Levator Ani Avulsion and pressure/pain

Submitted by momtofive on November 16, 2014 - 11:43am
Body: 

I have searched and searched for such a long time but have yet to find anyone who experiences the same issues I'm dealing with. My hope and prayer is that there is someone here who is (or has) experienced this and can share their experiences or provide me with some moral support.

My problems started during my 4th pregnancy. About 4 months into it I started feeling a great amount of vaginal and rectal pressure. It increased to the point where I could barely walk or stand. Thanks to a V2 supporter, I was able to manage through the rest of the pregnancy. After pregnancy, I was in a horrific amount of vaginal and rectal pain. I could not stand or sit for more than a few seconds without crying and having to lay down. Walking was intolerable. Eventually, things healed to the point where I could function "normally" yet I continued to have rectal pressure/soreness 24/7. It was constantly on my mind.

I saw a number of specialists thinking I had some sort of prolapse. No one was able to detect a prolapse... at least not anything major enough to warrant any sort of treatment... just what they said was "normal" for a woman who had 4 children. So I figured I'd just have to live with this. I think my problems may have actually started during the delivery of my 3rd child who was born just shy of 43 weeks gestation. I struggled to push him out, so the midwife (had a homebirth) had to assist me in helping to get him out while I was laying on my back. Perhaps this caused damage that was exacerbated during the 4th pregnancy when more weight was put onto my pelvic floor.

I am now 12 days postpartum after having my 5th child. During pregnancy, the increased vaginal/rectal pressure, etc., started much earlier... about 10 weeks into my pregnancy. I sought out physical therapy and also got the opinions of my midwife and a urogynecologist. They all separately gave the same opinion that I had a levator ani avulsion. The urogynecologist (who had seen me after my 4th child and did not diagnose a prolapse) also added that he thought I had a rectocele/enterocele and that I was so swollen he had a hard time finding my cervix. He recommended surgery, but only after I was dong having children. I have also been determined to have diastasis recti which I'm sure further complicates things.

I am now still struggling to stand and walk, even with the aid of either a V2 or the Bellefit postpartum girdle I wear 24/7. It hurts to sit, stand, or walk. Laying down I still feel pressure/soreness, but it's much better than when I'm standing. I have been doing Kegels during the pregnancy and continue to do them now, along with abdominal breathing to strengthen my abdominal muscles. I feel my pelvic floor muscles are actually pretty strong.

My question is, has anyone else ever dealt with levator ani avulsion? Or do you know anything about this? Can physical therapy help to heal muscles that are not even attached to my pubic bone anymore? Could this levator ani avulsion be the sole source of my pain/pressure/discomfort? Any thoughts/advice?

This is such a lonely and sad time. I feel my body is broken and it is hard to enjoy my new baby and care properly for my other 4 children. I had hoped to have another baby yet but can't imagine going through all this yet again and possibly making things worse.

I know this was long, so if anyone has even read the whole thing, I appreciate it. It is not something I feel I can talk with other women about. The few I have shared my physical issues with have never experienced anything like this, and as I wrote earlier, even after over 2 years of internet research, I have yet to find any help/advice online. It's a very lonely feeling.

Thanks,
Momtofive

Forum:

Surviving60

November 16, 2014 - 12:32pm

Hi momtofive. Just wanted to mention that I deleted your second posting. It doesn't serve any purpose and just complicates the responses. Your question won't get a wider audience by being posted in separate forums. We are just one group here. More later - Surviving

lifegoeson04

November 16, 2014 - 4:04pm

Just wanted to say sorry I don't have experience in your issue and I hope someone will come along and help you. I don't know your medical issues but all I would recommend is stop doing Kegals and if you research the whole woman way you see why. Made me so much worse. Please look at what Christine stands for and I hope someone will come with more info but wanted to just say hello and take care as much as you can

Aging gracefully

November 16, 2014 - 4:15pm

You may want to get a consult from Christine for this. I don't think anyone has even brought this up before on the forum, so I wouldn't know where to direct you. Has the doctor told you that it will heal over time?

Surviving60

November 16, 2014 - 5:04pm

Here are two articles by Christine which might be of interest. You can search the forum and blog yourself, both have search boxes.

https://wholewoman.com/forum/node/1242
https://wholewoman.com/blog/?p=385

momtofive

November 17, 2014 - 1:40am

Thanks, Surviving60, for those links. I would still love to find someone else who has this levator ani injury. From what I understand, it is irreversible. I'm just trying to figure out if it is the levator ani avulsion which is causing my 24/7 rectal pressure/pain or if it is some sort of prolapse causing this. Since my levator ani muscles are not attached to the pubic bone (except for the left side which, to my knowledge is still attached), it seems there is a lack of support for my body and my body needs to overcompensate in some way.

I have been trying to hold a better posture (think this is what the "Whole Woman" concept entails??) but it doesn't really alleviate this pressure for me. I am only 40 years old and cannot imagine living the rest of my life feeling like this. It is constantly on my mind because it never goes away. I have gone from being an active person, running around and playing with my children to not even being able to comfortably sit or stand, and even unable to carry my children. It saddens me that I cannot fully enjoy my children and that I am unable to carry my little ones.

Does anyone have any thoughts as to whether wearing my baby in a Moby wrap would make things worse? I used to carry my first 3 children all the time. But my 4th child I hardly carried at all due to this and the same is happening with my 5th child.

Surviving60

November 17, 2014 - 5:20am

First let me say that Christine has written extensively about avoiding Kegels; they don't help prolapse and they can aggravate it because they are pulling the organs into the vagina instead of away. I did Kegels for decades so I am certainly living proof. Go over to the blog tab and put Kegel into the search box, to find these articles.

I don't know about the girdle you are wearing 24/7 but if it is holding your belly in, then it too is aggravating the situation. Whole Woman posture has the belly relaxed and the chest pulled up to close everything down the front line like a pair of elevator doors. Abdominal "core" strength is an inappropriate and harmful goal for women because our core is lower, at the level of the sacrum.

I would recommend learning and practicing WW posture. In correct posture, the extra weight of carrying a baby close to your body can actually improve the dynamics of keeping the vagina a closed, airless space.

Does your discomfort go away when you are down on hands and knees? The goal of posture is to retain that basic pelvic orientation when standing and moving. A lifetime of chronically tightening and pulling in the belly makes this quite a monumental change for many of us to wrap our heads around.

I don't know anything about your injury except to say that moving the organs forward into their natural positions by cultivating WW posture, is your best bet.

And as suggested above, a consult with Christine might help you get some perspective on this, and she might have specific suggestions. You can search the forum for additional threads. Please ditch the kegels as well as anything that is compressing the belly. - Surviving

mysterymomof7

November 17, 2014 - 1:21pm

Hi there-I feel your pain literally, and suspect I have something similar happening but am sorry to say I haven't resolved these issues either. I did find the site "listen to your gut." She is also holistic and against surgery. If you find the symptoms list on the left side and scroll down to rectal spasm/levator ani syndrome. She details some ways which might bring some relief. I do think her "potty habits" as far as positioning on the toilet, would not conform to the whole woman posture, so keep that in mind, but otherwise it may be a help. She suggests using the "squatty potty" which I believe WW would disagree with. She has some ideas though on how to relax those muscles. I also have that right side pressure into my groin area, and rectal pressure which feels like coccyx pain, which led me to this site. Is it such a scary feeling.

Surviving60

November 17, 2014 - 2:32pm

Momtofive, did you get a chance to read Christine's article review (second link I posted above)? It's pretty technical but I think her views come through loud and clear by the end.

Learn Whole Woman posture, and please don't kegel. In natural posture, the rest of the pelvic diaphragm should take over the work of closing against intraabdominal pressure. You are only 2 weeks post partum, give it some time. Forget surgery of any kind. I wouldn't trust anyone who says that is the solution here. - Surviving

momtofive

November 17, 2014 - 3:58pm

Surviving60, I did read Christine's article review. However, I think my injuries are related to a levator ani avulsion and not to a prolapse as I had originally thought. I just had my 2 week checkup with my midwife and she could not find any evidence of prolapse. She feels (like my pelvic physical therapist) that my rectal and vaginal pressure and discomfort is related to the levator ani avulsion on my right side, where, by palpating, they are able to detect that my levator ani muscles are detached from the pubic bone.

I am not interested in surgery, because I know there are risks associated with surgery, and no guarantee of healing, especially with this type of injury. From what I understand, there is not really any way to rehab muscles that are detached from the bone. If there are not connected, the damage is irreversible. But how can I manage the constant pressure feelings and the discomfort of sitting. If I lean to my left side when sitting it alleviates the discomfort for me, but this is not good posture.

I don't know if the whole woman posture can help this, as it is apparently not a prolapse problem (although I did not have a rectal exam, so it's possible I could still have a rectocele or enterocele??). Will whole woman posture work to alleviate the pressure caused by lack of muscles to support my body? It seems all my other pelvic floor muscles are having to work overtime to compensate for the lack of levator ani support...

How would I arrange a consult with Christine to see if she has encountered anyone with this problem and/or if she has any advice as to how to alleviate my discomfort? Would there be a fee associated with this consult?

Surviving60

November 17, 2014 - 4:28pm

Since you have found your way to this site, you should probably do some more research. WW posture is not something Christine invented as a way of dealing with prolapse. It is the natural spinal shape that we all had before we were taught to suck in our bellies. It is the same posture children have, until their dance or gym teachers start to teach them otherwise. It is vital for the health of the spine, hips, and the entire body really. Whether it will help your condition is a moot point really, because you should be learning it, and then you will know. Post partum is a great time to start.

You can schedule a consult with Christine through the Store tab. There is a fee. - Surviving

momtofive

November 17, 2014 - 4:51pm

MysteryMomof7,

I'm so sorry to hear of your pain and struggles. Is is a very lonely and isolating feeling to not know others going through the same struggles and to have a "taboo" in our culture of talking about problems with this area of our bodies. If we were to have a broken bone, we would get easy support and concern. But it's so very hard and embarrassingly personal to talk about these issues with other people.

Thanks for the referral to the "listen to your gut" site. I may email them and see if they've encountered anyone struggling with pain/pressure from a levator ani avulsion. I can find virtually nothing about how to deal with this issue. My midwife has been attending births and homebirths for about 30 years and cannot recall anyone with issues such as mine.

I'd rather be struggling with hemorrhoids or something else that could potentially resolve itself over time... instead of this. From what I understand, prolapse doesn't necessary cause the level of pain/discomfort I'm feeling. Sitting makes things worse, but since I'm postpartum, I'm supposed to rest. And with 5 children sitting is about the only rest I can get...

momtofive

November 17, 2014 - 4:51pm

Surviving60,

Do you know what the consult fee is with Christine?

Thanks!

momtofive

November 17, 2014 - 4:53pm

sorry, surviving60... the consult fee is clearly marked on that tab. not sure i can afford that at this point in time, so i'll continue seeking info as much as i can online, etc. thanks, though!

mysterymomof7

November 18, 2014 - 10:36am

Momto5, I was just wondering how you were diagnosed with this? Was it only by palpitation or was an ultrasound done? Also does this translate along your spine at all? Do you have pain in other areas of your back or neck? I am having issues along the entire spine, so I was curious. I tried to sit with a small pillow kind of just under the left side of my bum, which seemed to alleviate some of the pressure on the right while still allowing me to keep posture. But then my neck symptoms started up. But if you're not having any neck issues, maybe that might help, worth a try:)

Feelingblue

May 8, 2015 - 4:50pm

Hi there - just wondering how you are going now that you are 6months down the track? I had the same injury (which would explain why I chose this user name a year ago). The pain lasted for about 4 months and was awful. However it did subside eventually... I ended up with prolapse symptoms which were very uncomfortable and seeing a good Physio who specialises in pelvic floors has helped me regain strength and encourage muscle repair where the muscle tore from the bone (and some muscle was damaged completely). It's more common than you think and from what I've read of late, it is the cause of a decent percentage of prolapses. You're not alone. Hope you got through those painful first few months... must have been very very hard with 5 kids.

Feelingblue

May 8, 2015 - 4:53pm

I absolutely could not carry my baby that way either, it was agony. It baffled me at the time, as I didn't know about the injury until I was 5 months post partum. I was so envious of all the other mothers zipping around wearing their babies.

Treens

April 2, 2017 - 2:28pm

I know this is an old post but I have been searching as well for someone who may have what I have. A trial of forceps delivery left me with a torn levator ani (complete tear) on the right side. I went for 2.5 years seeing many docs before getting a diagnosis.
My syptoms include:
-Pain on the right side (hip, lower back, pelvis, and internal pain)
-Very tight pelvic muscles from compensating, tight hamstrings, glutes
-Unable to stand, sit or walk for very long
-Pressure and pain on the right side with a BM or in general as gravity does it's work thoroughout the day

An internal exam by someone who was trained on this injury diagnosed the problem, and an MRI of the pelvic floor confirmed and showed the tear.

What I've tried...please comment if you have any other suggestions! I will be sure to read and follow the info that others have posted in this thread.
-I have had surgery to sew the muscle back to the midline to try and create support for my pelvis. It has helped a small amount.
-6 rounds of prolotherapy to stabilize the sacroiliac joint
-Regular IMS, Active Release Technique, and pelvic floor physio
-A seat cushion that I take with me
-Exercises (small ones to strengthen my legs and glutes) I also can do a small amount of swimming with a pull buoy which allows you to swim laps without kicking your legs
-Botox injections to the pelvic floor (helped a little for a short time, I worry about putting that stuff in my body a bit..)
-I do not take pain meds as I'd rather not and I find it masks the pain and I end up pushing myself too hard and it's a setback

Has anyone had any luck with something that helps with pain and symptoms of a levator ani tear? Also if you want a buddy if you are in the same boat I'm here for you.

Surviving60

April 3, 2017 - 4:46am

Hi Treens and welcome. This is complicated and I know you are still checking out the posts on this thread (I have two important links posted up there). Hope you can find some relief. The surgery and Botox in particular, have implications that we forum ladies can't really address, so I suggest hooking up with Christine on this. - Surviving

meandfluffy

May 13, 2017 - 12:21am

I have a partial avulsed levator muscle and have suffered many years with all the symptoms you've listed plus more. I've found sacro support belt helps some but nothing completely rids me of the pain. It was repaired many years ago and I led as normal a life as possible but then after 15 years it ripped out when I was doing heavy lifting. Oh how I've regretted that! The doctor who repaired it years ago has since retired and I can't find anyone who will repair it. Fecal incontinence is also becoming very bad now. I'm at the point of just ending it all.

Surviving60

May 13, 2017 - 3:08am

Hi meandfluffy. I'm so sorry about what you have been going through. I found your other post from 5 years ago and realized that you have had many, many repair surgeries of various types. It is not surprising that you can't find a doctor willing to venture into that territory again. Your story is an important one, so I hope you can find something positive in the experience of sharing it here for the benefit of others. There was nothing in the way of information or support available to you in those years. What is hardest for me to understand, is why so many women are still subjecting themselves to these procedures today. Thanks for sharing. - Surviving

meandfluffy

May 19, 2017 - 8:26am

It was repaired. After it broke down again, I can't find anyone to repair it. Physical therapy sessions have actually made it worse, bladder problems now along with other problems. Now have an enterocoele Such pulling, tightness because the other muscles are compensating. Eventually the entire pelvic floor will descend to where it was when the rectum fell so far down they had to pull it back up. Doc then said my rectum was moving up and down inside of me 5 inches. Still lost. Why can't some doctor just mend that one avulsed place with mesh I wonder? Need some innovation here.

meandfluffy

January 11, 2018 - 5:57pm

Anyone in the US who would attemp this repair. Desperate; my child just turned 60 years old in 2017 and it reminded me how many years and how many surgeries I’ve had this avulsion and the problem still exists 100 fold. After all the pelvic floor prolapses, now diagnosed with spondylolisthesis of L5-S1 whereby the disks have slipped forward and nerve damage, fecal & urinary incontinence. I begged and pleaded with the one person in Australia who could repair this to let me come there and be his patient. Denied! I’m doomed.