1 year postpartum

Submitted by mindful on March 13, 2011 - 8:35pm
Body: 

Hi I'm new and this is my (long) story:

I am 27 years old, and I am a physical therapist (but a very open-minded one!).

I had a boy last March after 33 hours of labor. Took Bradley classes, had midwife, planned on natural/water birth. Labored 24 hours after water broke, then got pitocin leading to epidural (surprise surprise!), pushed for 3 hours in lithotomy position (due to epidural-again surprise surprise!), OB came in to try vacuum assist, gave me an episiotomy which extended to a (minor so said the OB report) 4th degree perineal tear upon delivery (could've predicted that!). Took about 10 minutes to stitch me up and the OB said it wasn't that bad. Ended up with a healthy 8 lb 20.5 inch baby boy. We were able to breastfeed immediately.

Recovery was manageable with colace, high fiber diet, no straining, sitz baths, ice pack, and a variety of witch hazel pads/epifoam/dermaplast, etc. I was out taking short walks at 2 weeks pp wondering why it felt like my insides were going to fall out. Healing progressed leading to uneventful sex at 4 wks pp which may have helped remove a tag of perineal skin left over or may have been bad? It felt fine. A few weeks later I found another tag of flesh that disappeared after awhile.

Started doing evening primrose oil/vit e oil perineal massages after lochia stopped around 4-6 wks pp. Started a perineal stretch massage too because I was afraid of scar tissue forming (finger inserted in vagina pressing back on perineum in a back and forth C motion). I don't think that was a good idea.

At 6 wks pp got the all clear from midwife to resume all physical activities, stitches healed, no mention of prolapse.

As recovery went on every time I felt the urge for a bowel movement I had uncontrollable vaginal air escape, but no solids. I was unable to control farts as well. Both of these issues have improved, I have full control of farts, but if I hold back the fart then air escapes through my vagina. If I let the fart pass by itself, no vaginal air.
Fistula?

Anyways, upon internal examination I can't feel any opening in my posterior vaginal wall. The escaping air and bowel urgency were my first symptoms. Bowel urgency as in the longer I wait the more vaginal air escapes as the rectum is filled, and the less I am able to squeeze the bowel movement back. I honestly don't know how long I would be able to hold back a bowel movement, I have never let the urge go for more than a few minutes. I have never needed to splint or felt the need to, but there is a fullness inside my posterior vagina if I am holding back. Upon examination, there is an area of stretched, soft, squishy flesh inside the posterior vagina.
Rectocele?

I have had one episode of slight fecal incontinence during sex in the seated position, and an episode of fecal incontinence when vomiting/diarrhea from the stomach flu.
Poor anal sphincter control?

Went back to busy full-time job, sex was no big deal, no new issues.

Went on vacation around 7 months pp and on my period. Was gone all day with Divacup inserted and no place to stop to pee. On the 1 hr ride back that night had bladder spasms from holding pee all day, tried to pee on diaper/water bottle, nothing happened. Got back to hotel, peed a long time, still had bladder pressure, removed Divacup, and peed even longer. Since then if I drink too much before going to bed (hot chocolate specifically) I will wake up with bladder spasms, go pee, feel bladder pressure when I think I'm done, do some kegels, and pee even longer. I have never had urinary incontinence, whether stress or urge, pregnant or not. Upon examination I feel a saggy, pouchy, spongy area of flesh inside the anterior vaginal wall.
Cystocele?

Quit my full-time job in lieu of part-time job and more time with baby. Gained 10 pounds from winter/decreased physical activity from job change. Started noticing irritation in clitoris/urethral area from my jeans seam. It feels like clitoral hood/urethral area is lower/saggier perhaps and brushes against the seam. It is less noticeable with longer pubic hair, to be completely honest. The urinary opening is bigger than pre-pregnancy and my urine stream is sluggish.
Urethrocele?

My cervix remains 2 knuckles high now. During menstruation it is 1 knuckle high leaving me unable to comfortably wear a Divacup without pushing it back up all day. Prior to pregnancy per palpation my cervix was almost unreachable with middle finger.
Uterine prolapse?

I unfortunately did not 'get to know' my vagina and all her parts pre-pregnancy so I do not have any comparison. Except for palpating the cervix for fertility charting that is. I know what I see now and that's it. I do not feel any balloons in my vagina when sitting/standing/walking. I do feel like my labia have dropped and they rub between my legs when walking, but not a bulge. I have the pressure or draggy sensation in my abdomen around menstruation which returned 4 mths pp despite breastfeeding. When I stand and look in the mirror I see nothing 'peeking' from the vagina. When I do a full squat I see an anterior and posterior bubble within the vaginal entrance.

I have started WW exercise program and posture recently. Learning firebreathing/nauli. Still doing vit e oil perineal massage, but have stopped the stretch perineal massage. Sex is painfree in missionary or on-top positions, but rear-entry such as spooning is painful on the perineum, and doggy style pulls on my bladder. With enough lube though, we make it work! Husband says vagina is looser overall, but cannot feel any 'bulges'.

I am in the process of weaning breastfeeding, now down to two feedings a day in attempt to shed these 10 pounds and balance my hormones out before even thinking about getting pregnant again. I am committed to giving my body a year break before trying for another baby. I am scared of tearing again, even though I have read others' accounts of them having minimal/no tears the 2nd time around. I find comfort in reading of those who have 'been there, done that' birthing after prolapse.

Questions:
Do I indeed have a fistula/rectocele/poor anal sphincter control/cystocele/urethrocele/uterine prolapse?
Should I stop doing perineal massage altogether?
Will my bowel urgency/passing vaginal air continue to heal? This does not seem to be a factor addressed in WW practice.
Is there any part of my story that is a red-flag or Dr. visit worthy?

Thank you!

mindful

Christine

March 13, 2011 - 10:59pm

Hi Mindful,

Welcome to Whole Woman. I am startled by the calm, level-headed attitude with which you are facing your injuries. Yes, a thorough exam by a well-trained eye to rule out fistula is certainly in order.

I can only guess that you indeed have the global prolapse and anal sphincter damage you surmise. The odd vaginal air symptom needs to be checked out. Prolapse can cause intestinal air to sort of flap through the labia, creating a sensation that it’s coming from the vagina, but yours sounds like it actually is. I wrote a paper a few years ago on the subject of surgical laceration of the perineum, which you might take a look at.

From what I’ve been able to determine, severe injury to the anal sphincter is basically irreparable. However, it’s worthy of professional examination, because the missing part of the nerve-damaged circular sphincter is often visibly noticeable. You need to know what you are dealing with as well as the risks of surgical repair, should it be offered to you.

That said, and this is *complete speculation*, but I think another pregnancy might be in your best interest. Here's why:

Luteinizing hormone, or LH, has several functions in the body, some of which are inflammatory. LH also builds and repairs nerve connections. The pregnancy and fetal analogue of LH, human chorionic gonadotropin, or hCG, is what rapidly builds the fetal brain over the course of pregnancy. It has been demonstrated that the surface area of the perineum increases during pregnancy, which I believe hCG must also be responsible for.

The point being that only in pregnancy will you have super-high levels of nerve-generating hCG. If my logic holds, any improvement in your perineum would best be met in the pregnant state.

My hope is that you would see some more improvement in the urgency and flatus incontinence.

It is my assumption that perineal massage is not going to be of much benefit, but perhaps others will share their experience with this.

I think we can safely say YES! your prolapse symptoms will improve with this postural work. It’s all about fascial planes being drawn into their natural directions and with them improvement in bulges/sagging.

Our long-time member, Alemama, is about to deliver her 5th child post-perineal tear. Hopefully we will hear from her on this matter.

Wishing you well,

Christine

Diamond

March 14, 2011 - 7:15pm

Hi Mindful

I am rather surprised the medical people gave you the all clear! from what I remember when I had my babies 6 weeks after giving birth a physical examination by the hospital gyno was mantatory to ensure all was well. You are very young to have these issues with prolapse - I really do think as a suggestion to get yourself examined by a Urogynoecologist to confirm the different types of prolapse mentioned - it does not mean you should have surgery but at least to discuss with a urogynoecologist consultant and especially if at a later date you may want to have another baby.

Eating chocolate or drinking chocolate will further irritate the bladder! it is best to limit chocolate as an occasional treat.

Take care

bad_mirror

March 14, 2011 - 9:58pm

Mindful,
Yes, an evaluation for fistula is wise. However, it is a myth that a woman is completely recovered from pregnancy and birth at 6 weeks post partum. (The vagina is nowhere near completion of it's process of involution). Or even at one year post partum, for that matter. It takes a good two years! Chinese medicine recognizes this, and it has certainly been true for myself. I was a million times better at one year post partum, and a billion times better at two years! You have a vast amount of natural healing in front of you, and whole woman will make it that much more effective. Take heart! Also, don't buy the myth of "too young for prolapse." A member here once said that the only woman who does not have prolapse post partum is the one who doesn't look. I think this is true. It is very, very common among our cohort, and I think it is overlooked simply because it does indeed get better. Best wishes!

ETA: I am now pregnant with my second and have not had one iota of return from my cystocele.

marigold2

March 15, 2011 - 4:46pm

Hi mindful
Just a small comment - you mention wearing jeans at some point. It is almost impossible to let the abdomen relax in jeans. I sometimes wear trousers with a (not tight) waistband for work, but even that creates difficulty for posture. I have just read on another forum that one member needs to walk 3 miles a day to help the prolapse, and in my experience improvement comes from the combination of good diet, exercise etc.

PS after my third pregnancy - a whopper at 10lb 15oz! I had various symptoms, some like yours. Was examined at a specialist fistula hospital, but all was well. - no fistula, just weak anal muscles I think. After that I just got on with life, had another babe 7 years later, and only now post menopause have I got a prolapse - rectocele, which seems to be controlled fine following advice from Christine and the girls on the forum.

When you are able, keep this site updated. And all the best.

mindful

March 15, 2011 - 9:49pm

Christine-
Thank you for the reference to the article. It saddened me reading it because I knew going into birth that episiotomies were no good. In some ways, I feel I should go back for a 'consult' with the standby OB regarding my current symptoms and see if he still thinks that "I would be better off" with an episiotomy.

Thank you all for your warm comments and support!

I know the body has as amazing capacity to heal. I have also learned through my job that most everyone has 'something' or 'some injury' that is their issue. An issue that may or may not be life-threatening, whether a sore shoulder, a nagging headache, the ache in their low back after a long day, or a cough that just doesn't go away.

It's good for the soul to keep POP in perspective, yes?

clavicula

March 16, 2011 - 1:19am

Hey, mindful, welcome here! Yeah, some perspective is very useful in our situation. I am older than you (30), but I was "only" 28 when my POP popped in. Well, what can one do?

Christine is always saying that being healthy is not some pain free, problem free heaven where women drinking champaigne and eating strawberries. Being healthy is being whole, feeling content and accepting with peace and strength what life brings us. That is what we try to do here.....with tremendous success I can say! :)

Great to have you here
Liv

fab

April 14, 2013 - 9:37pm

Maybe the administrator needs to remove your post?