new with questions

The first thing I have to tell you is that you are only 5 weeks out. Since you have had 6 pregnancies and recoveries prior to this 7th birth you know it take much longer than 6 weeks to recover from birth. It took me a full year to feel ok and 18 months to feel GREAT.
Second CONGRATULATIONS on you baby. How wonderful to have a new baby to share with your family.
I can't tell you what to do about the PT. Some members here have had good experiences. I guess it must depend on your therapist. I wonder if she would be open to reading the book herself? It is very hard to accept a way of thinking that is contrary to your own education- but a good therapist will.
Christine just recently wrote a blog on kegels and how to do them. And yes overdoing them is no good and can in fact make things worse. Also I wouldn't worry too much about kegels in the early postpartum period- it takes a while for all the nerves and muscles to heal and fire together- and you will just feel bad because they tell you that your strength measure sucks - (well of course it does right now) and they will imply that the weakness is the reason you have prolapse (goofy) and you will feel like it is your fault- not good if you ask me. As your body heals and as you perfect the posture you will get stronger everywhere- you don't need a pt for that.
I think the self exam is in the book- and also here online under the articles section- I don't think you need an MRI to know what is going on. You can figure it out for yourself.
I think it is also silly to suggest a hysterectomy to a newly postpartum mom who has a cystocele- that is so so wrong. So at this point I have lost trust in your OB- forget him- use him for what you hired him for and find someone new for your well woman care. I know there are knowledgeable kind OBs and GYNs out there. Maybe your midwife friend knows someone.

I know you are confused. Who wouldn't be. Your medical professionals have disagreed totally with what you have read in Christine's book. All I can tell you is that there are a number of us here who practice the posture, watch our eating, and they way we dress and we are all stabilizing and even reversing our prolapses.
I have three kids now and am pregnant with my 4th. I would love to have 7. This will be my first pregnancy and birth knowing about my prolapse (but I know I had them before) and I look forward to the postpartum time and watching my body heal.
I when your lochia stops go ahead and start the fire-breathing. Slowly work your way up to the ballet work out and when you feel you are in pretty good shape check out Nauli (this is how I got rid of my cystocele and shrank my rectocele to unnoticeable). You have time on your side.
Enjoy that baby. Don't let your anger and frustration get in the way. you will get better over time and with the adoption of WW principles.

first of all...congrats on the arrival of your beautiful baby! how blessed you are to have seven ;-)
I am so sorry you are having to deal with this, and that you are not getting better support from the doctors. a few things i was told by my midwife, doctor, surgeon, and phsyio who all miraculously seemed to be on teh same songsheet (and was then supported by women here--but i thought it would be reassuring to hear that doctors do say these things!)

first, it will get tons better. where you are at right now is no indication of where you can get to. you will do a lot of healing in the next year, and even beyond.
if you are breastfeeding, and anyone tells you you need to stop because of this, you can ignore them. the surgeon said he wouldn't see me again till i quit breastfeeding, but feed for as long as i wanted as it won't make it any worse. when i stop, i might get a bit better, but don't stop!
surgery is there is you need it but if you can live w/o it you are much better off (and that coming from a top surgeon!). after i came here i knew it was definately not an option--the risks are too great compared with what my body can do in its natural state.
too many kegels are bad. the first physio i saw had me do 100's. i got worse, went numb--it was awful. the next (who was highly recommended and specialises in this) had me do a few. like 15 good ones. then slowly work my way up.

now, i had a good physio experience. as to how it's contributed to my recovery, no clue. but what it did do was give me a chance to see someone every week who said "you will get better" every week. and i could ask her any question, talk about anything, and really, it was like therapy! so in that respect, she was a miracle worker. did the kegels help? don't know. if i don't do my few good ones i do feel worse, but did i need to go for that? couldn't tell you. but i would say, if you are going, be sure the person is supportive, not believing you need surgery (she was very anti surgery except in extreme cases...), makes you feel better when you leave then when you walked it, and helps you believe you will get to the other side of this.

...and have faith. christine's work is amazing, this community is amazing, and the wisdom has changed my life. i had severe prolapses (grade 3--think large piece of fruit for pelvic organs) and now am able to comfortably get on with life. i must be mindful all the time, and i do feel them some of the time, but it's a state i can live with no question.

take care, enjoy your baby, and let your body rest (as much as you can with all your lovelies!) and heal.

kiki

Hi and welcome,

I had physical therapy after both babies - the first time I was referred for some incontinence and very bad bowel urgency (I needed to get to the bathroom within a minute flat or else!). The second time I was referred for cystocele. I had two different OBs who used two different PT's; in retrospect I wish I had requested my first PT the second time.

My first bout of PT helped a lot. It didn't cure the incontinence, but greatly improved the bowel urgency. The second PT didn't seem to have any impact on prolapse; however, the prolapse itself and possibly internal injury made doing Kegels and building strength much harder the second time.

What I liked about my first PT was that she didn't focus on squeezing the PC muscle alone. She had a set of exercises that combined Kegels with inner thigh squeezes, with outer thigh exercises (opening your legs against an exercise band), standing, and standing with plies. She also had me exercise my glutes, do pelvic tilts for the transverse abs and do a few crunches for the rectus abdominus. I do believe that even if her methods were a bit different from Christine's, the fact that she focused on a lot of different muscles all working together was part of what made that therapy more successful.

As for making prolapse worse, I don't know the data but I can give you this advice: If you feel symptoms getting worse, back off the Kegels. If you over-fatigue the muscle you weaken your pelvic floor support temporarily; if your organs are prolapsing through that support then the prolapse is getting worse and the muscle will have a harder time recovering. (I'm sure someone else here knows a more scientific explanation for this, but it makes sense to me and was my experience.) Second, if you are very weak or feeling worse symptoms, my PT told me it is better to do Kegel exercises at night, so that your muscle can recover while you are lying down and there isn't any physical strain on it. She told me when I had a bad cough (very hard on the pelvic floor) to not do any Kegels at all.

I don't personally think there's any harm in trying PT. It might not help the prolapse but could still help in other ways, like preventing urinary incontinence down the road.

Sarah

welcome and congrats on baby number 7! how totally awesome! and how peverse to mention hysterectomy to a pp mom of 7 babies. your uterus deserves more respect than that. that you haven't had any degree of prolapse up until now speaks to the inherent strength of your design. 5 weeks pp is soooo soon, too soon to say what will be in a year's time.

some random thoughts, though

you don't need an mri. you need to do more reading here, learn about the normal anatomy (not, by the way, the anatomy your dr has learned is normal because you don't go around with your legs up in stirrups) and feel around for yourself. its not rocket science. a bulge in the front is usually bladder and/or urethral prolapse. bulge in the back is a rectocele. something hanging down in the middle is your cervix and/or uterus.

pp, its common to have some degree of muscle and/or nerve malfunction. that almost always resolves on its own. if not, PT's can be helpful. but know that while kegels can help manage stress incontinence, they cannot reverse a prolapse. your bladder is not held up by those muscles. it is held in place from its fascial supports and by its placement over bone when standing in the posture christine describes.

so here's my advice...ease up on yourself right now. a pp mama needs not to be overwhelmed. prolapse is not life threatening, it will not likely progress to the point of no return in the next couple of weeks. be careful to avoid straining on the toilet, constipation is NOT your friend! take care to fully empty your bladder at least once a day to prevent UTIs. in response to the last post, avoid crunches, avoid 'pelvic tilts' (which I am assuming are posterior pelvic tilts aka counternutation) to strengthen abdominals. these exercises put undo pressure on your pelvic organs and place them unsafely over the vagina. whole woman philosophy advocates the opposite - place pelvic organs over bone (with an anterior pelvic tilt aka nutation) and avoid straining (ie crunches).

you have time on your side, so you can afford to prioritize. I know its terrifying and overwhelming at first (I've been there too!) but don't let this rob you of your babymoon. take it one day at a time and hold on to hope. I bet you can safely keep your uterus inside you where it belongs.

{{{{{{hugs}}}}}}}

I should have clarified that the ab exercises my first PT had me do are not compliant with the WW theory and posture - this was all long before I found this site because I didn't have prolapse yet! To Granolamom and others - I'm curious to know whether pelvic tilts are harmful on your back, which is the only way I've ever done them. They are a counternutation, but a very focused ab exercise - if you are flat on your back is it still harmful? Or is exercising the transverse abs simply not as necessary when you adopt the WW posture and allow your lower abdomen to assume a more relaxed, natural position?

I definitely do NOT do crunches anymore, and although I truly love yoga, I won't even attempt any variation of "boat pose" where you try to balance on your sitting bones with legs and torso forming a V shape. I never could do it before without straining my back and now I see that it is really not compatible with our anatomy!

Anyway, I'm sorry, I didn't mean to recommend you do the ab work. Just saying that I had a better experience with the PT who recognized that in general there is more to pelvic support than just Kegels and the PC muscle.

Sarah

I'm sorry, sarah, if my last post was in any way offensive, I honestly didn't mean it to be. I did understand your point, that your PT focused on the big picture and not just the kegels, and that was helpful to you, which is cool. but I just wanted to clarify for others reading that the crunches and posterior tilts might be harmful for prolapse. didn't mean to invalidate your entire post.

as far as pelvic tilts done on your back, well, I'm not sure what the goal is? assuming to strengthen abs? if that's the case, I'd avoid it. when I do that, I can feel pressure on my perineum and I don't like that. its subtle, but I've learned to pick up these subtle sensations and I'm extremely protective of the area. I can't imagine any scenario where doing these tilts would be worth the risk of worsening the prolapse.
as far as strengthening abs, I haven't found anything as strengthening as going about my day in wholewoman posture plus a few minutes each morning and evening doing nauli. nauli, by the way, has given me an almost-six-pack thing. which is incredible for me, I've NEVER had such definition. and after 4 pgs (each with a weight gain of over 50lb) that's kinda cool. and nauli works the transverse abs too.
I do pelvic tilts in other positions though. hands and knees for one. It feels good, especially when pg. also for firebreathing the pelvis tilts posteriorly during exhalation, and I can only get the nauli thing going with a posterior pelvic tilt (those are both done standing). I don't feel that is problematic.

in your PT's defense though, crunches are best done with the pelvis posteriorly tilted. most effective and protective of the spine that way. I just don't think crunches are the best way to strengthen abs in women, certainly not women with prolapse.

I wasn't offended at all, just realized part of my post had gotten off track. Thanks :)

I need to do some more reading and practicing on nauli - tried it a couple of times and didn't feel like I quite "got" it yet, but I could see how once I get the hang of it it could be really useful.

Sarah

Rectum and anus are perfectly acceptable words here :)

I can't tell you if that's a rectocele or not; it could be hemorrhoids. I've had internal hemorrhoids that when they are bad can make you feel like there is always something there. Often a rectocele can make it more difficult to empty the bowel completely which can also leave you with the feeling you have to go.

My advice: BACK OFF THE KEGELS. As I said before, if you are feeling worse then they are not helping you. It is okay (in my opinion, someone correct me if wrong) to feel a little fatigued shortly after a session - that is why it can be a good idea to do pt work right before bedtime. But if you are experiencing worsening symptoms and then keep doing the kegels, you aren't giving your body a chance to recover and that could be harmful.

I have felt like Kegels are much harder to do since developing prolapse. Look at Christine's blog post "Kegels the right way" and read the comments also.

Now, as for blaming yourself. I've been there, and still go there frequently. I hardly rested at all after my second baby and I was lifting my 35-pound 3-year-old a lot, partly because my OB actually said it was okay (!) and partly because he was having such a hard time and I wanted to indulge him. Anyway, the fact is, in a perfect world we would know before the fact exactly what to do to prevent problems, and then we would have enough time and help to always take care of ourselves the right way. But it's not a perfect world. Sometimes you have to pick up your baby, or you get so overwhelmed with life that you can't do all the self-care things you wanted to. It's life. You are a mother doing her best, and you're not alone. Hang in there!

((Hugs))
Sarah

I definitely felt worse before I began to feel better. and I agree, back off the kegels. I don't know if too many kegels caused my rectocele, but it developed shortly after I found my cystocele and began kegeling like there was no tomorrow.
those muscles are oh-so-tiny. they fatigue easily. don't overdo it.

If you feel you have brought this upon yourself than the ability to reverse the trend lies within your power as well. up until now you've been ill-advised by those who just don't know any better. and you are so not alone. now you know. so now you'll start to do things differently and good things will happen. of course you're lifting your 15 mo old, what mother wouldn't? but at 15 mo your toddler can probably be satisfied at least half the time, by your sitting down and allowing him (her?) on your lap. let the dishes pile up, get household help a few hrs a week if you can swing it, teach dh to do some laundry, eat sandwiches for dinner for now. spend some time thinking about what can be let go of, and what cannot be. then think about how the priorities can be accomplished in as prolapse-friendly a manner as possible. this is a new way of thinking, especially for us do-it-all moms, but it is possibly the best part of learning to work with my prolapse. I've learned to slow down because of the cystocele and my family has benefitted tremendously.

and just so you know, we went on a little walkabout at a local nature preserve today (gorgeous weather here in ny - low 60's bright sun). I wore my 24 lb 18 mo on my back for about 45 min and then carried my almost 5 yo back to the car after he took a tumble. also spent some time swinging from a vine with dd and playing tag with the boys. my prolapse didn't enter my mind at all. its fine now, I can do these things without second thought. I was once where you are and now LIFE IS GREAT.

hold onto hope