tear, Frances has been left with a fistula which causes faeces to leak constantly from her vagina. She underwent surgery and had a temporary colostomy, but continues to suffer the same symptoms.

On 10th March 2010, Frances began to experience labour pains. Over the next three days she returned repeatedly to hospital but the midwives kept sending her home, ignoring her pleas for pain relief.

She was eventually admitted on 13th March, by which time her unborn baby was showing significant signs of distress. A doctor finally decided to do a scan, despite a midwife saying it was unnecessary. This revealed that the baby was lying in the wrong position, preventing the progress of the labour and causing Frances extreme pain.

She was taken down to theatre and given an epidural. She was not given an episiotomy. Forceps were applied to turn the baby and a healthy boy was delivered shortly afterwards. Straight away the doctor told Frances that she had sustained a 4th degree tear and would be repaired immediately.

The epidural wore off before the repair and was not topped up, even though Frances kept saying she could feel the stitches. She is therefore certain that an examination was not carried out before and after the repair, meaning the doctor could not have known if the defect had been entirely stitched. Furthermore she was not given antibiotics.

Two days later Frances passed her first bowel motion since the delivery. To her horror faeces came through her vagina. Thereafter every time she opened her bowels, faeces leaked through her vagina. There was also a slow leak of faeces in between bowel motions. This would burn and sting very badly because of all the stitching.

Frances recalls the smell was very noticeable and awful to cope with. She showered constantly and would have long baths, sometimes amounting to six hours, just to keep the area clean. By 24th March she knew help was needed and contacted NHS Direct. She was told to return to the hospital where she gave birth as she was at high risk of infection.

She was attended by the same midwife she had had during labour. The clinicians were very dismissive of her symptoms and said there was nothing wrong. Swabs were taken and Frances was told they would contact her if faeces could be seen on the tests. She never heard back from the hospital.

Meanwhile her symptoms continued. Thankfully, at her six-week check-up in May, Frances was seen by a different consultant who instantly realised that she had a recto-vaginal fistula. He said this was clearly visible even without an internal examination. The hole was 1.5cm and was causing faeces to pass through her vagina.

The consultant looked at her medical records which showed the swab results taken in March. They identified profuse faecal cultures, but the hospital had failed to take any action. Frances was told she would need three surgical procedures: one to fit her with a temporary colostomy for four months, one to repair the fistula and one to reverse the colostomy.

These operations were performed over the following year. During the first procedure the consultant discovered that the injury was very severe and that part of the anal sphincter was also deficient, meaning the 4th degree tear had been poorly repaired.

Despite this treatment, Frances remains symptomatic. She leaks faeces constantly, making the area sore and regularly infected. She is conscious of the smell and is obsessive about showering and cleaning the bathroom, sometimes washing up to 10 times a day. The colostomy was also traumatic as it would often leak.

These problems made it very difficult for Frances to work. She could not focus properly on her job as she was so aware of faeces leaking out of her and the smell.

All this has taken a heavy toll on Frances' relationship with her husband and son. She could do very little in the first two years of her son's life and has been unable to bond with him. She is also aware that she will never be able to have further children, which she finds deeply upsetting.

We helped Frances make a claim for the negligent care she received, namely: the failure to carry out an episiotomy, the failure to prevent a 4th degree tear, the failure to examine Frances before/after the repair, the failure to carry out a reasonable repair, the failure to administer IV antibiotics and the failure to diagnose the fistula.

Frances was awarded in excess of £100,000 compensation.

(Details which might identify our client have been changed.)

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