Pelvic Pain and Trauma following Childbirth

Submitted by ama on June 7, 2008 - 10:48pm
Body: 

I delivered occiput posterior (baby's head was facing up) last October. Lots of perineal trauma, swelling, bruising, hemmoroids from pushing etc. No bowel movement while I was in the hospital for 4 days.......once I got home I was incontinent of bowels.....blew it off as recovering from birth, etc. At day 7 saw GYN to re-check perineal swelling - she checked my anus and there was no tone whatsoever, hence my incontinence. I was referred to a UROGYN at day 10 post partum who did an anal ultrasound that revealed my external anal sphincter in absent from 9 to 3 o'clock, and my internal anal sphincter absent from 10 to 2 o'clock, and a small perineal rectocele. In addition I had been in severe pelvic/perineal pain/pressure since birth when standing - felt like the baby's head was still between my legs, sharp stabbing pains in my vulva and rectum, etc. UROGYN thought I likely had a pudenal nerve neuropathy contributing to both the pressure symptoms and the incontinence (as well as the torn sphincters). I had already started breast feeding and this UROGYN would not do surgery due to the high incidence of failed repair when estrogen levels are low (with nursing). He put me on Metamucil daily to "bulk me up" and give me more notice to get to the bathroom. Told me to come back when I had stopped nursing and had 2 periods then we could consider if surgery was still necessary.

Well it's been 7 months now. Things did get gradually better, the Metamucil helped with the incontinence. I still have periods of "pocketing" of stool and of course if my stool is loose at all, I have leakage.

My chief concern continues to be my ongoing perineal discomfort. It HAS gotten better with time. Initially I couldn't make it through a shower without having to lean forward and shift my weight off my pelvic floor. Any prolonged standing was intolerable, but again I was able to get immediate relief with sitting or lying down. Now when the pressure complaints are bad they vary from a size of a golf ball to a grapefruit in pressure/weight on my perineal area, sometimes it seems more at the vagina, other times the rectum or the entire perineal area. No longer have shooting pains in the vulva but do continue to mild shooting pains at times in the rectum. The UROGYN didn't have any answers, went to another specialist - a colorectal surgeon in a "Pelvic Floor Disorders Clinic", she didn't have any answers, I've spoke with multiple OB/GYN's and a physiatrist and none that I spoke with have any understanding of these symptoms. They sound like a prolapse, however I've been checked 3 times for prolapse and its not evident. All we know for sure it the sphincter damage and small rectocele. Could these alone be causing my continued discomfort in standing? Again - it has gotten much better, as long as I sit frequently through the day and rest on the weekends I can usually make it without taking anything for comfort (I'm still nursing so I try to avoid medications). But it's summer and the baby is 7 months old and I want to be able to tolerate walking through the zoo, etc.!!!

Other approaches I have taken - I've had myofascial release twice within my rectum over the last 2 months to release various points, I am also presently doing a trial of electrical stimulation intravaginally to strengthen my levator ani muscle (it's toast since delivery). At my last visit last week I had improved with my readings so it seems the stim may be waking up some neuromuscular connections - but again unsure if this will fix me as I haven't noticed any change with pressure complaints as of yet. (Curious note -> each time following the stim, my perineal area felt really good - no pressure complaints - for several hours)

I don't want surgery - unless they can guarantee that this will fix the pressure complaints because I can live with the incontinence with my current bowel management routine. If these complaints are due to the neuropathy - will it eventually go away? I've been doing some research on pudendal nerve entrapment but those people tend to have most discomfort with sitting whereas sitting provides me relief.

Yikes! I've written a book! I'm just so glad I finally googled the right search and found you guys!

Any insight would be greatly appreciated.

louiseds

June 8, 2008 - 4:39am

Dear Ama

Welcome to the world of Wholewoman. I am sure we will be able to help you to find your way through this. You have so many bits that are not quite right.

I can only implore you to keep doing what you are doing. Every week must feel like an eternity to you, cos recovery is so slow.

We reckon that it takes a woman's body at least 12 months to recover from birth, some say longer. You are now 7 months and it sounds as if your body has made some significant progress. It sounds like you have also found some worthwhile therapies to help you along the way, and figured out how to manage your bowel contents. Women here know *all* about constipation and managing it!! ;-)

I have had good success waking up pelvic floor muscles with electrical stimulation after a pregnancy that started with me swollen up like a balloon and pelvic floor muscles that were shot before week 10 of the pregnancy. The nerves eventually responded by themselves and I have no trouble now. It is very good news that you experience no pressure for several hours after a session. Something is not totally destroyed, and will no doubt get better for longer as time goes on!!

Only time and some hard work will tell how well you will ultimately recover.

I am familiar with pudendal nerve entrapment and posted about it here after attending a seminar at our big women's hospital. Use the search box at left to find it. Also check out www.tipna.org and their Forums if you haven't yet done that.

It seems that most PNE happens after pelvic surgery, which is one of the big negatives to surgery, as you have found out. Christine Kent's theory is that surgery alters the pelvic structures and geometry irreversibly, so Wholewoman techniques may not even work for a woman who has had surgery. A woman needs all her pelvic organs to support her own pelvic structure.

My theory following on from that is, for a woman who has had no surgery, that Wholewoman posture will lessen the tension on the pudendal nerve because WW posture allows the organs to move forward and take their weight off the pelvic floor and perineum. The perineum can then rise spontaneously and reduce the tension on the nerve which is the cause of the pain and discomfort. The new surgical procedure for pudendal nerve release does the same thing by cutting away bits of ligament and giving the nerve more room to move. I suspect that, as you have all your organs, you can release the tension on this nerve just with postural changes, all by yourself!

You may be able to lessen your discomfort considerably, just by using WW posture, though it may take time for the hurting to stop, cause it is a nervous system thing. So go to www.wholewoman.com and check out the FAQ's. You can find out more about this new way of looking at female pelvic anatomy and how to manage your body's pelvic problems yourself by purchasing Saving the Whole Woman, by Christine Kent, *2nd edition* . This isn't a hard sell. It is just a darned good book, and has the endorsements to prove it.

Meanwhile, keep loving that baby and breastfeeding, do some reading, amend your posture and clothing, eat well, and let your body do its own healing for quite a few months yet.

Call back with more questions and comments. You are in good company here.

Cheers

Louise

Christine

June 9, 2008 - 12:36am

Hi Ama,

Just to add a couple of things to Louise’s response to you…this sounds like classic “levator ani syndrome”, which can be brought about by the sort of trauma you sustained. Management is usually conservative and I think the recent suggestion in this forum of saltwater sitz baths would be very good for you. Although painful, LAS is generally benign and dissipates over time.

One of our members, Mommynow, had a very traumatic first delivery and still suffers the tremendous heaviness in the back wall that your describe. You might email her.
Also…check out my blog titled “Long term implications of surgical laceration of the perineum and anal sphincter” for information concerning surgical response to these conditions.

Wishing a complete recovery for you,

Christine