round ligament, genitofemoral nerve, and prolapse

Submitted by Christine on February 13, 2011 - 6:27pm
Body: 

Hi Everyone,

As our long-time mods will remember, we've had a very small percentage of women report that they experienced some traumatic event, usually involving lifting, heard or felt a “pop” and went on to develop severe prolapse accompanied by equally severe and enduring pain.

I spoke to a 39 year-old woman on the phone Saturday whose condition seemed to validate what I’ve been pondering for some time regarding the above set of symptoms.

She was doing a great deal of heavy physical work with her husband and while lifting something particularly heavy, heard/felt a “pop!” By that evening she had terrible right-sided pelvic pain, and developed severe prolapse shortly thereafter - her cervix being the leading part. Before long, she was experiencing pain and numbness down her inner thigh.

She went from doctor to doctor trying to find answers. Most told her she had very mild prolapse and there was nothing they could do for her. One told her pain is Never associated with prolapse and suggested she was exaggerating. Unfortunately, one offered laparoscopic surgery and right now she is sitting in a hotel room, far from home, awaiting surgery in the morning (so many women find and call me days or hours before their surgery - akk!)

A former model, she told me her posture was classic zip-n-tuck. She had two typical hospital births with episiotomy both times.

The round ligaments are analogous to the hefty spermatic cords in men. These come off the front of the uterus, travel down the inguinal canal, and embed in the labia surrounding the vagina.

The genitofemoral nerves arise from L1 and L2, pierce the psoas muscles, then travel down the inguinal canal alongside the round ligament on both sides, where they innervate the labia majora and inner thighs.

I have a hunch there is an inguinal injury of the round ligaments that is not paid much attention by gynecology. When the ligament is dislocated, swelling and inflammation affect the genitofemoral nerve, resulting in pain and numbness. Extremely symptomatic prolapse follows, with a feeling that “everything is falling out.” Nerve involvement may amplify prolapse sensations. I believe some members with this sequela have opted for surgery, certain their severe symptoms required that level of intervention.

Unfortunately, an injury such as this is probably resistant to surgical repair. Surgical exploration of the round ligaments would be extensive and highly invasive. Scar tissue and adhesions would likely present even worse symptoms than the original soft-tissue injury. It is my best guess that time, anti-inflammatory medication and favorable posture would be the most prudent course of action. Uterine anteversion takes stress off the round ligaments.

Just as acute injury leads to this set of symptoms, might they also arise in a more chronic way? Many women report some level of pelvic pain with prolapse. Could this be round ligament pain and inflammation?

These are questions without definitive answers at this time, but something we might keep in mind for the next woman who comes along with pain and prolapse.

Christine

wholewomanUK

February 14, 2011 - 4:37pm

Keep those fascinating thoughts going Christine. You're on fire!

I also experienced uterine prolapse which became increasingly painful triggered by pushing a car stuck in the snow, skiing & stressy lengthy journies. However my experiience was more an increasingly demanding pain and discomfort rather than a definate prolapse moment.

On a bit of a tangent - I know this may seem a bit strange but I have found it helpful to hear that some other women have felt/feel pain & discomfort with prolapse. Reasons include: 2 medical professionals have made light of my prolapse and made little or no attempt to guage my levels of pain or discomfort, before saying I was fit for work & by implication impling I was exaggerating my symptoms & thereby working the system. I have found it difficult to say "it hurts" & "I can't function normally" when some medical practitioners don't seem to ackowledge or want to hear that. Part of me feels guilty, begins to doubt myself & think 'they must be right' & 'I must do as they say'.
Helpful strategies so far include being kind to myself as if I was my best friend, being true to myself, keeping in touch with reality & telling it how it is. This feels like a gentle path to being grounded, powerful and assertive. The awfulness of having a prolapse is taking me into exploring some heroic new territory!

louiseds

February 15, 2011 - 9:30pm

I have a picture in my head of a very small WholewomanUK standing in the doctor's surgery, and a very tall, thin doctor with slicked down hair and a stethoscope around his neck looking down at her over the top of his spectacles, wagging his finger at her, and saying "you do not have pain from prolapse". WWUK replies in a very small voice, "but telling me that I don't have pain isn't making the non-existent pain feel any less worse."

Sigh ...

alemama

February 16, 2011 - 9:03pm

many many times
but when people describe pain from prolapse it doesn't sound like my rl pain. For me it's a stabbing sharp pain if I get up too fast. Don't most people report an ache in the pelvis?
Let me ask you something, don't you think the rl are made of tougher stuff? They stretch so much to accommodate pregnancy (even twin and triplet) and then help manage the weight of the pregnancy and they even thicken.
The intra-abdominal force of heavy lifting can't touch the force of birthing!
It is an interesting theory and there has got to be an explanation for acute onset of prolapse. I wonder how easily visible these ligaments are on MRI or ultrasound....

granolamom

February 16, 2011 - 9:46pm

I've had round ligament pain, mostly in early pg, and the pain radiates down into my thigh.

I think the round ligaments are not in the same position when doing heavy lifting as they are during childbirth, and the forces are probably very different as well. also, and this is just going on my gut feeling and nothing scientific at all, but it seems to me that during labor and childbirth, there are so many things going on that have protective effects on the body. maybe the thickening during pg is what protects the ligaments during childbirth. those things would be absent during heavy work/lifting type exertion.

Christine

February 17, 2011 - 2:19pm

Yes, I'm thinking the injury is in the inguinal canal - a closed space where nerve compression would be a greater possibility. Lifting with a flat back creates forces in opposition to what the pregnant body achieves. Maybe in time we'll have more data.

alemama

February 17, 2011 - 3:47pm

My dh just told me that he removed two rl in is 90 year old cadaver. She (his cadaver) had a hysterectomy and he said they were almost nonexistent- very short and brittle.

fab

February 17, 2011 - 6:59pm

Hi Alemama,

How did your husband's cadaveress' uterine round ligaments compare to those in her femur and elbow etc ?

clavicula

February 19, 2011 - 12:34am

Far back when I had poor posture and retrovertd uterus, I also had terrible round ligament pain during my period and also ovulation. Guess I also had rl inflammation?

Thanks, Cristine for the info!
Liv

louiseds

February 19, 2011 - 10:13pm

Hey Alemama

Let us know when there is another anatomy lab, so we can submit questions for you to pass on! ;-)

Cadavers are sacred gifts for learning. What a privilege it would be to learn from an actual person's body, that they no longer needed.

After hysterectomy what were the round ligaments attached to a the top end?

Louise