a pt visit

An update, I had decided to try seeing a physical therapist, since my rectocele diagnosis was spurred by acute episodes of lower back and pelvic pain in the past 2 months (constipation involved with some of the early episodes), and the acute pain episodes are the only symptoms I can't cope with, which would push me toward possible surgery. So instead of hoping rectocele surgery might eliminate these symptoms, I decided to at least investigate what could be done about the pain/seized muscles more directly.

I had my first pt appointment yesterday (I'd been traveling earlier in the week, on a family vacation, during which I had another lower back flare, mostly resolved for the pt visit. )

The good news seems to be, I am all messed up. She noticed things that seem remarkably obvious once pointed out --- for example, when I walk, my left arm stays locked at my side, while my right arm swings freely. On all sorts of tasks and exams, my right side works well, but my left side is weak or tight or painful. She says I have torsion in my sacrum, and my whole left side is tight, with my left sacroiliac joint locked up. She's out of town next week, so wanted to stick with mostly diagnostic work that wouldn't flare anything, before we start therapy sessions a week+ later. My posture is really deranged right now, I have too much forward tilt at the pelvis which propagates upward so that the next curve starts at the wrong place. But I don't know how stable my posture is now, since it's mostly been adapting to find whatever positions are non-painful, and I've lost any intuition about a good equilibrium position for standing, sitting, sleeping --- nothing feels stable or right. It seems many of my resting/relief positions are far from a neutral back position, in both directions. She thinks my initial back injury (last fall) was probably a torsion injury, but that now I've developed all sorts of compensations . . .

But the good news about all that is that she thinks a lot of improvement can come about in a short time-frame (6 weeks) by first working on the misalignment and loosening up the muscles on the left side (which she thinks involves many muscles in spasm and pressure points). Only after that should I work on any strengthening and retraining of muscles . . . she highly discouraged any strengthening attempts, including abdominals or kegels. Did look briefly on ultrasound at the pelvic floor and that looked surprisingly good, nice emptied bladder up above the pelvic floor which I could lift well (though the muscles quickly tired for repeat lifts, also that very simple lift is not the stronger lift-and-squeeze which I think of, probably incorrectly, as kegels, and which I feel so incapable of. She also thought my pelvic floor was in some spasm as well, based on the jagged shape of the resting bladder.)

Anyway, I'm feeling optimistic, because finally someone has identified a problem whose degree and resolution seems directly connected to my pain. Also it seems less that all my muscle tone is just atrophied, requiring years to bring back, which was sort of my despair, and more that the muscles can readily come back to behaving normally once the weird stresses and muscle lock-downs are removed.

She said the rectocele could have been present and asymptomatic for a long time, and that these left side musculoskeletal problems, all seized up just where the descending bowel comes through, could have impeded bowel function and made the rectocele symptomatic.

I write this not because you're all fascinated with my health ;-), but because it looks like a good avenue to explore for a rectocele whose main symptoms are acute lower back or pelvic pain episodes. Neither my doctor nor urogyn surgeon suggested exploring this avenue, I was on a streamlined medical path from reporting these acute pain episodes to rectocele surgery, which would actually be much cheaper out-of-pocket for me than trying the physical therapy . . . I feel like I have at least a sustainable path to try now, which won't quickly fall apart because my strengthening and posture attempts just make things worse . . .

alphamom