mediolateral episiotomy

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I've been wondering if anyone can describe possible risks/complications of a mediolateral episiotomy?

I've had 2 bad tears - no episiotomies - the last one went through my anal sphincter but I don't know how much or whether or not the internal sphincter was affected (i didn't even know there WAS an internal sphincter until I started reading about tears here).

I've healed up ok apart from the rectocele, which is currently asymptomatic.
I thought I had some flatulence incontinence since i'd find myself gassy without being able to hold it in but then i realized that I can hold it in - it's just that I've been trying to relax everything down there so much that I've let gas get out as well. When I've tried to hold it in I can do so. other than that, my anal sphincter seems to be ok.

In thinking about having another child I've been really worried about causing further damage...
I know 1 option is a c-section, but i'd rather stay away from that, especially since it can't be good for a cystocele.
so then I started thinking, maybe a mediolateral episiotomy would a lesser of 2 evils? maybe someone with more anatomical knowledge could chime in and let me know what they think...

edit to add: i'm not as concerned about the cyst/rect since I know now that I've got tools to deal with those if they get worse - i'm more concerned about what another tear could do to my anal sphincter.
thanks!

Hi TM - we can't really advise you here on the forum; unless Christine comes on to post. You might want to book a consult to further discuss the choices in your particular situation. I can tell you what she says in her book:

"Midline episiotomy predisposes women to rectal injury. Mediolateral episiotomy [an angled cut from the vagina toward the side of the anus] does not protect against rectal injury, and is bloodier, more painful, slower to heal, very disfiguring, and just as damaging to the nerve supply of the perineum."

So it sounds to me like there are some trade-offs in exchange for possibly less risk of rectal injury. But only Christine can really help you weigh your options. - Surviving

thanks surviving for reminding me to sometimes go back to the book - I tend to search here only but sometimes answers can be found there.
I guess I'm wondering how it can still cause rectal damage - but like you said - maybe Christine will have a moment to answer (or anyone else with anatomical or midwifery knowledge).

I need to look into a consult as well....
I'm also going to try to book into a home birth midwife group near me to see if they do well woman checks to have someone look at my specific situation (instead of a traditional gyne) but i guess I was looking to see what the general issues are with mediolateral episiotomies. My gut tells me they're not a good idea but I wanted to learn more about them.