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While pregnant again following a 4th degree tear with my first child, I did ALL the research I could. My doctor even printed every study he could find in the hospital and online libraries. Unfortunately, there aren't enough conclusive studies done regarding 4th degree tears. Most studies only focus on 1-3rd degree tears. There is conflicting evidence as to where a repeat delivery will increase your chance of fecal incontinence. Many studies say that incontinence following a c/s is the same as following a 4th degree--it is the act of carrying a fetus that weakens the pelvic floor. Some studies say that a C/S should be done following a 4th degree. My own OB advocated vaginal, saying the 2nd baby could slide out like a bar of soap, but my colo-rectal surgeon said that even if the delivery went smoothly, I would suffer incontinence later in life, b/c the muscles will have lost much of their elasticity after the initial 4th degree repair. The colo-rectal surgeon specializes in fissures/fistulas and he says that his patients in their '50s who suffer incontinence (urinary and fecal) all delivered children. You rarly encounter an older woman who has incontinence and never delivered children. Following the colo-rectal surgeons advice, I had a C-Section, and it was a piece of cake! Yes, I needed help getting out of bed, but I also needed that after the 4th degree! I weighed the percentage chances: if you have a repeat tear, then you're in just as much pain (I think more) as a C-Section. You can do perineal massage etc. and may not have another episiotomy, but you may suffer other consequences later in life (incontinence.) I'm especially glad that I chose the C-Section! The surgery risk to me and the baby was worth not having the high risk of being in diapers for the rest of my life. Sewing anal tissue is like sewing jello. My surgeon said that anal repairs have a low success rate, while all C/S types of repair (even if there are complications) have a high success rate. Good Luck!

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