Missed Fourth Degree Tear Leads To Fistula

After days of excruciating pain, Hester was diagnosed with a missed fourth degree tear and a perineal abscess. This led to a fistula, faecal incontinence and a permanent colostomy.

While giving birth to her first child, Hester’s unborn baby became stuck and his heart rate dropped. The attending doctor therefore proceeded to perform an episiotomy and deliver the child with forceps. Thankfully a healthy baby was born.

The episiotomy was then sutured, although it was only afterwards that a digital rectal examination was carried out. The doctor then realised that the external anal sphincter was torn, representing a 3rd degree tear. The stitches had to be undone and the repair done again.

Thereafter Hester was moved to the transitional care ward. For the next five days she suffered agonising pain in her perineum, particularly when going to the toilet. She repeatedly told nursing staff about the pain, and also reported faecal incontinence but no action was taken.

Five days after having given birth, Hester was examined by a female doctor. Only then did it become apparent that she had sustained a fourth degree tear, rather than a third degree tear. She also had a recto-vaginal fistula due to the use of forceps, and a large perineal abscess, which should have been prevented with a routine course of antibiotics.

Understandably, Hester was very upset by the news. She was told that if the fistula had not healed by the following day, a colostomy would be needed. She was also given antibiotics for the abscess, but by then it was so large that medication did not prove effective. It subsequently burst, causing Hester great pain when passing urine.

As the fistula did not heal within 24 hours, she was taken to theatre to have a colostomy bag fitted. This has remained in place for the past three years and it is unlikely that it will ever be reversed. This has had a devastating impact upon Hester’s life. She cannot do any of the things she once did, and eventually she lost her job.

The knowledge that these complications could have been avoided has also been very difficult to cope with for Hester. Had the fourth degree tear and fistula been recognised shortly after the birth, it is very likely that she would have remained continent.

We helped Hester claim for the damages she suffered because of a missed fourth degree tear, a missed fistula, and a preventable perineal abscess. She was awarded in excess of £350,000 compensation.

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