perineal repair and prolapse?

Body: 

I am 3 weeks postpartum after a vaginal delivery (my second) that involved a 2nd degree perineal tear. My midwife gave me just one stitch, but that stitch was causing all kinds of swelling and terrible pain, so at one week postpartum, she said I could go ahead and clip it, and that the tear would heal completely anyway, but just take longer.

So I clipped the stitch. That was when I first started feeling the pulling, stinging, "misplaced tampon" feeling that I have since identified as a uterine prolapse (my cervix is about a fingertip-length inside the vaginal opening-- I finally checked a few days ago after increasing discomfort).

My question is, could my not-exactly-repaired perineum have exacerbated the problem? Essentially, my vaginal opening is still considerably larger than before, and although I can imagine that the perineum could continue to heal, I'm feeling really worried that the wide-open-ness of the whole area could be part of the lack of support for my uterus-- similar to how episiotomy could be a culprit? I have no idea, but it's bugging me and I'm feeling terribly depressed about the whole situation.

Hugs for you, Lovely Rita. I don't know the answer to your question, but there are a lot of very informed women here who may be able to answer. I just wanted to say I saw your post on Mothering, too, and my heart goes out to you. I am also in kind of a dark place right now, and can't seem to get the kind of straight answers I want from doctors, etc. I am starting to find them here, though. Please, rest rest rest for now. I keep hearing that the whole year postpartum is full of healing potential. That gives me much hope, and I hope it will for you, too.

Hi Lovely Rita,

Some of our most successful women - and by that I mean women having gained great results with this work - have perineum issues similar to yours. I believe your prolapse symptoms - like those of many other postpartum women - have more to do with needing to position your organs toward the front of the body than tightening up a “floor” at the bottom. Women with fairly serious, unrepaired tears have gone on to become basically symptom-less. It’s all about pulling the pelvic interior forward, which you can read about here, or buy the dvd for a thorough explanation. As far as we can tell, this is truly the work that all women in yours shoes require. There is only one pelvic organ support system and only by returning to that framework can prolapse symptoms be reversed. This includes a seemingly large, open vagina, which narrows and closes when pulled taut by natural female posture.

Wishing you well,

Christine

its a mess! never had an episiotomy, but tore here there and everywhere. no one ever thought to stitch me. or even tell me about most of the tears. but I know what's what.

so yes, I think that perineal tears do compromise the support system, but not so much in the way that we tend to think. the purpose of the perineum is not to hold up the pelvic organs. the pelvic organs are successfully supported by orientation within the pelvic cavity (over bone and forward of the vaginal opening, rather than center and suspended over the opening), a combination of fascia, ligaments and muscle action as well as the forces generated by breathing.

so yes, this situation is terribly depressing. but here's some hope for you; my perineum never really healed well and EVEN SO my prolapse is not as prominent as it was when I first found it. it does not impact my life. at all. I have no symptoms aside from pressure occasionally around the time of ovulation or right before I get my period. I've gone on to have another baby and am no worse for the wear.

some more good news for you is that many women with postpartum prolaspe seem to do very well rather quickly. not that I can make any promises or predictions to you, but three weeks pp is sooooo very early. so much healing will take place. and toss the 6week-myth out the window. it takes a year. and then some.

learn the posture
get some rest
eat well
never ever strain on the toilet
constipation is your biggest enemy
and while its totally normal to grieve (this IS a real loss!) try to keep in the back of your mind the knowlege that we've been there, and are doing better now.

((((((hugs))))) and congrats on the new baby

oh, just wanted to add, I read somewhere (and I think alemama mentioned it here once) that to help with proper healing without stitches you should try to keep your legs together as much as possible.

i am not on this site often because i may decide to undergo surgery. however, this site really helped me cope with my condition when i first discovered it. your post really touched me, so i felt i must respond. i am now postpartum 20 months. it takes many months for the body to go back to normal. so please hang in there and don't get discouraged. i feel my vagina and pelvic organs did not reach a baseline condition til 9-12 months. each month gets better. so it is way too early for you to know how things will finally be. try to focus on your sweet baby...i had much anger and resentment towards my OBGYN for quite some time, and i find it was wasted emotion. good luck to you. j

Hi Jsnyc

How ya goin'? You haven't posted for quite a while. I remember how distressed you were when you first posted. If you have time, please tell us how your postpartum period progressed to this stage and how it is now. Hope your beautiful baby is now toddling around charming both of you.

Cheers

Louise

you are definitely one of the whole woman veterans that helped through the tough times-when hormones were haywire (not they ever stop). and i felt like a billiard ball was going to fall out of my vagina! things have definitely improved....plus life just moves on in ways that make you not focus on it as much. alas, i now have a herniated lumbar that is taking up my attention. so some days good, others not. also had to rule out breast ca....and a bunch of family members are having medical problems. so unless i am having a terribly bad prolapse day, i don't think about it too, too much. but when i do, i do think about surgery, and that is why i am not here very often. so i take an occasional peak at the forum....stay well...and i will always appreciate all you have done for me. j

elisewolv
I had major surgery three months ago: re-hanging of the womb, posterior vaginal repair, rebuilding of the pereneum and tvt sling for the bladder. I had a lot of pain for 3 months, then seemed to be better. Functionally,bowel and stress continence problems have cleared up. However, in the last two weeks, I am having pain on sexual intercourse, and when run down or tired, far worse and more continual 'dragging' pain than I had before the op.
Will this improve? Did I make a mistake in allowing the op to be done (I had lived with the symptoms, which included dragging, occasional fecal incontinence and slight bladder incontinence, for 15 years)?
Can I do anything now to improve things given that my insides are all repaired and re-fashioned (consultant's words), or am I just done for now? I feel desperate, as I have started a new relationship but my entire wellbeing is being compromised. I was told I had healed well - but now what? Either it is too soon to expect the pain to go, or they have really messed me up. I am going back to the hospital in two weeks. I am feeling panicy. Every day is a trial at the moment. Can anyone advise me?

I'm so sorry to hear that you're having post op trouble. unfortunately this is far from uncommon. most of us here are managing prolapse without surgery, so we won't have much first hand advice. there's other sites where you might find more of that, from women who've gone the surgical route.

as far as what to do now. this site is all about using our natural design to properly support our pelvic organs, now that you've been 'refashioned' I'm not sure how much of this will apply to you as it applies to a women who hasn't been surgically altered. not to say there isn't anything to do now. I think first of all, you must learn your new anatomy. I know this is a tall order, especially if you're like most women and didn't know your anatomy well before hand. but once you understand what's what down there, maybe you can begin to make sense of what aggravates and what improves your symptoms. I'd imagine that its a good idea to avoid constipation like the plague, never to strain on the toilet. I don't know what the pain on intercourse is all about, whether its due to your new design or scar tissue/healing issues. definitely speak to your dr about that. christine has some nice healing balms (for sale on this site) which may prove to be soothing for you. or at least use some vitamin e oil or aloe or something to promote healthy tissue. and as I'm sure you know, stress can make any bad situation worse. try not to panic. let the grieving process begin so you can get through it. what's done is done, and now you will learn to live with your new normal.

you're more than welcome to stick around here and see what you can apply for your situation, but I really do recommend also finding a forum where more women can share their post-op experiences.