Advice on managing acute episodes/Rectocele & lower back pain

Submitted by alphamom on May 2, 2009 - 12:45pm
Body: 

Hello all, I'm new here, and this may not be the right forum --- I'm only 5 days into a specific diagnosis of degree 2 rectocele, no other prolapses. I'm 44, overweight, with 12 and 9yo daughters. Though my youngest's delivery was traumatic, and I never really got pelvic tone back --- the cavernous/no leverage/minimal sensation feeling during sex, and routine pelvics where my gp complained of very saggy vaginal walls collapsing and obstructing her in finding IUD strings --- these pelvic issues never seemed acute before. I had tried an internal resistance device for kegeling but never felt I had any muscles where I was supposed to, the only tightening I could ever do was much higher up, near the cervix --- so no tone but little active distress. But now I'm one month into an acute flare and not managing; still waiting for the book, can't really visualize the posture etc. And it seems that most of what I read seems targeted mainly toward uterine prolapse, with rectocele as a late or incidental complication, while it seems to be my main issue (though I just had vaginal ultrasound yesterday to rule out other issues, like ovarian cyst, I don't have that report back yet).

Aside from feeling like an overstuffed sack of * which can't get out, which presses and swells everywhere, and which teeters precariously and painfully against aching back and abdominal muscles, I'm coping.

What has been most distressing me have been half-day episodes of acute lower back pain, stiffness, and weakness, where 3-4 ibuprofen doesn't touch the pain, and I can't bend, squat, or find any comfortable positions --- as bad as when I've had a strained back --- but instead of healing slowly over many weeks, this comes on acutely and can be fine 8 or 12 hours later. I'm now in my second of these acute episodes, and have had several moderately bad days as well, but not sequentially --- I can feel perfectly fine on days in between. It does seem that wearing my old pregnancy back support belt helps the pain and wobbliness during these episodes -- the pressure/support feels helpful, in the low back and the low sides of the pelvis. So does wearing shoes, and walking if I can get relaxed enough to do it. (Yet on in-between days I'm fine to do my usual stairstepper exercises, even with high-intensity fast intervals, no pain at all.) I would be *so grateful* for any suggestions to cope with these episodes of acute and debilitating back pain!

This acute month began with nasty menstrual cramping (uterine/gut/back), disabling in the mornings til the 3 ibuprofen kicked in, which then settled into an acute lower left pelvic pain, which after a day resolved into constipation, and gradually improved with treating that. A week later, an acute lower back day. Since, some moderate lower back days. A pelvic with my gp was no big deal, but the pelvic with the gyn/urogyn surgeon Monday was harsh! What he did was standard, pushing on the rectocele from the rectum side, but I've not really got over it . . .Many crampy days, and a gut that's very agitated/won't fully empty (I've not got splinting to work really, or found anything discrete to 'push back in'). . . and now I'm back to another hyper-crampy menstrual period and acute back day. . . I'm feeling quite broken and ready for repair, or at least recuperation, now . . .

I also have stress incontinence (not major and much better than while I was pregnant with out-of-control asthma and bronchitis) and a bladder that seems not to empty (was full just after voiding at the ultrasound yesterday, demoralizing).

Any tips to tide me over this initial uncontrolled time would be very welcome, even just encouragement that this can improve!

alphamom

Christine

May 2, 2009 - 5:27pm

Welcome to WholeWoman, Alphamom,

Acute pelvic instability is no fun, although one of the main symptoms that resolves with this work. Try lying flat on your back on a firm surface, completely relax, and breathe through your nose while allowing your lower belly to rise and fall. Place your hand under your lumbar curve and feel that your lumbar spine rises with each inspiration. That natural movement, which in actuality is creating pelvic organ support and pelvic joint stability, is what we are taught to compromise by pulling in our stomach and with all "core" exercise. Keep your pelvic belt on while you’re up and visit the FAQs here for a bit of instruction on the posture.

It sounds like your vaginal sphincter was very compromised by the way you describe it. The reason you can feel contractions at the cervical level is because that is where the pelvic floor muscles are located. I like the way you put your experience as being associated with “little active distress”. The pelvic diaphragm muscles are what squeeze the penis and that’s why men generally do not sense the “cavernous” feeling as much as women. The mouth of the cave may have widened, but a few steps in it’s just as it’s always been. Actually, many more women have cyctocele/rectocele that UP. Yours are classic symptoms that should improve considerably with proper postural and lifestyle changes. Fair warning that you are probably developing a cystocele as well - the urinary retention is a classic sign. The good news is, when your bladder falls back a bit more the SUI should completely resolve.

The sack of sh** phenomenon will just have to be babied along until you are able to reposition your organs. Stop all straining against the toilet seat (rock forward onto your feet whenever you need to increase pressure), utilize splinting and small enemas to protect your back vaginal wall. Make sure your diet is very healthful.

Maybe other members will chime in here and suggest their favorite menstrual cramps relief. I discovered mine by accident very late in my cycling years, but it worked like a charm every time: 2 organic oranges followed 30 minutes later by a glass of red wine. Not a good daytime treatment, but it was infallible in the evening.

I’m not pleased with the urogyn’s tactics. He didn’t have to use much pressure to get a sense of the anterior bulging of your rectum and he also knows the delicate nature of the problem. Gr-r-r.

All I can tell you is that many women improve with this work and I believe you will too. What we are doing is very, very simple - using gravity, our breath, the natural shape of the female spine, and the weight of the organs themselves to return to the true pelvic organ support system.

Wishing you well,

Christine

louiseds

May 3, 2009 - 2:55am

Hi Christine and all the Wholewomen

This topic has got me thinking. I am having a bout of lower back pain the last few days, and it is doing my head in, as well as trying to limit me physically.

Why on earth does lower back pain go with POP? Is it just coincidence? Or is something else at work here? I actually have had a couple of pimples and a little spotting this last few days, so I suspect in my case it is a vengeful perimenopausal menstrual cycle at work. Yes, I have also had a bit of a low POP time as well. Sure, the pelvic area gets a little inflammed before a period. Sure, a period is just a little, pretending labour and birth. Both the latter also imply loosening of ligaments.

My physio tells me that back and pelvis type pain which is associated with muscle spasme happens at the attachment points of tendons. The pain from a sprained ankle is often ligament pain, but also bruising.

So maybe all this lower back pain is pain at the attachment points of fascia (same tissue type as ligaments) to bone, or to other parts of endopelvic fascia. The broad ligament and the round ligament are the two I am really thinking about, but there are other pelvic ligaments as well. With prolapsed pelvic organs these may be in a stretched state for some of the time, which would irritate them and possibly produce pain. There are also a lot of muscles that attach to the sacrum and lower spine, as well as to the pelvic bones.

Christine, how do you think this pain is caused?

Cheers

Louise

alphamom

May 3, 2009 - 11:57am

I may go to the er.

The lower back pain won't let up, 4 ibuprofen won't touch it, I can't reach to wipe in front, put on my own underwear,etc. It's only good in the hot bath. I am fine in a hot bath, abdomen softens, no pain.

I took a half dose of senna laxative last night, helped me last time. At this point it's just about all liquid. Yet I passed out on the toilet this morning, not straining, just very painful and cramping around the front of my belly, passing liquid in back. I feel so swollen, that swelling is the main obstacle. I feel woozy again, now I'm out of the tub.

If I had confidence this will resolve, it would be ok. At times the pain/wooziness is like early labor, at times like postpartum recovery, at times like the start of my postpartum hemmorhage. Two of those had a natural progression to get better, one was disastrous. Often if I'm getting this woozy from pain there's infection or something I can't heal myself, though I did feel this way postpartum (thought I might pass out in the recovery room toilet, but didn't; though even that was a day after a tremendous hemmorhage, maybe my confidence is only retrospective). Er will probably be a long painful unpleasant slog, or worse, but I'm not sure I can proceed without some confidence nothing will endanger me, or better pain management.

Argh, my kids will miss a favorite weekend activity, argh. My low-profile management is lost.

Thanks for the sympathetic ear, and the context which I lack,
Alphamom

alphamom

May 3, 2009 - 4:49pm

Am back from the er, feeling a bit better, waiting on a vicodin prescription, they think it's all vagal reaction to pain, but nothing dangerous or emergent with the gut (like blockage or strangulation of gut tissue). er doc was able to read online notes from the recent urogyn pelvic exam and thought the very aggressive exam could cause this level of pain/spasming and reassured me that not being able to empty (especially since I can't even reach my perineal area now) does not threaten dangerous or progressive things. Just knowing this isn't a sign of a seriously emergent situation that I need to get managed helps. I'm hopeful the painkillers help too.

Thanks again, the posture clarifiers really help. I wasn't sure the pelvic belt agreed with the FAQs on posture. It's hard to get on in the morning (right now doing any self-care is hard) but having it on and an upright torso for multiple hours seems to really help. Ibuprofen, not at all . . . would it be bad to wear the belt at night too, all my pain and wobbliness is worst in the morning?(getting out of bed, first bowel attentions).

Ugh, I don't think I'll be able to rationally assess much of any of this til I can get past this acute flare. But knowing I can hang out in a hot bath without pain or imminent doom is reassuring. The last time I just accepted pain at this level spiralled into such trauma, confidently placing it within a healing and not escalating process helps so much.

Sorry to catapult onto the group like this! Pain and lower back management tips, miraculous healing anecdotes, still very welcome!

alphamom

louiseds

May 3, 2009 - 9:33pm

Hi Alphamom

Hang in there. It must be nigh on unbearable. It may also have been aggravated by the exam at the ER. Perhaps really pamper yourself for a few days, and give the body a bit of a break from exercise. Just let it rest and recover a bit. Use WW posture as much as you can when you are up and about.

(((hugs)))

Louise

Christine

May 4, 2009 - 12:35pm

Hi Alphamom and Louise,

Hope you are feeling better today. Although we can never know what someone is actually dealing with physically, there is so much we have in common that we can certainly generalize.

I don’t agree with your PT’s statement, Louise. The most progressive orthopedists (which include our friend Dr. Stephen Levin) know full well that a critical relationship exists between the lumbosacral region of the spine and the entire ligamentous “stocking” that surrounds. it. They’ve used immunohistochemical markers on nerve axons to discover that ALL these connective tissue structures receive the type of nerve fibers associated with “nociception”, or pain.

What’s more, there is a whole neurochemical cascade that can happen when this area gets irritated, resulting in a full-on inflammatory response where pro-inflammatory molecules cause the release of histamine and the recruitment of white blood cells. The result is tissue edema and PAIN!

What sets it off? Who knows. We know that our bowel function is just *different* during menstration and I suppose these hormonal influences might be extended to the surrounding musculoskeletal area.

As far as prolapse and low back pain is concerned, I think that is strictly structural and ameliorated with proper body mechanics. I know you’re very mindful, Louise, and can only think some sort of biochemical/hormonal process might be contributing to your discomfort. Dare I ask if belly dancing might be an aggravating factor?

True sacroiliac joint dysfunction (I think dislocation is a better term) is completely debilitating and something I have incurred twice. There is really nothing to do (outside of help from a knowledgeable body worker) but lay out flat on the floor, slowly stretching side to side, or remain standing as much as possible when symptoms are acute. My episodes of SIJD were before I opened my studio and began working out on a regular basis. I seem to have developed my core, which I believe includes our low back and buttocks, to a point that not much disrupts it - even unexpected episodes like carrying my heavy, 2 1/2 year-old granddaughter half way across town.

Alphamom, the pelvic belt won’t do any good while you’re laying down, but is designed to squeeze the SIJs together while you are upright. This is their greatest position of stability and the belt supports that externally.

Christine

alphamom

May 4, 2009 - 6:00pm

Thanks all, I'm feeling much better today! It's early evening now, I took a vicodin last night and one at 7 am. At first it seemed to take the constancy of the pain away, leaving the same stiffness/weakness/limited range/pain on bending and reaching. But by late afternoon I started feeling much better, with more range of motion (like I could drive without feeling painfully stretched), even without taking a second dose.

Maybe it was just, as Christine suggested, a spasm/inflammation cascade and I needed to break into and stop it somehow.

I'm still a little wary, it's always worst in the mornings and I may need to take another dose then, but that's mainly the voice of restraint trying to rein in my optimism at feeling so much better!

I got the ultrasound results back today and there was a 3cm cyst on my left ovary . . . so great, seek and ye shall find, now I've got 2 issues (degree 2 rectocele and smallish ovarian cyst) --- neither of which are symptomatic in most women who have them, but either of which can create the tangle of symptoms I've been having. It makes the decision-making even more complicated, though it seems the constipation/emptying issues would point more strongly at the rectocele as causing my troubles.

The instability I'm talking about isn't a joint instability, my joints feel solid; it's muscular, the feeling that my back/abdominal muscles are ready to just let everything fall where it may, there's no equilibrium or restoring force to little bends forward or back. It's hard to explain, but I had it postpartum, too. I also had it when I had a real muscular strain of my back from carrying a too heavy load, which took a month+ to heal (though the acute wobbliness healed quicker)

Gotta go eat dinner, feeling much braver now,

alphamom

Christine

May 4, 2009 - 6:51pm

Pelvic instability is my newest favorite subject, which I believe is greatly under-diagnosed in women. The pregnant population is believed to suffer often from it, yet post-partum women with prolapse are never correlated with PI. How astonishing! Why has no one elucidated what all women who have been successful with WW posture instinctively understand: Pelvic instability = Pelvic organ instability?

So glad you are feeling better and perhaps if you work on your posture, your cyst will reabsorb!

louiseds

May 4, 2009 - 10:34pm

Hi Christine

I know that my PT's reasoning is not the whole story. I was really just putting a heap of stuff on the table. Your answer to Alphamom makes sense. It resonates with my thoughts.

I think some of the pain is sometimes from this attachment point cause, because stretching will relieve it, after a day or so to let the inflammation subside. I agree that there is something biochemical going on, and yes, I think prostaglandins are involved because Ponstan (an anti-prostaglandin prescribed for period pain), just a couple of doses, relieves it, and will cut short an episode, which doesn't really return with avengence when it wears off. One non-steroid anti-inflammatary capsule will do the same thing. I just don't like taking stuff. I would rather root out the cause and change direction so it doesn't happen, and use my own movement to prevent it, and treat it.

Yes, bellydancing may be a cause, but it is not directly correlated, cos it doesn't happen every time, and it is not necessarily worse if I do more bellydancing for a few days. In fact bellydancing is one of the ways in which I loosen my body and get it moving more smoothly. It just feels really nice as long as I keep WW posture in the front of my mind as I do it. I guess it is possible for one activity to both cause and treat the same problem? I also guess that means that it is not the activity that is at the root of it, especially if other activities have the same twin effects?

I prefer to keep the range of activities I engage in as varied as possible, so I am using different muscle groups in different ways all the time. I have been trying to solve this puzzle that is body pain for many years now. It is a day by day process. What will hurt today? Rarely does a day go by that something doesn't hurt some, even if only for part of the day. I think some of my pain is habitual, related to old responses to old injuries, so my subconscious thinking is involved too. There is brain re-training happening. The pain is manageable, using a variety of techniques and activities, exercises and stretches, with occasional body work. It is nowhere as bad as it used to be. I was hospitalised in traction for four weeks with another four weeks of part time home traction, about 25 years ago. That was the beginning of working it out and treating it myself. I am never laid out by it these days.

Thanks for your concern and thought-provoking comments.

Louise

alemama

May 5, 2009 - 12:03am

alphamom get your butt in bed. Pain is one of the languages your body uses to communicate important information to you. So right now you are masking that communication with meds but that doesn't mean you are all better. Rest. I am glad to hear you are feeling much better.

and be cautious: most of those meds list constipation as a side effect.