In early December, at the age of 34, I gave birth to my first baby – 7 pounds 8 ounces. I’ve always considered myself in excellent shape, thin/slight, resilient, robust. Am very surprised to find it taking so long to recover. (This is not the point of my entry here, but in my 2nd trimester, I was surprised at the pain in the front of my pubic bone which became diagnosed as Pubic Symphysis Dysfunction… this pain, as those know who have experienced it, made it extremely difficult/painful to stand on one leg to wash a foot in the shower, put on socks, put one leg at a time into a pair of pants, get in and out of the car, roll over in bed, stand up and walk upon lying or sitting down for any length of time. I was told by specialists and friends/family that this is something older women experience, or women who have had several children experience. This PSD is still going on, 3+ months after the birth.. I am told it will subside with the decreasing relaxin/oxytocin/prolactin hormones (from breast feeding). Want to breastfeed my baby as long as possible, though – and am not interested in weaning to solve this problem.)
The main point of this entry is to seek advice about this problem: After the birth, I became aware of something that bulged in my lower vaginal canal – right at the opening, and an accompanying heaviness… at about 2 weeks postpartum, as things were healing, but this sensation wasn’t going away, I explained this to and was examined by my midwife and then also by a gynecologist to get a 2nd opinion… nothing was wrong, they said… my body is healing and things will fall back into place with kegels. I used a mirror to look at the progress of my healing now and then and saw the pink, shiny, smooth bulge filling the vaginal opening.
Two plus months postpartum, I felt and looked healed down there, except that there was still this bulge-y feeling. I looked at it again after not looking for awhile, allowing myself to heal. The pink bulge was still filling my vaginal opening. I was alarmed. I thought that maybe the midwife and dr. didn’t notice it because I was lying down during the examinations, so I went into my bedroom, laid on the bed and looked… still there. I pushed,…. It bulged out… I was really alarmed. I called the midwife who with my over-the-phone description said it may be a prolapsed uterus. I was devastated…. Imagining all sorts of negative implications. With this informal “diagnosis” I went to see the doctor who said it is a cystocele…. And besides that who said my vaginal canal is “remarkably” stretched out, as if I’ve given birth to multiple babies. I don’t know why neither the midwife nor the dr. recognized it for what it is with my description and their own examination of it! This baffles me; I looked online and my description of a heaviness and something bulging pretty much fit the description perfectly for a cystocele. Anyway, as was mentioned in another woman’s story/explanation on these forums, I was offered 4 choices: do nothing, have surgery if I’m sure I’m having no more kids, get fitted for a pessary, or go for physical therapy. I decided to get fitted for a pessary (again, something I’m told by the doctor, my mom, and others is something mainly needed only by older women and/or those who’ve had many children… even my mom who had 8 children never had this happen to her). Before, during, and after the fitting, I was in despair. I found this website while searching the internet for others in my situation (mid 30’s with only 1 child) who have had this problem. And I found that there are actually other options than the 4 I was given. I feel hopeful now! But I do still have many questions:
1. Does squatting encourage the bladder down into the vaginal canal/opening and therefore exacerbate the prolapsed? (Squatting was something my midwife said would help the baby drop down the vaginal canal and open me up, so I wonder if the same is true for a bladder dropping down.)
2. Does this soft-tummy-forward,-butt-out stance squeeze the lower back vertebrae? As I stand this way, with what feels like an exaggerated lower back curve, I feel pain in that area.. wondering if I’m doing it wrong.
3. How should I safely cough, sneeze, and blow my nose? I feel the reverse/balance pressure pushing down through my vaginal canal when I do these things.
4. Is it safe to lie on my back at night if I have a prolapsed bladder? Is it rather recommended to lie on either side or stomach to keep the bladder from falling into the vaginal canal? All are comfortable positions for me. It does seem that lying on my back would encourage the bladder to fall onto the vaginal canal.
5. Do these terms all mean the same thing: prolapsed bladder, cystocele, herniated bladder?
6. I’m afraid to run because it will put additional pressure down there… even just to jog a short distance of some yards to catch a child running or something of that sort.
I’m considering the pessary thing again, because I’ve tried the new stance off and on since finding this site about a month ago. But it does sound like a pessary is like putting something solid into a bowl of jello. And I think it will hurt to be inserting and removing it at the occasional times I’ll need to do that. Also, I already feel so little aroused these days, this will be even more of a block to me being able to meet my husband’s needs…… I already don’t feel like it, plus I’ll need to remove my pessary before we do anything… nothing too sexy about that!
Please help me with advice, hope, or encouragement. Thank you.
I.R.
bad_mirror
March 26, 2011 - 3:00pm
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Hello, I.R.
I bet you will heal just fine -- I did. You can read my story in the long-standing member's success stories forum titled "postpartum cystocele success." I had my baby at age 31, home birth, and had a cystocele. I only have a few minutes, but to answer your questions in brief:
1. squatting with your butt tucked encourages the bladder to come down. squatting with lumbar curve in place and feet turned out slightly is fine, at least for me.
2. shouldn't cause pain or vertebral compression -- revist the FAQs, watch the YouTube videos, or get the DVD to help fine-tune. the spine is actually quite elongated in this posture.
3. bend at the hips, maintaining the lumbar curve
4. yes. no need to fret when sleeping, as gravity is not at work in the same manner as when standing. sleep however you feel most rested
5.pretty much
6. search the site for running and prolapse. many women do it, but in whole woman posture. start with long walks in posture and move up to running.
Maybe try a sea sponge or sports tampon instead of a pessary -- cheaper and more user friendly. I used these at first, but now have no need. Reduced libido *happens* in the pp period. Lube and a glass of wine can go a long way to help :-) Take heart in knowing so many women have healed from this. You will too. You will. Read old posts with postpartum update in the title -- they can be very inspiring! Keep asking questions, we'll answer!
louiseds
March 27, 2011 - 1:28am
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Welcome IrishRaven
Hi IrishRaven
You have a lot of information to deal with now you have found us. It is indeed a steep, but worthwhile learning curve, so stick with us.
The first suggestion I would make is that you use the Search box on the left to search for keywords like 'postpartum cystocele' and , 'postpartum prolapsed bladder'. You will learn a lot just from different women's experiences. This can be quite overwhelming because we discuss them a lot. Use your browser's Find function on each hit, to find the term in a topic string. This way you can skim all the posts for highlighted text.
Second suggestion. Check out the FAQ's at the top of the page.
Third suggestion. Go to YouTube and view Wholewomaninc channel, where there are several excerpts from the DVD First Aid for Prolapse.
Fourth suggestion. Buy the DVD for immediate things you can do. Buy the book to fill out your understanding of your pelvic region and the theory behind it. This book is a very comprehensive resource for making all the changes in your life to accommodate POP. You will eventually be able to return to all the things you did before, by slightly tweaking your posture and technique.
It takes a full two years for your body to revert after a pregnancy, then some subtle changes for the next few years. Your 6 week checkup is just so the OB can satisfy themselves that birth complications are resolved, and that you have contraception sorted out, (and that the baby is growing OK). It has nothing to do with saying, "You are now officially over your pregnancy." You have a lot of post-pregnancy and birth reversion to do, even after you look 'back to normal' on the outside. Your body has stretched and grown for nine months and during the birth. It will take a long time for all that tissue to become small again. Now you have had one pregnancy and a birth your body is now mature, and will probably have some looseness that it never had before. That is quite normal. It just happens. Prolapse is looseness gone mad, but that looseness doesn't have to mean the end of a worthwhile life. You just need to make a few changes to go with your new maternal body and your prolapses shouldn't bother you much in the longer term.
Kegels will help your pelvic floor to get moving again, but will not heal a cystocele. The cystocele is caused by stretching and possible tearing of the fascia that support it, not by muscle weakness. If you had episiotomy or tearing there may be some muscle that has torn and not healed or been sutured adequately, but the pelvic floor is not horizontal in standing posture. Nothing is held up by it. It is more diagonal, going up considerably at the back, at about the same angle as the lower abdominal wall.
They both stabilise the pelvic organs, which rest on your pubic symphysis. If the stabilisation muscles at the front are equal in effect to the stabilisation provided by the pelvic floor (wall) at the back, then your pubic symphysis will be stabilised. If you are in Wholewoman posture your pelvic inlet is vertical and your pubic symphysis has parallel edges, ie the front of it is no more open than the back. The whole joint is in compression at the base of a bony ring. It is is inflamed by unequal pressure, as in PSD, it will take some time to settle down. WW posture will aid that by equalising the load at the front and the back. I am not certain how long it takes for relaxin level to fall after birth.
It takes time for your body to get used to WW posture. Lifting your chest is the main difference from normal posture. The lower back takes care of itself, but the muscle memory of both your abdominal and back muscles have to learn some new normals, so it will take time before you can relax. Just try to get your chest lifted and let your lower back relax. As your vertical and oblique abdominals will be more stretched out in WW posture they will become stronger, and more stretchy, and your hamstrings will be the same. Your pelvic floor will tighten in WW posture. The mechanics of this are in Saving the Whole Woman.
This can be hard when you are in 'nurture' mode with a little baby. Just do your best for now and figure out how to nurse without slouching over. Lumbar support for you and a pillow on your knee under Baby are often helpful, but lying down seems to work best until you can get your body stronger and baby is more able to adapt to your posture. You didn't actually say how old your baby is.
Squatting, see BadMirror.
Try blowing your nose with your chest raised. You will notice the pressure in your relaxed abdomen less than in your pelvic floor, because of the change in the direction of these intraabdominal forces when your diaphragm can push out the front instead of straight down. The same will happen when you sneeze. It is a weird sensation opening your pelvic floor, knowing that it is bigger and tighter than when you tuck your butt under, but it does work. Sneezing and coughing are both reflex actions for clearing your respiratory system of irritants and blockages, but they don't have to be as explosive as our body does automatically. Have a play with it.
Sleeping. See BadMirror. Whatever relaxes you best will be best. I personally try to keep my shoulders and hips parallel, because I am prone to muscle spasms.
Pessaries can be useful for certain activities. I have used one in the past, until I needed a different size, but I eventually decided it was more trouble than it was worth, with menstruation, bowel emptying and sex. You can end up living your whole life around your pessary. With WW techniques I am able to minimise my symptoms without it affecting aspects of my lifestyle and hygiene.
Your interest in sex will return in time. I really don't think postpartum women are supposed to be interested in sex. If I was the Creator I would make sure that a mother of a new baby was concentrating on nurturing her baby, not running off trying to get pregnant again or satisfying her carnal desires, and leaving her baby alone in the cave, where animals might devour it! It will happen in time, and probably your husband won't even notice a difference! Husbands don't.
Louise
beauty
March 5, 2012 - 9:02pm
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RE: feedback appreciated
bad-mirror you are so sweet to take the time to reply to I.R. I also benefited from this exchange. I was also given a bunch of confusing information in the months following the birth of my daughter (1st baby). I was 35 at the time. I am now 39 and what I now realize was a stage 1 prolapsed bladder all along --leading to incontinence issues-- has become a much more troublesome problem a stage 3 prolapsed bladder. In my mind the only thing worse than elective surgery is emergency surgery! I have tried PT and I am trying 2 months of lifestyle changes before I schedule the surgery. I am curious about the sea sponge, I will search this site to see what I can find out. I was told by my doc that it is possible to remove the pessary on my own but the sea sponge sounds like it may be worth a try! Perhaps this will aid my efforts at realigning my bladder using firebreathing? Also I wonder if anybody out there has thoughts about alternative treatment/prevention for bladder infections, perhaps I should keep cranberry juice or cranberries on hand? Also advice on yoga poses is welcome, I have practiced for many years now and I wonder if standing on my head might be helpful for realigning my pelvic organs?