to have or not to have another op.

Submitted by bellydancer2 on April 12, 2009 - 10:17am
Body: 

hi everybody. I am new and this is my sorry tale!

3 children, three very long second stage labours,
3 episiotomies ( the first one was a large one i was told and had to be done because my perineum would not stretch and i was told they "cut too soon through 3 layers of muscle"?)
2 of my three births also had forceps.
Second birth episiotomy, i had an abcess on my stitches,
third birth episiotomy stitches came out, so i was left to heal naturally and assured that was ok.(yeah! right!)

So after the birth of my third child, 21 years ago, I am now 55. I started to have problems, one of which was controlling flatus, well fact was I had no control. Not only that but when I passed wind it seemed to move forward and get caught up in my vagina. I also started to soil myself if i could not reach a toilet very fast. I started to get a bit nervous and neurotic about what was going on and found the stress of it all very depressing. I finally had to give up my job as a teacher because I could not rush out of the classroom at a moments notice. Anyway finally after 12 years of worry and depression and grotty part time jobs. I finallty plucked up the courage to talk to my doctor.

Hospital referal ensued and i had anal manometry, nerve damage tests and all sorts. seems i have nerve damage loss of sensation and control, virtually no perineum, and rectocele. i had an operation , which worked as far as the soiling was concerned but not the control of flatus.

So now its all back again, had a horrendous accident last week because i could not get to the loo, and it was hideous. and I sound like i have a whooppee cushion inside my vagina!
My doctor has refered me to a proctologist who is sending me for an mri scan to see if I have a fistula and then an operation under general anaesthetic to see what is going on, which apparently involves lots of blue dye.

This whole thing has cost me my career, caused me to be on medication for depression and i really do not know what to do next!!!!

I have taken up bellydancing tho' and I absolutely love it, just worried i might have to give that up as well.

Christine

April 12, 2009 - 2:28pm

Hi Bellydancer and welcome,

Sigh...my heart goes out to you. Obstetrics needs to be reformed as much as any other practice and we are the generation(s) of women who prove it. I hope you will read the blog post I wrote a couple of years ago: Long Term Implications of Surgical Laceration of the Perineum and Anal Sphincter. It’s on the last page of my blog.

It’s good that you are planning to get a definitive diagnosis, but your symptoms do not necessarily mean fistula, although fistula IS a common outcome of deep perineal/back vaginal wall surgery. Rectal air flapping through the labia (feels like the vagina) is common and not diagnostic of fistula. Nor is fecal incontinence.

There are a whole series of questions that colorectal surgeons should ask women (I outline them in that blog article) to determine if their present symptoms might be better to live with than the potential outcome of surgical intervention. This is because it is very well known that anal sphincter surgery is highly risky and often unsuccessful.

It is possible your symptoms will not appreciably improve, however, it is also very possible further surgery could make matters worse - even to the point that you might have to consider whether a colostomy is preferable to horrendous fecal incontinence. I have no way of making that determination, which can only be decided upon by a good surgeon’s knowledge and your honest (and informed!) appraisal of your situation.

We have no data in this regard, but I want to believe that returning your body to WW posture could only help naturalize your rectum/anus. In this posture we get the pressure off our “backside” and tilt the pelvic organs - including the guts - toward the front of the body. Even with an inadequate sphincter, in time the urge incontinence may subside because things are naturalized above the injury. In other words, you may be able to sense rectal vault filling in a way that you are currently not programmed to do.

I hesitate to caution you about bellydancing since it gives you so much joy. However, the only way to shimmy the abs is to loosen them first and this must be accomplished by tucking under the pelvis. Tucking the pelvis rotates the sacrum (drops the tailbone) and also loosens the pelvic “floor”. This loosening of the pelvic floor actually gives your anal sphincter more ability to contract, but sustained continence relies on those muscles being lengthened so that the autonomic nervous system can work (non-stop - even when we sleep!) to supply tone to their fibers. Belly dancing may be therapeutic for you and it may not be - only you will be able to judge that by your sharpened awareness.

Bless you, Bellydancer! So many of our problems began - not by birthing our children, which I for one did very easily - but through routine and unnecessary procedures performed by our attending obstetricians.

Wishing you well,

Christine

louiseds

April 13, 2009 - 10:15am

Hi Bellydancer

It sounds like bits of your life are being denied you, one by one. Hopefully you will reach a point where you can still enjoy the things that you can do, and are not so bothered about the things you are unable to do. Adaptation is definitely a part of healing.

So glad you are getting a thorough diagnosis. That way, whatever decision you make re surgery, you will make it knowing everything you can know.

I also do bellydancing, and find that it is wonderful in many ways. Christine's comments on bellydancing and posture are correct. There is no escaping the perils of butt tucking. However, I have also found that I am able to apply Wholewoman principles to my dancing. My teacher is aware of what I am trying to do with WW posture, and is able to help me work out other ways of doing steps and moves that do not involve tucking my butt in. Sometimes I have to almost turn moves through 90 degrees, using different muscles from other dancers for visual effect, or I do it the proper way and end up looking quite different, because my pelvis is oriented differently. It certainly gives my brain, as well as my body, a thorough workout. Any time I feel pressure in my vulva I re-assess what I am doing and how I am doing it. So far, so good, twelve months on from starting weekly lessons.

There are some things I cannot do, eg chest circles. However, I may be able to learn to do them with a full body undulation for similar effect, without blowing my vulva out. Likewise, an Egyptian shimmy is more manageable than the looser Turkish-style shimmy.

Another thing I am getting very clearly from bellydancing is body awareness and enhancement of my femininity (particularly as I am near menopause, at 56). I have found that having a 'sympathetic' teacher is absolutely necessary to give me the confidence to do what I can, as imperfectly as it is in her eyes, and to be accepted as a dancer. I will never be a solo standard performer, but could dance in a troupe quite easily. Right at the moment though, I am just enjoying being able to dance.

BTW, there is another women in my school who is a beautiful dancer, who suffers similar symptoms to yours as a result of the birth of her first baby going badly. I think her rewards are similar to mine. In fact, the more I find out about fellow dancing students, the more I find that we all have something about ourselves that challenges us. We are all human.

All the best.

Louise

bellydancer2

April 14, 2009 - 6:40pm

bellydancer2

The posture you talk about seems very like the one i am taught at bellydance classes, soft knees, feet straight ahead, lifted chest, relaxed and down shoulders, elongated neck etc , the only difference being the pelvic tilt. I have been doing bellydance for five years now and I love it, and even though I say it myself, not bad at it either! Its been a constant source of fun, and enjoyment and i would be devastated to have to stop. From what I have been taught though, the dance was originally a preparation for and recovery from childbirth and a way for women to pass on their knowledge to their daughters, so i would have thought that it could only be beneficial for the pelvic floor??
One query I have though is the ww posture not bad for the small of the back (lordosis)? I have disc problems in my neck, and from everything i have read on bad backs they seem to advocate standing tall with the tummy tucked in, and having the belly held forward puts a strain on the back. So I am more than a bit confused??

Also is it possible to have anal sphincter damage without the actual shincter being cut? because as far as I know although my perineum was cut ( I can still hear the crunching!)And to think that , under the heavy influence of pethedine, I told my doctor to "Make sure he did a good job down ther e because I was a needlework teacher!" He obviously didn't! I did not think my anal shincter had actually been cut.
"Rectal air flapping through the labia (feels like the vagina) is common". This may be my problem, but i presumed that it was going into my vagina as after i stand up from sitting i make horrible "Whoopee cushion type noises". But i also think i have smallish bulges that meet inside my vagina. I have no urine incontinence though ( Thankful for some mercies!)

Anyway my blue dye test is on friday, so at least i feel that i am learning more from this site and won't go into any surgery as blindly as I did last time.

Thank you for your help and advice.
bellydancer2.x

Christine

April 14, 2009 - 11:49pm

Hi Bellydancer,

I think Middle Eastern dance is and always has been great for women. The problem is that we are much weaker in terms of our original human musculoskeletal design than women of older cultures. Many of us are compromised due to medical/lifestyle/nutrition factors and therefore some movements and postures that healthy women do effortlessly can be problematic for us.

Whole Woman Posture is very good for the entire body, most especially the back. Not unlike gynecology, orthopedics has been very blinded by a surgical framework that did not allow them to see the big picture. Human spinal curvatures cannot be straightened out. If we lose one curve the spine will always compensate by accentuating curvature elsewhere. To be human is to have a pronounced lordosis and when the lumbar curve flattens due to poor posture and cushy furniture, the spine compensates by increasing curvature elsewhere - in women it presents as a hump at the base of the neck.

As far as I know, your symptoms suggest internal (flatus) and external (soiling) sphincter injury. The vaginal air does sound extreme and it will be good to receive the thorough exam on Friday.

Good luck and we will be waiting to hear how it goes.

Christine

louiseds

April 15, 2009 - 1:17am

Hi Bellydancer2

Re "One query I have though is the ww posture not bad for the small of the back (lordosis) ... and having the belly held forward puts a strain on the back".

If you are getting the posture right you are not holding the belly forward. It just sits there by itself, quite relaxed, like the rest of your muscles. WW posture increases the distance from bottom of ribs to pubic bones, which makes the rectus abdominus taut. With the butt tucked in the distance from bottom of ribcage to pubic bones decreases, so there is some extra rectus abdominus muscle which becomes floppy, so you have to hold it in too, or else it *will* spill out the front.

Let me tell you, there is a lot of belly in my bellydancing! It is not just rectus abdominus moving out front there! My dancing is not that of the nubile young virgin, more a wise old spoof of same! LOL It really is such good fun enjoying the movement of my body.

L :-)

Louise