[chester]

I'm wondering if anyone had pelvic floor damage with the birth of their first child and can tell me how the pregnancy and birth was with the second?

I am incontinent now due to my son's birth (10/02). I really would like to have another one (soon!) but am very scared of being in much worse shape after the birth. (also afraid of the support -or lack thereof- during the pregnancy in my pelvic floor).

ok
Thanks,
Chester

 

[Erin Pavlina]

I became incontinent with the birth of my first child, as well. But with Kegels I was able to get to the point where only sneezing or coughing triggered it.

Had my second child and now it's MUCH worse. My second child is nearly 11 months old and I still need to wear a poise pad EVERY day. Consulted with a urologist who told me he could fix it with drugs and surgery but I need to be done breastfeeding first, which I'm not. My health insurance has also excluded me from receiving treatment for it for a year. So, until I stop bf'ing and until that year is up, it's Poise pads daily for me.

Although this sounds like a horrible problem, I try to remind myself that if the cost of having two beautiful kids is a little incontinence, I can live with it if I have to. I am hoping the surgery will fix a lot of it.

Anyone out there have experience with the surgery? Does it work?

 

[pilesoflaundry]

s I've never experienced your problem, but my dad's girlfriend had the surgery and it helped her a lot

.

 

[stafl]

Are you doing squats every day? Sitting on my birth ball every day during my second pregnancy really helped prevent incontinence issues I had with my first pregnancy. Instead of sitting on the floor when I played with my toddler, or when I was picking toys up, I would squat. Worked much better for me than kegels.

moving this to birth and beyond, where hopefully you will get more replies

 

[Evergreen]

s

 

[chester]

Thanks for the replies.
I too have to wear a poise pad everyday. I have had a lot of physical therapy too and practice at home daily (including various types of kegels, stuff on the birth ball, bio-feedback, and ...using a weight(!).) I see a tiny bit of improvement but I have permanent damage so there is only so much I can do. This is why I worry about how much worse it can get after baby number two.

I too feel very lucky to have a wonderful son and have felt like- " oh well,this happened, I can deal" I can't really complain, I'm not in pain etc. but lately I have been getting really bummed about it. More as my son (now 21 months) gets even more active and I feel restricted in playing with him. Also professionally as I am a dance teacher and dancer and although I am not teaching that much right now, I wonder about the future.

Pilesoflaundry-- do you know any more about your dad's girlfiriends surgery?
That has been suggested to me but not until I am a. older and b. done having children. They said older because they don't know how long the synthetic materials used to sling up the urethra will last inside the body and they wouldn't want to do it more than once. I wonder if there are more than one type of surgery.

oh, while I am telling all - I also tried a pessary ( a ring that fits inside the vagina and pushed the urethra back up) but, it... fell out! I was carrying my big son around alot that day so I think that had alot to do with it.

I am going to try it again, it was hell to get in but once in it did help. (but like I said, it was only temporary.) phew that was loooong.
Chester

 

[chester]

I have also had a two people ( a doctor and a physical therepist) suggest a c-section if I have another baby, to prevent further, permanent damage.

(the doctor who recommened - (an ob/ gyn - she does not work with pregnant women, but was giving me an evaluation after my son was born) also suggested this as my tear was bad (3rd degree) and she feared I could tear worse and with my already weak pelvic floor, have fecal incontinence.

 

[party_of_seven]

I'm so sorry you are having so much trouble.

FWIW, I had a forceps delivery with my first and ended up with a 4th degree tear. It was a bugger to recover from. After many many kegels, I went on to have 3 other children. (all homebirths) All of those babies but 1 were bigger than the first. I have never had to have stitches with any of my homebirths. I haven't had any problems with incontinence either. So even though my first birth was so damaging, none of my other pregnancies/births ever made it any worse.

I sure hope that you find something that helps you!

Good Luck!

 

[MinnieMouse]

I have pelvic floor damage due to the birth of my first child. But I haven't had a second yet (not preggo either) so I can't help you there.

What I can share is this...

I have had bowel movement issues ever since Beth's birth close to 3yrs ago. I had a 4hr labor, and Bethany was in distress (cord wrapped tight on her neck and short) which necessitated emergency transport in an ambulance from the freestanding birth center across the street to an ambulance. My midwife was able to avert the automatic csection (found out the ER was ready and waiting for me) and Bethany was born VERY QUICKLY with forceps assistance (complete with episiotomy).

I tore ALOT. Nothing over a 3rd degree, but it was up, down and up both sides. They took over 45min to stitch me up. To be honest I would go through labor and delivery w/o drugs over and over again before I got stitched up again like that.

I saw my midwives at 6wks post-partum but it was still really too early to tell. At about 5mo post-partum I went to my PCP (a DO) and she told me that my bowel movement issues were due to the "pregnancy hormones still in my system since I was still nursing." I KNEW that was wrong!

I just bit the bullet and lived with it. It's not a HUGE issue....just that it's not right...if that makes sense. I need to use a lot of support to my perineum for bowel movements and some bleeding due to the stress of them. (Sorry if that is TMI). I also have almost NO internal cues any longer to indicate to me that I need to have a bowel movement....I either don't have to go or I have to go RIGHT NOW. Interestingly, I didn't have any incontinence issues until recently and they are quite minor...but increasing. Not sure why that would have changed??

When I went back for my 1yr appt I had a long talk w/ the midwife. She said there was definitely a problem and referred me to a few different places (all different paths for treatment). One was biofeedback which I didn't pursue and another was a dr. I did some more research and found this...

http://www.pelvicfloorinstitute.com/pelvic.nsf

Who would of thunk that they would have an entire INSTITUTE?? It's in a local hospital here in Philadelphia. I called and made an appt for an evaluation.

It seems that the back portion of my pelvic floor was torn during Beth's delivery and although externally it was stitched and healed, internally the muscles never healed back together. This is what is making it difficult to "push" during bowel movements. I saw a great dr ( I think she was a resident or something similar) at the PFI and she explained it all to me...very clearly too I might add.

She said that seeing as I was going to the birth center for my gyn care as well as the birth of Bethany, she could tell what my answer would probably be regarding my options .

They could do surgery to fix it. She was VERY clear that it wasn't very invasive and would be A TON less recovery (and pain) than when I had Bethany. However, having another child (or children) vaginally would probably re-injure the pelvic floor and the surgery would have to be repeated.

She suggested that since I seemed to be doing okay, despite the damage to my pelvic floor, that I wait until after I am done having children and then return for the surgery. She didn't share any other options other than surgery at that time....not sure if it is because there aren't any or that they just don't consider it...but based on the info I have about them...it doesn't seem to be that way.

I did specifically ask her about carrying and delivering more children and she said that (at least in my case) it shouldn't be a problem. She said if there was even any minor problems carrying later in pregnancy that they could "easily" place a device under my pelvic floor for support. I can't remember the name she used for it..but it seemed like it was something easily done in office...not surgically inserted at all. The dr specifically told me that she had seen women with significantly worse damage to their pelvic floor successfully carry and deliver (vaginally).

In subsequent discussions w/ my midwive(s) they all seem to indicate that it shouldn't be an issue for a subsequent pregnancy.

My annual is due this summer and I will discuss it w/ the midwife again. I hope this helps in some way???

Christine

 

[cottonwood]

One other thing, in addition to the good info and advice everyone else has given, is that you might want to think about how your next birth is managed. As others have mentioned, pelvic floor damage is often caused by the use of forceps, so to avoid that you should insist on having care which facilitates physiologically normal labor, i.e., privacy, affection/sexual attention (to increase flow of oxytocin), no mental pressure from being "on the clock", no unnecessary interventions (AROM, EFM, cervical checks, etc.,) being allowed to move around and make sounds as you wish, and not being told when and how to push. That last one is important: pelvic floor damage can also be caused by pushing too hard and too long. So it makes sense to throw out the idea that you must start pushing as hard as you can when you hit "10 cm" or have a little urge. Your body's tissues probably aren't going to be ready yet, so to avoid damage you let your body do the bearing down (which may not happen for some time after you are "fully dilated". Contractions may actually slow down at that point, and you may get a rest period -- this is normal.) Also consider birthing in an upright position so that less stress is needed to be applied on your tissues from the inside.

 

[Greaseball]

I don't have incontinence issues, but I had a forceps delivery with my first and, uh, it still hurts! I had 2 internal tears (somehow managed to keep the perineum intact) and they were only a 1st and 2nd degree, but they still hurt. Usually it's during sex or bike riding, but sometimes it's during other physical activity too. I mentioned this during a gyn exam and was told "It's healed nicely; there is no reason it should hurt."

: Like I was making it up.

Currently I'm having a few "almost didn't make it to the bathroom" issues but at only 4 weeks pp it doesn't really count.

 

[Erin Pavlina]

I was told the same thing, to wait until I'm done having kids.

I would love it if surgery was the answer. I'd like to believe I won't have this problem my entire life. I don't even remember what it's like to just wear underwear... I constantly have a giant pad up against me. I can't laugh, cough, or sneeze without my entire bladder emptying itself. It really sucks.

 

[chester]

I am so glad to hear from others with this problem - ok that didn't sound right because I REALLY hate to hear that others have it but I haven't met anyone who has had this. To be able to talk about it WITH others and not just talk TO people about it is VERY helpful to me.

I want to comment more to the others' responses but don't have time right now- I did want to ask:

Those of you with incontinence - how much weight did you gain during your pregnancy? I am sure my damage happened during the birth but I wonder about starting to strain the muscles in the months prior. I am 4"11" and was 95 pounds when I got pregnant and I gained 60 lbs. I am small framed, boned so it was a considerable weight. Son was 8lbs. 11.6 ounces.

I know about the poise pad every day, I know! ugh.
Chester

 

[Erin Pavlina]

I will say this for Poise pads... they work! I should buy stock in their company. I swear, my health insurance should pay for it as a medical expense.

I gained 20 pounds with first preg and 25 with second. But I am tall and a little overweight, sort of the opposite of your situation there so that probably isn't much help.

And I agree... talking about it with people is nice. It's not the sort of thing most people want to hear about.

 

[stafl]

Quote:

Originally Posted by chester Those of you with incontinence - how much weight did you gain during your pregnancy? I am sure my damage happened during the birth but I wonder about starting to strain the muscles in the months prior.

I gained, I dunno, 70 or 80 pounds during my first pregnancy, the one that gave me incontinence. And, I never did go into labor, much less deliver vaginally, so the damage had to have been prior to DD's birth.

disclaimer, the incontinence went away on its own (well, with exercises and stuff on my part, but not surgery) about a year after baby was born, so I don't have the same sort of serious pelvic floor damage some women do.

I gained I think it was 30-40 lbs with my second pregnancy, delivered vaginally, and thankfully didn't have those same problems again.

 

[lunchbox]

I feel your pain. I had a 4th degree tear and an episiotomy and a 10 lb baby. The short story is that I had a bad birth experience and pushed too hard and too quickly and was augmented with pit for no good reason.

I have fecal incontinence. It sucks. It also interfers with my sex life because it makes me paranoid and I can't really be spontaneous - I have to make sure I am clean first.

The urinary incont is only really bad with coughing and sneezing and laughing. If I have bronchitis, a hard cough can cause me to lose my entire bladder, not just a trickle.

Since I won't be having any more kids, I can't speak for that part of your question. I am hoping that one day, I can have surgery for both.

That being said, I would do it all over again if I could.

 

[Tanibani]

Quote:

Originally Posted by blueviolet That last one is important: pelvic floor damage can also be caused by pushing too hard and too long. So it makes sense to throw out the idea that you must start pushing as hard as you can when you hit "10 cm" or have a little urge. Your body's tissues probably aren't going to be ready yet, so to avoid damage you let your body do the bearing down (which may not happen for some time after you are "fully dilated".

I agree with that.

After an 18 hour hospital labor, I was too tired and never felt the urge to push once I got to 10cm. I opted for PITOCIN (rather than end up with a Csection) to get contractions going again. My homebirth midwife said I probably could have used a nap

(rest) or food and then they might have come naturally.

Anyway, I had a 2nd degree tear (vagina) 3rd degree tear to my anus. No forceps or episiotomy - I just blame my forced pushing on Pit. I was so furious

with my OB and DH for almost 3 yrs. I have stitches on my anus... which caused horrible CONSTIPATION for the first 3 years after DS's birth. I literally couldn't go because of the knot!!! There was a blockage.

Two things cured me: Accupunture (needles and drinking Chinese herbal tea)

I also noticed that anytime I was angry

the constipation was worse. If I let go of any anger or resentment, no problem. Today I have perfectly normal, daily poops. My chiropractic adjustments help as well.

I've had lifelong incontinence issues. Eversince I was a young girl. I've never had to wear POISE pads

though. Again, Accupuncture and the herbs helped 100%. I couldn't believe it!!!!

So I highly recommend you look into it.

Anyway, I just had my 2nd baby, 4 years later (I too was worried that I couldn't carry another baby - also had some uterine prolapse issues early on - that seems to have disappeared.)

My experience with Maori Healers

I had a homebirth and this time I reached 10 cm and the urge to push was incredibly strong. Three strong pushes and my baby was born.

I did tear at the original 2nd degree site (a first degree tear there). I was very bummed about that, but my midwives reassured me that old scar tissue is the weakest (Oh.... OK....) and at least I didn't tear at my anus again.

I feel OK down there. I am going to do KEGELs, and I may even see someone to help strengthen my PF again.

Another thing that may help is TAKING IT REAL EASY during the postpartum period (6 weeks) after you give birth. No physical exertion. Hard to do now that my help is gone and I am alone with a newborn AND a 4 yr old. Anyway, I blame being on my feet too much the first time, when I got home from the hospital. This time I stayed off my feet (served meals in bed) for the first 2 weeks at home.

 

[chester]

I agree that I would like to manage my birth differently than the last time but I do fear anything coming through - even in an upright position with no counted pushing.
I planned for a intervention free hospital birth but when I went two weeks over I got various interventions - cervadil, pit, epidural. I did push in various positions and birthed semi sitting up but with knees to my chin and counting to ten. The doctor missed it and although she thinks she could have prevented me from tearing as badly I don't think she could have prevented the incontinence from happening.

I wanted to add that I learned that a surgery that I had as a young child may have contributed to this. I had a urethra stretching to somehow help with my then, constant uti's. I learned that women who have had this surgery are more prone to incontinence. They don't do the surgery anymore - and this is one of the reasons.

Erin Pavlina - How were your two births different from each other? Also, I always say that - I should have stock in Poise!! I tried the other brand (what is it.. the blue package) and ended up wet to my knees ( no good!). I am no longer embarrased to by them though.

Christine - thank you for all the information, that was helpful. I wonder if what she was suggesting for pelvic support is a pessary (I tried this). I only tried one type but will try another when I can.

Lunchbox- So sorry to hear about this- is there a surgery for this? I know some of my exercises are for the rectum- has anyone suggested that that might help?

Greaseball- sorry to hear you still have pain.

I got accupuncture for prolapses of the bladder and uterus - and it fixed it!

 

[Electra375]

Read Pelvic health and Childbirth: what every woman needs to know by Magnus Murphy and Carol L Wasson.

It is a pro-c/s book in my opinion but one page stands out to support vaginal birth p. 233 last 2 paragraphs. I borrowed this book from the library.

Only you can make that decision, but I will tell you from past experience BF is hard with a c/s, something doesn't go right hormonally whether its scheduled or after labor has already started (did it both ways).

I have been doing Kegals since the day my DD was born at home. My midwife explained a few deep kegal techniques. I haven't had an incont problem that I know of. I might have had a problem when I was **** wearing pads from pp bleeding. I do feel like I might leak if I don't get to a bathroom soon enough, so I gues I'm pretty lucky. I have a friend who also wets herself when she coughs or sneezes.

I know a woman who had a c/s for her 3rd after she had had the first 2 she had surgery to repair 4th degree tears. I have to support that decision for a c/s.