perineal soreness

Submitted by blythe on October 8, 2007 - 4:30pm
Body: 

Hi All

I have been following this site since Jan 2007, taking hope and positivity from it and especially when feeling particularly low. You are such amazing, strong women, women who without you knowing, have helped me feel that I am not alone and that there is something that you can do and that you can improve the quality of your life.

Just a bit about myself - I have two gorgeous girls- 2years 5 months and 16 months- the lights of my life. I had a second degree episitomy with forceps which ended up being a third degree tear with my first and then a bad second degree/ third degree with my second. Both were big babies 9lbs 9 ounces and 9lbs 11 ounces. Four months post partum I was diagnosed with a mild bladder prolapse which I have been told is still the case today and my cevix is now and has been for the past few months pointing towards my buttocks and back passage and if I insert my finger up to the second knuckle, I can touch it. Noty sure what grades my prolapses are as I have never been given one! I think my UP has got worse since the first PT said she could 'feel my cervix' 4 months pp, as I didn't have all these symtoms at that time. I was leaking urine and had a friction feeling now and again but that was all. Leaking stopped at 11 months post birth and my bladder prolapse is largely asyptomatic although soemtimes when I walk it feels like I am about to leak but don't, as if something that shouldn't be mobile is, do you know what I mean?. Most days though I have back ache- UP or learning posture I am not sure- and ranging from a little discomfort to outright pain in my buttocks and sitting bones, and sometimes anus ( coud this be a rectocele?, depending upon the time of the month. I have the heavy feeling in my abdomen, more towards when my period is due. I also quite regularly have soreness in the perineal area, which sometimes only kicks in when I am lying on the sofa in the evening. It can then really throb and ache in that area.

I only started practicing the whole woman posture and incorporating it into my daily life from April 2007 and I have noticed some improvement though sometimes it feels like one step forward and two steps back. I do the daily exercises from the DVD and not much else at the moment, though I have just started to go swimming in the last couple of weeks. Why did I start so late after my original diagnosis I keep asking myself? I guess I was in denial, thought it would all go away by itself and thought what time do I have to try anything with 2 children to look after? I am still going through the whole range of emotions - anger at being left in this state after heavy handed medical intervention, grief for the body I had, and the feeling of wanting to run away from and not deal with where I am at. I feel like I am at this major crossroads though and now is my chance to take control of this situation, my body, mind and soul and give it all I have in improving how I feel in all these areas. I am normally a very positive person and had huge faith in my body but I am seem to have lost a lot of that along the way and keep finding then losing again that faith in my body to heal itself. I am still scared to take regular walks which so many of you have said has helped as I am fearful of making things worse especially in the perineal area as I am aware of the bad tears I received and therefore how compromised that area might be. However I am determined to try the daily walk and see what happens.

Wow - I didn't know all of this was going to come tumbling out as I wrote! I am new to forums and have never joined one before but I feel supported here already and need your advice and encouragement. Can I ask a few questions?

Does anyone else have experience of this perineal soreness? Is it a prolapse thing or is it the nature of the scar tissue? Can I do anything to make it feel better? Sometimes when I do a pelvic floor lift before lifting someting heavy it aches., and feels a bit 'tired'.

My preferred swimming stroke is breaststroke but again could this be putting undue pressure on the perineasl area? I have had a few days of perineal achiness and wonder if this could be because I went swimming a few days ago and my stroke was breastroke.
I only do 6 long and 6 short keges a day as I have read how they can aggravate prolapse symptons however I wondered if a few more would help make that area stronger?

Before sneezing/coughing I lift the pelvic floor for example and then 'feel' the cough/ sneeze in the rectum which then momentarily aches. I have another apptoinment with my PT next week and I will ask her as well but just wondered if anyone here could enlighten me.

Thank you so much and apologies for the huge outpouring! It feels good though to 'talk' to someone else about it other than my partner and family, someone who is going through the same thing.

Wishing you all much love and light

Frankie x

louiseds

October 8, 2007 - 9:06pm

Hi Frankie

Welcome to the site. I seem to have read so many stories like yours over the last three years on this Forum.

Progress is often one step forward, two steps back, and sometimes it feels like two steps forward, one step back. The last week or so of my menstrual cycle often brings lower back pain and it feels like everything drops right down until my period is halfway through. Lots of women experience this, but I know it will go away, and it always does.

I think the worst thing is the fear of it getting worse, and not getting better again. Once you experience recovery enough times you start to trust your own body more and the fear kind of goes out of it. So time and self-awareness may in fact be the answer.

The other fear I still have sometimes is doing further damage. All I can do is to be mindful of my posture, particularly when lifting or doing other strenuous things (and get help where I can); attend to my diet so that I always get plenty of fruit, veges, fibre and water so I never strain on the toilet; always make sure my clothing is not compressing my abdomen, so there is always a safe hollow low in my belly, over my pubic bone, where my pelvic organs are always supported safely; and get some good exercise.

There seems to be three parts to living well with prolapse.

1 Get to know it, which you are already doing. Be aware of it whenever you are pushing the boundaries. Look after it so it doesn't get worse and learn how you can reposition your organs. You are doing these things too. There are new ways being developed all the time on this Forum. I am talking about posture and exercises here. Get Saving the Wholewoman, Christine Kent's book. You can learn a lot about your body from this book.

2 The other part is getting used to how your body feels with prolapses. Once you have faith that these restless organs will not actually come out if cared for properly, you can get on with day to day life and not be bothered quite so much by the sensations. You kind of become aware of them tapping you on the shoulder and reminding you to carry your body properly, eat properly, live properly. They cease to ellicit fear. We need a bit of fear in our lives to sharpen our survival instincts and enjoyment of life, but not between our legs!LOL

3 You also learn to work around them, and it becomes automatic after a while. eg, You stop trying to carry two littlies at once, and you stop bringing in all the shopping in one trip. Your daughters can probably both walk now, and the older one can help you bring in the shopping in several trips, and the big things can just be dumped inside the door until you can deal with hungry or tired kids.

Whether or not you have more babies, you are probably over the worst of the carrying. You at least have two sets of growing hands to help you, though they will still hinder you sometimes for many years.

Fortunately you have been diagnosed at a young age, so you can do these things. I had a pretty big episiotomy and forceps with my first, and had constipation and urinary incontinence as a child, so the scene was set. I was diagnosed with slight prolapse at the age of about 33 but the whole collapse thing really happened with the strenuous activities of building a garden, farm work, asthma, marriage stress and accompanying constipation, leaving my marriage and coming back. Avoid all that and you may never suffer any further damage! ;-) Had I known about Wholewoman twenty years ago I am sure I would be in better shape now.

Re posture, ensure that you are using all those muscles around the pelvis to maintain the lumbar curve, not your back muscles. From my experience using my back muscles too much caused my hamstrings and gluteal muscles to tense up, trying to balance my pelvis. The pain I got in my sit bones and whole pelvis and buttocks was the tendons being strained at the ends of these muscles where they join the pelvis. I am now learning to use more muscles in posture and activities through Feldenkrais and am finding that all this pain is resolving. It is slow, but a definite improvement. Back pain for me has been for many years, so it is going to take a while to get my movement right again.

The perineal pain may be connected but I can't really help you with that. Enough from me.

Cheers

Louise

granolamom

October 8, 2007 - 9:39pm

my bottom hurts just reading about your births. there is a concept of 'pain memory', you know. I don't think its a well researched or well documented area, but I *personally* believe it. your perineum's been through quite a trauma or two. I'm not sure if the pain you have now is leftover from the cutting, tearing, scarring or from the prolapse. I developed some perineal pain similar to what you describe, after the birth of my second child. his big head got stuck on a cervical lip. after 2 hours of trying to push past it, the midwife got her hands in there, pulled the cervical lip over his head and told me to push. ouch ouch ouch. I got torn up pretty bad, and was not surprised to be sore afterwards. I WAS surprised that the soreness never fully went away. it comes back with every cycle. much less since I went off the pill and eliminated caffeine and dairy from my diet. I also have some perineal soreness if I get constipated, so I make sure to eat well.

the comments you made about feeling a sneeze/cough in the rectum makes me wonder........what would happen if instead of holding everything tight in a kegel during a sneeze, you relaxed your belly and bent over slightly at the hips? maybe this would give the high pressure somewhere to go, rather than forcing it to the rectum?
kinda like holding in a sneeze pops your ears, kwim?
or maybe that makes no sense. anyone else care to comment?

do try the daily walk, a short walk, in good posture. even just around the block, breathing deeply can do wonders for your faith in the strength and integrity of your body.

other than that, I have nothing else to add to the last post. we can always count on louise for some words of wisdom.

feel free to pour it all out here. it helps.
((hugs))

louiseds

October 8, 2007 - 11:05pm

Hi Granolamom

I concur with you about the posture for sneezing. Don't know about you, but I have a lifelong habit of 'tucking my bum in and squeezing my thighs together while kegelling' to sneeze. It is hard to change, but my brain knows it is not right for my pelvic floor. I will now practise sneezing in private bent from the hips with a loose belly, until I get this right!

Cheers

Louise

blythe

October 9, 2007 - 1:45pm

Thank you so much granolamum for coming back to me and for your advice. Your posts have always been a great inspiration when I have read them during the last few months and when I read your reply today I felt so much more positive and lighter for sharing my experience and hearing about yours . I will definitely try the position you suggest for sneezing/coughing and am going to start my daily walk tomorrow. I am with you about the concept of 'pain memory'. I wonder if it is also like a lingering memory that you cannot let go because you wanted the outcome/experience to be different eg a birth and you hold onto the disappointment, anger, grief both physically and emotoinally. In any case I need to let go of these negative emotions and regain the faith in my body and know that healing is possible.

I am so sorry to hear about your perineal pain after the birth of your second child- ouch is not the word. I hope that it continues to decrease for you and I will let you know if I find anything that might be of help. I am thinking of trying Christine's perineal balm and seeing if that helps. Maybe regular massaging of that area might help?

I have also just started taking some homeopathy and am searching the area for an osteopath as we have just moved. I guess it is about trying to turn the fear around where you feel powerless and regain some of that power back.

Wishing you lots of love and continual healing

Frankie x

blythe

October 9, 2007 - 2:11pm

Thank you so much Louise for all your wonderful advice and for sharing your experiences with me and making me feel very welcome. I am so glad that I have found this site. Like Granolamum, you have always been a huge source of inspiration for me and are energising in your positivity.

I know what you mean about the fear, the constant fear that what you are doing will make it worse. My newest fear is the perineal soreness equals disintegration of the episiotomy/tears! I want to get to a place where I am not thinking about my POP every 24/7 and checking them daily and stop restricting myself so much from doing anything. It is about regaining the faith and confidence in the body's ability to heal and also proactively helping this process, something of which I need to do far more. I am guilty of hiding my head in the sand a bit, hoping 'it' will all go away.

I have Christine's book but I am guilty of reading it only once. I will read it again and again to empower myself with knowledge- after all knowledge is power. I will take more note of my body and how it reacts to different activities, and therefore become more self- aware. Irrelevant of POPs, this can only be a good thing. I think as mothers we are so used to putting ourselves last in the area of care and attention as we are so busy giving and wanting to give our all to our family that we don't have enough time or space to think about what we might also need. I have to say that I have just started swimming twice a week and that little space for myself doing something for myself totally energises me and is of huge benefit to both me and my whole family. I absolutely adore my beautiful girls and wonderful partner and am grateful to be able to be a full time mother at home, but I do treasure that time for myself and intend to increase it!

Your garden building and farm work sounds amazing- what a strong woman you are! I am 38 not sure if that makes me young but I am young at heart!

I just wanted to ask you if you don't mind what muscles you mean when you talk about the other muscles around the pelvis and also what is Feldenkrais? I am very interested.

Wishing you much love

Frtankie x

MeMyselfAndI

October 9, 2007 - 2:28pm

At first as things get easier you will forget for maybe an hour... Ths will go into a few, then maybe a whole day will go by when it is easier to deal with :-)
But you will get there...

Sue

Look into the eyes - They hold the key!
http://www.bringmadeleinehome.com/img/maddy544x150Banner.jpg

granolamom

October 9, 2007 - 9:15pm

I agree with you frankie, many times pain lingers as a result of anger and grief. the funny thing is that after that second birth I was THRILLED with my birth experience because the first time around was so much worse. It wasn't until I had my third, at home, that I realized what I didn't have for the second.
in anycase, its probably always a good idea to let negative emotions go. easier said than done, right?
I'd be nowhere if not for the support I've gotten here.
and I'm thinking of getting some of that peri balm. I have the vulva balm and I was honestly surprised by how well it soothes the skin. been using it for my dd too, she gets , oh I don't even know what it is, first dr said yeast, second said 'irritation due to soap', I think its stress related, but she gets terrible redness, inflammation and itching. a few drops of the vulva balm and within minutes she's happily running off to play.
priceless. and it beats the steroid cream the dr's gave her.

and one more thing......how was your walk today?

louiseds

October 9, 2007 - 10:17pm

Hi Frankie

First Feldenkrais. You can google it, or here is a link, North American Feldenkrais Guild . There are more local sites for other countries.

It is about getting all your muscles involved in movement by re-establishing nerve pathways that have gone out of use as a result of injury or something else. It is about using your whole body not just the habitual ways of moving, so the stresses are spread instead of concentrated in a particular area. That's what I understand about it anyway. It works in very well with Wholewoman.

Secondly, the other muscles. The book Saving the Whole Woman (second edition) has really good descriptions and illustrations in the chapter on Pelvic Organ Support. This book is essential reading. I refer back to it again and again. If you have the first edition the section about all the muscles is not there. The second edition is so much more comprehensive. If you don't have the second edition a good anatomy atlas will list all the muscles involved in keeping the pelvis where it is stable, but may not include the upper body muscle groups.

I found out that I was mainly using my gluteal muscles, hamstrings my erector spinae and my transverse abdominus muscles to keep my pelvis stable. This was the cause of all the instability. There are also the quadratus lumborum, the psoas muscles, biceps femoris and quadriceps femoris, adductors, lateral rotators, latimus dorsi, which are attached to the pelvic bones at one end and other bones at the other end. These extend both upwards and downwards. There are also a heap of other muscles further up which control upper body directly and lower body indirectly. You can't really separate them out because it is all one geometrically related system, that also incorporates the bones and the fascia.

Some of the exercises I am currently doing use these 'other' muscles to move my pelvis around while in a position where it is easy for me to not use the ones I normally use. These current exercises aim to wake up the other muscles (which for me are mainly the ones that are joined to the top of my legs at one end and the pelvis and sacrum at the other end) so they can play their parts in movement along with the muscles I have been using in the past. The movements are very small, but they are about the nerve messages going from brain to muscle, not about muscle strength. It is hard to believe that such tiny repetitive movements could be doing anything, but they definitely are.

Waking up and beginning to use all the extra muscles is slowly and steadily making all my movements smoother and less painful. I assume this is because loads are spread instead of concentrated on certain fascia/tendon anchorage points and skeletal joints.

That's about all, I think. Post again if I have not answered you fully. I am still very new at this Feldenkrais thing, and I too am still trying to get my own head around all the nuts and bolts of how the body works, particularly in the pelvic area.

Cheers

Louise

blythe

October 10, 2007 - 2:51pm

was great for both the body and the soul! I went with my two year old who was pushing her 'baby' in her buggy and we walked further than I thought I could. My body felt stronger than I imagined and lighter and things felt a bit more compact when I had finished. I was aching a bit in my pelvic and sitting bones and belly on the way back but it felt so good to get some exercise on such a beautiful sunny autumn day and to let go a bit of the fear. I find learning to walk in the posture like trying to ride a bike or drive a car- I am continually checking lumbar curve, belly, shoulders, head etc and I guess one day it just becomes natural and automatic.

What I find sad about negative emotions is they first affect me but then affect everyone around me because of my mood. Fear is one of the hard ones to let go- like the last couple of days my symptoms have changed from pain in buttocks to more pubic bone and sitting bone pain and immediately I fear that things are getting worse....do symptoms just change from time to time with POP?

But hey I went for a walk and this is the start of good things. Have booked an osteopath appointment for next week- will let you know how it goes and I think I am going to order the peri balm- the vulva balm sounds fantastic.

Thanks for your support

Frankie x

blythe

October 10, 2007 - 3:05pm

Hi Louise

I got very excited when I read your email about Feldenkrais - it just seems to make so a lot of sense. Unfortunately when I went to the link, there were no practitioners in the UK. Very disappointing. I will however do some research on the internet and see if I can find any other info out re Feldenkrais and the UK.

I do have the second edition of Christine's book- I got the initial print run before it was properly bound, etc when it was first offered on the Wholewoman website. I will read that chapter again and see if I can get my head around it and try and work out if there is anything I can do myself to try and use the other muscles that support the pelvic organs.

Thanks for your clear description of it all. I am beginning to understand a bit more how the body works- I guess I took it for granted before but it feels good to be more in touch with my body.

Thanks for your guidance

Frankie x

blythe

October 10, 2007 - 3:09pm

When I can go for an hour or two without obsessing about it all and that it doesn't rule my life or define me. It gives me hope when I read your comments on this forum Sue and how you have improved and are so positive. It is great to here that it will get easier and thank you for letting me know that.

Frankie x