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!
Friday, March 26, 2010
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.
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.
Wednesday, March 24, 2010
why?
"They" say that after having a baby, everything "down there" just goes back to normal after a few weeks. Not for me. Not yet anyway. Kibuyu was born in a hurry, with forceps, because his heartrate was too low to endure any more labor. That didn't allow my body to stretch. Plus, he was 9 lbs 7 oz, with a 15 in head circumference. He essentially destroyed my crotch. I had 2 long tears down (or up?) the birth canal, which took a long time to stitch up, but are the least of my worries. I also tore through my perineal muscles, anal sphincters, and partially through my rectum. Not quite a textbook 4th degree, but much more extensive than a 3rd degree tear, so we're calling it 4th degree. The doctor put me back together again (it took an hour and a half), but I'm nowhere near back to normal yet.
She checked on me at 5 weeks postpartum, said it looked like I was healing well, and had me see another doctor at 8 weeks postpartum.
That doctor surprised me with a rectal ultrasound. He said that my muscles are back together but very, very weak. If I attempt another vaginal delivery (hypothetically, if I have another kid), I will probably tear worse and most likely have a lifetime of fecal incontinence, unless I go to physical therapy and work on strengthening these muscles.
I don't know anyone who's had pelvic floor physical therapy. I looked online and found very little information, and only a couple of brief personal experience stories.
My PT starts on Friday, and if it's interesting, I'll chronicle my journey here: my journey of getting "back to normal down there."
She checked on me at 5 weeks postpartum, said it looked like I was healing well, and had me see another doctor at 8 weeks postpartum.
That doctor surprised me with a rectal ultrasound. He said that my muscles are back together but very, very weak. If I attempt another vaginal delivery (hypothetically, if I have another kid), I will probably tear worse and most likely have a lifetime of fecal incontinence, unless I go to physical therapy and work on strengthening these muscles.
I don't know anyone who's had pelvic floor physical therapy. I looked online and found very little information, and only a couple of brief personal experience stories.
My PT starts on Friday, and if it's interesting, I'll chronicle my journey here: my journey of getting "back to normal down there."
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