Wednesday, January 11, 2012

it's been awhile.

I did not reassess at the next 6 month mark, like I had promised to do in my last post because I was pregnant again. Kibuyu's 2nd birthday is coming up this weekend, so I am assessing my recovery now.

While pregnant, my symptoms worsened.

During the second trimester, my leaks had gotten so bad that a standard panty liner was no longer enough. I upgraded to Poise liners. If I needed to cough or sneeze, I could clench my muscles to keep from leaking, but the pressure of the baby on my bladder caused me to leak throughout the course of the day, and I wasn't always aware of it.

My scars were more painful, daily, as pregnancy went progressed, and I couldn't take ibuprofen. I just had to live with it. Staying off my feet and soaking in a hot bath tended to help. I don't remember the pain being bad enough that I resorted to using an ice pack.

BB (as I've nicknamed baby # 2) will be 4 months old this weekend. I keep thinking that at this point in Kibuyu's life, I was still in pain daily, sitting on ice packs, and taking ibuprofen all the time. My second experience with childbirth was much, much better.

BB was born via scheduled c-section. It was wonderful. They kept morphine in my IV for the first hours (maybe 12 hours?) afterwards, making the first hours of his life virtually painless. Once I was on oral pain meds, day 3 was bad, but the recovery was a breeze compared to my first.

As for my symptoms now, I think I am slightly better than I was when I wrote my previous post in Nov 2010. I have found that I can wear only one brand and style of thong, but no others as they hurt my scar. My scar also hurts the first day or two of my period. The first 6 weeks of BB's life, my c-section scar hurt more often and more intensely than my Nate scar, but it became the opposite around week 7, and that remains true. I only have leaks if a sneeze (or something else that causes me to tighten my tummy muscles) sneaks up on me, and I don't have time to intentionally tighten my pelvic floor muscles. I feel like I have a lot better control of those muscles now, but I still lack the reflexive tightening that should happen during a sneeze.

I "met" someone online recently who had possibly more extensive damage than I. (I say "possibly" because we didn't compare scars or anything. It's not a contest.) She had two surgeries to try to repair her damage. When I was referred to physical therapy, I was told that surgery would be my other option. Sometimes I wonder if my current symptoms would be "cured" through surgery. However, the symptoms I am left with aren't bad enough for me to pursue that course.

All in all, two years later, I am either getting close to "back to normal," or I am used to my new normal.

Saturday, November 13, 2010

So how am I doing now?

It's been about 6 months since the wonderful, amazing, first day without pain. At that point, I was feeling that my recovery would continue at a rapid pace, and I'd be back to normal in no time.

I'm still not back to normal. Before I go into all my complaints, I just want to mention this. I've talked with other women about their experiences, too. These aren't women who had 4th degree lacerations or women who have been to pelvic floor physical therapy. They are women who sustained more "average" damage during childbirth. Many of them share my complaints. Their babies are generally younger than mine, but not always. It definitely makes me feel better to know that this is kind of normal, especially the accidents part.

I have pain a few times each month, usually coinciding with my period, but other times it seems to be (this is still a TMI blog, right?) a result of sex without enough lube. When I was still having lots of pain, we were over-lubing, but not so much anymore. Sometimes we don't need it. Other times we think we don't but when I'm in pain the next day I realize we did need it. I also can't wear thongs two days in a row. A thong one day is ok, but the next day I need to wear some gentler undies or I will be sore. The pain is nothing a couple of ibuprofen can't take care of, but it is annoying and discouraging.

The other thing I'm still dealing with is more annoying. It doesn't happen every day or even every week, but occasionally I have little accidents. They are always caused by sneezing or a coughing fit. My physical therapist had warned me not to exercise and strengthen my tummy muscles before my pelvic floor muscles were strong again. I felt like my pelvic floor was pretty strong at 5.5 months postpartum when I started exercising. My pelvic floor muscles seem pretty strong still, and I feel that I can control them very well, but if I don't intentionally tighten them in anticipation of a sneeze or something, the slightest pressure can cause me to have a little leak. It's not complete loss of bladder control. I just wear panty liners to keep my clothes dry.

Being more active
I lost my job about 6 weeks ago. When I'm home, I'm on my feet more. I think this has caused my two chief complaints to appear to get worse. Even back when I was in pain every day, I was usually ok when I was sitting. And even when I had no bladder control at all, I didn't pee my pants when I was sitting. So I feel like the fact that my working lifestyle was to sit for 8+ hours a day made me appear to be more recovered than I actually was. And the appearance is that I've gotten worse these past 6 weeks, but actually, I believe it's just a result of me being more active.

At this point, I am kind of afraid that I may be dealing with this forever. It just seems to be a part of my life now.

I continue doing my Kegel exercises, though I must admit that I forget to do them sometimes. I weaned off my alignment exercises/stretches (for my crooked pelvis and tailbone, which were causing the majority of my pain, if you remember) long ago. I am interested to know if I'm still in alignment. But, the fact that crooked bones aren't pulling at my muscles and my scar and hurting makes me think my alignment must be pretty good still.

In the beginning, I felt that the physical therapy would get me back in good enough shape that if I, hypothetically, have another baby, I could give birth vaginally without causing myself so much damage. Now, I am certain that if I get pregnant again, I will insist on having a c-section. I absolutely, 100%, never, ever want to go through all this again. The doctor who referred me to physical therapy said that next time it is very likely that my damage will be even worse. No. Way. I'm not going to risk it.

I think I will reassess myself in another 6 months.

Friday, May 28, 2010

3rd PT

We didn't do everything we'd planned to do. We started by going over my pain and leaks from the past two weeks. I'd had no leakage, good for me! Probably eight or nine days of the past two weeks have been completely pain free. I mean, completely. When I'm getting ready for bed at night, I do a little assessment. Five or six days, I realized that I had a tiny bit of pain, which was significantly less than before my second therapy session. The rest of the time, I couldn't feel any pain. That was the most exciting part of my assessment this morning. She said that the days I'm having a bit of pain is probably from my bones slipping out of alignment, though I am still doing the exercise to line them back up. And that's why it's important to keep doing the exercise.

She checked my alignment next. I had gone down the stairs, up the stairs, and down again between doing my alignment exercise this morning and the appointment. However, my pelvis was correctly aligned! My tailbone, on the other hand, was twisted. She gave me a second exercise to do, which went like this: I laid on my left side, with my left leg straight, right leg bent, and right shoulder back. It is a twisted position. Then, she put her right hand on my right shoulder, and her left arm sort of over/around my right hip. I pushed my right shoulder forward and my right hip back, held for six seconds, then repeated. At the end of that, my tailbone was straight. To do this on my own, I sit with my knees together, feet apart, and put a belt around my legs, right above my knees. Then I push my legs apart, against the restraint of the belt. This is being added to my pelvic alignment exercise.

Next, she wanted to check my muscles. Since I've had no problems with leakage and no trouble doing my kegels twice a day, she didn't think it was necessary to hook me up to the computer again. But she wanted to check the nerve endings that she checked at the first appointment to see if they are still sensitive. Remember, I had pain at six, seven, and eight o'clock (positions on my pelvic floor), and the number four nerve on the inside. She checked all of those. They are still a little tight, but she said I'm "almost normal." The number four nerve was uncomfortable when she tugged it, but not even close to painful. At the first appointment, it was the most painful.

And that was it. She said that I am well on my way to complete recovery. It's unusal for the majority of pain to be caused by the pelvic bones being misaligned, but it appears that mine definitely was. I have assignments to do my pelvic bone alignment and tailbone untwisting exercises twice a day for a while (at my discretion). I can drop the tailbone exercise when I feel like my pain is completely gone. Then, I can wean myself from the pelvic bone alignment. I should keep doing kegels twice a day, but can eventually drop to just before bed. And really, all women should do kegels once a day.

Then, she canceled my remaining appointment with her and asked if I wanted to cancel my appointment with the doctor. He wanted to see me again to make sure my muscle tone is good enough to be safe for a future vaginal delivery. But, I don't feel the need to see him again. If I happen to get pregnant again, we can assess my muscles at that time. Also, if my pain comes back or I have further concerns, I can do more therapy.

In conclusion, if you are experiencing pelvic floor pain or urine leakage many weeks after delivery, pelvic floor physical therapy can work wonders. I was skeptical that it could do much for me. I had 120 days of pain before my second therapy session. The 121st day was pain free. It was definitely worth it.

Sunday, May 16, 2010

2nd PT

We started by going over my homework (the log of my drinks and restroom trips). She had no problems with it. She was curious as to why I was drinking so much, but when I explained that I was pumping milk for Kibuyu, she understood. I estimated how much I drink and go to the restroom now that he's all on formula, and she said it was very normal.

Then, she checked to see if my pelvis is misaligned. It commonly happens when a woman gives birth, since the bones have to separate to make way for the baby. They don't always return to the correct place. She first made sure that my legs line up straight, which they do. Then, she compared 3 points on the front by putting her thumbs on matching bones on each side and checking to see that they're even. I rolled over and she checked a few points on the back, too. She said that, compared with the right side, the left side is rotated towards the back. But, she couldn't tell by looking which one was right. So I stood up, she found a bone in my hip, and I raised my leg. We did that on each side so she could feel my pelvis while I raised my leg. She then concluded that the right side was good, but the left side was messed up.

To correct it, I laid down on the table again. She had me hold my right knee and hang my left leg off the table. I was to push my right knee into my hands, towards the wall at the foot of the table, while pushing my left knee straight up, into the therapist's hand. I held for six seconds, then rested. We did that three times, and she checked my bones again. I was straight then.

There are many things throughout the day (especially including walking up and down stairs) which can throw the alignment off again. For the next two weeks, I will do this exercise twice a day. Since I go down the stairs of our apartment and up the stairs at work every morning, and return every evening, I'll be doing the exercise when I arrive at work (on a table) and when I return home (on the bed). Since the therapist isn't here to hold my left knee, I hook my heel around the edge of the table or bed and push to the right, rather than up.

After realigning my pelvis, she stuck some sensors to my pelvic floor muscles, and plugged them in to her computer. They measure how tense the muscle is. Zero is completely relaxed, five and over is flexed. (I don't know what the units are...) When resting, the muscle should be under two.

When she turned on the program, my relaxed muscles were between three and five. While laying on my side, I flexed and held for as long as I could. It wasn't very long, but the bigger problem was that my "relaxed" muscles were not relaxed. We went through ten cycles of me flexing for ten seconds and relaxing for ten seconds. By the end, I was able to relax completely. Then, we went through ten cycles of me flexing for one second and relaxing for two seconds. In the beginning, two seconds wasn't long enough for me to relax. But by the end, again, I was able to relax my muscles. I will also do those two exercises twice a day for the next two weeks.

We did a test run of me doing the Kegels while sitting. It was worse than my first attempt. I was so tense. We were running out of time, though, so that will be what we work on at the next appointment. Sitting, then standing. Maybe after two weeks of doing them lying down, I'll have enough control to do it better sitting.

I don't know that it's been long enough for this to have any effect. Possibly if my pain was coming from my misaligned pelvis pulling on my muscles, aligning it would eliminate that pain. I don't remember if I had pain on Friday. But I do remember that when I went to bed last night, I had not experienced any pain all day. That was my first day with no pelvic floor pain since Kibuyu was born! He was four months old yesterday. I hope that eventually my pelvis will stay in place so that I don't have to keep realigning it every day. When next I see the therapist, I will go down the stairs at home but not have a chance to realign my pelvis before my appointment. We will see how crooked I am then.

The other thing on the schedule for my next appointment is working on the scar tissue. She hasn't told me yet what all that entails.

Friday, April 30, 2010

i haven't forgotten about you

My second appointment is in 2 weeks. I felt awkward and nervous about my first appointment, but I'm actually kind of looking forward to this one.

Nate is 15 weeks old today. That's 105 days (!), which means I've been in pain for over 100 days. Now that's just ridiculous. I am so ready to get this all taken care of and over with. I'm so ready to be pain-free.

The PT gave me some homework to do before my next appointment. She put me on a waiting list for an earlier appointment, so I did the homework the next week. I had to keep track of everything I drank and every time I emptied my bladder for two days. She had asked me how many times I went to the bathroom in a day. I estimated seven. Normal is six to eight times. The two days of the homework, I went eight and nine times. I also drank over 130 ounces of fluids. That surprised me. I knew I drink a lot, but I didn't realize it was that much. (I'm not drinking quite as much now that I'm not pumping anymore.) I was also to keep track of leaks, but I didn't have any.

But back to the pain. I can tell that it is much better lately. Previously, I was soaking in a hot bath every other day and sitting on an ice pack about twice a week - both to soothe the pain. I realized two weeks after we returned from our Easter weekend trip that I had not needed to soak in the tub since March! I also haven't needed to use an ice pack since March. I still have pain every day, and I don't notice it feeling less, but it must, since I haven't been driven to soothe myself (or maybe I've gotten used to it, but I'd rather think it's decreased). The pain is usually in the evenings after dinner and more intense if I'm on my feet. I had not done the dishes after dinner in months. I definitely didn't do them when I was 9 months pregnant, and I never did them after Nate was born because I hurt too much to stand in the kitchen that long. I've done the dishes after dinner a few times in the past couple of weeks. Mbuyu (that is, my husband) usually beats me to them, though.

I'm encouraged that, in letting nature take its course, as I wait for my second physical therapy appointment, my pain has improved. But, seriously, 105 days is a long time to be in pain. Come on, therapy. Let's do this.

Friday, March 26, 2010

first appointment

I met the physical therapist today. She actually has a practice in a nearby town, but sees patients at my women's clinic a couple of days a week. She is friendly enough to make an otherwise awkward thing very comfortable. (While examining me, she noticed I tightened up and told me, "If you have gas, just let it out. I don't mind.")

The appt started out with going over the basic anatomy and answering all the personal questions. Then, the exam: undressed from the waist down.

She first checked where my pain is. She pressed on 12 places in a circle around the pelvic floor, like a clock. The major scar on my perineum is at 6, and that is the only place that I had pain. Next, she did the same thing inside the vagina, in addition to "plucking" 4 nerve endings on each side. I had pain at 6, 7, and 8 - the right side. I only had pain for 1 of the nerve endings, again on the right side.

She had me do a few Kegels for her to check my strength. My muscles are very weak, so I wasn't able to tighten very much. Also, when she had me hold it, my muscles had a very hard time relaxing. She also had me bear down (as if having a bowel movement) and said that I did that part perfectly normally.

After hearing my answers to the questions, she said that it sounds like I have a nerve ending that got trapped in the opening of the tear when they stitched me up, and it is now stuck in the scar. After the exam, she is sure that's what's going on. That is irritating my muscles, which is what makes it hard for them to relax when they have been tightened. This is the first thing we'll address.

Since the pain is only on one side (it's usually the left, but I'm special), it possibly indicates that my pelvis shifted during delivery. She will check that the next time she sees me.

Also at my next appt, she'll hook me up to sensors that are connected to the computer, and I'll do Kegels. We'll see how strong my muscles really are. And I'll be able to learn to do Kegels correctly. Before then, I am not supposed to do any.

Since she only has a couple days a week at my clinic, her schedule is super busy and backed up. The first opening for my next appt is in May!

a little more background

There are 3 concerns with the pelvic floor: urinary incontinence, fecal incontinence, and pain.

The closest to fecal incontinence that I've had is that I couldn't control my gas. I have regained some control in this area just in the last week.

When I first got home from the hospital, I couldn't hold my pee at all. I wore thick overnight pads, not for lots of bleeding (that was very light after the 3rd day postpartum), but so that when I would get up to go to the bathroom I wouldn't pee all over my clothes. The nurse told me I'd have problems if I waited too long to go to the bathroom because I'd had the catheter so long, and now I no longer have a nine and a half pound baby laying on my bladder. But that was not my problem. I couldn't "find" my pelvic floor muscles to stop peeing. This gradually got better. After about a month I could start wearing panty liners because I only leaked when sneezing or laughing hard. Then a week or so later, that even got better.

I have pain every day, mostly on the right side of my vaginal muscles, but also in my perineal muscles. I have more pain if I'm on my feet a lot. Usually it starts around dinner time. I was sitting on ice packs during all my waking hours at first. Gradually I used the ice less and less. Up until a couple of weeks ago, I was still sitting on an ice pack every evening. Now, I only need to if I've had a particularly active day.

So I appear to be getting better on all sides.