Why hasn't my pelvic floor recovered?

[BruinBear96]

Wasn't too sure where was best to post this.

I gave birth 13 months ago. Horrendous, long drawn out labour ending in forceps/episiotomy, 3rd degree tear, post partum haemorrhage, urinary retention...if there was a complication to be had, I had it. Needless to say my pelvic floor strenth was absolutely shot. I've seen pelvic physios, done endless pelvic floor exercises and whilst definitely improved, my pelvic floor strength is still not what it was. I can't control wind if coughing, still struggle with little dribbles of urine, still occasionally feel a bulging sensation in my vagina. Is it just endless pelvic floor exercises that will fix this? I desperately want another baby, but I don't want to get pregnant until all these issues are resolved as I'm scared enough as it is about another pregnancy and birth without exacerbating problems I already have. Also still find sex a bit painful despite loads of perineal massage.

Is it unrealistic to expect to ever recover to the extent that I was pre birth? I'm starting more pelvic physio next week so obviously I'll ask all these questions but I just feel so upset I'm still not "back to normal" over a year later, just hoping to hear something off people who may have been through similar. Thanks.

Are you breastfeeding? Are you exercising? Do you do any manual labour? Do you lift your child a lot?

Do you find that your pelvic floor issues are exacerbated by any of the above - eg after a long walk, or carrying your child around a lot?

Where is the pain during sex?

Your body is still healing after 13 months x

I'm not breastfeeding. No proper exercise at the moment apart from walking because I don't have any childcare to go to the gym the days I'm not at work. I did used to go to the gym a lot and I do miss it.

No manual labour but yes, I probably lift my child a hundred times a day. I do sometimes notice the bulging sensation is worse for a long walk but I don't notice anything worse for lifting my child.

The pain is in the scar where I tore. I really thought 13 months down the line everything would be better.

the bulge sounds like a prolapse. Have you been referred to urogynae?

@Mummyme87 no, I haven't. I presumed it is a prolapse too but it isn't a sensation that is there all the time and I've never had it the same time I've been examined so no one has been able to tell.

Could you be hypertonic and actually not relaxing properly? Your delivery sounded similar to mine and for the first year and a half after baby I did kegel after kegel with quite limited improvements.

When researching online I realised I likely have a lot of scar tissue and tension around where my episiotomy was. I eased off the kegels, learned to do manual release with a pelvic wand and to actually relax my pelvic floor.

I'm now (4.5 years after DS) 35 weeks pregnant with my second and despite a huge heavy pump still can sneeze/cough leakage free. I'm doing a normal amount of kegels now. Now I just hope delivery goes ok.

My first delivery & chronic constipation did leave some permanent damage - a mild recotocele which I manage with daily laxido and am symptom free with that also. Just have to avoid constipation at all costs.

@apples24 I have thought this as the first physio I saw kept emphasising how important it was for me to make sure I was relaxing completely in between pelvic floor exercises but I don't know if I was/am, or how to make sure I am? The second physio I saw did some breathing exercises with me and some general, overall strengthening exercises for my core, etc, and she never mentioned anything about it so I don't know. Is a pelvic wand one of the pelvic floor exersier probe things? I did buy one but I haven't been brave enough to try it out, suddenly panicked in case I made anything worse so it is still in it's box.

Does sound like a prolapse.

I had a similar first birth to you, and I wish more than anything that I had insisted on a CS for my second. Kids are now teens, and I’m waiting for surgery to get things back to where they should be.

@BruinBear96 the wand is a massage tool, it's helped me stretch the scar tissue. For relaxing, I've found the "happy baby" yoga pose good.

When I was overdoing the kegels I also used one of those electric PF exercisers and it 100% made mine worse, bacause of the hypertonia I think.

@NancyJoan I was told in a follow up appointment at the perineal clinic if/when I have baby number 2, I can have a c-section if I want. I definitely will, but I'm still worried about a pregnancy potentially making a prolapse or something worse even if I don't give birth vaginally again. Sorry to hear you've been through similar. I hope your surgery is successful.

@apples24 I definitely won't bother with the electric pelvic floor thing then in case my lack of improvement is do with not relaxing too. Ah ok, I understand what you mean about the wand now. I have one, on recommendation from my last physio for perineal massage to help with the scar tissue. It did, but I feel like even that's reached a point where it isn't improving anymore. Granted I haven't actually done it for a few months now.

I had the bulging feeling after a third degree tear, I had it checked and it wasn't a prolapse, so not a given.

Mine was very much a hypertonic pelvic floor.

I found it so, so difficult to know if I was relaxing my PF when doing breathing exercises so I started doing these exercises https://www.intimaterose.com/blogs/kegel-exercise/pelvic-floor-stretches

Made a big difference and they can't do you any harm to try x

I gave birth 4 nearly 5 years ago, and I still have this problem. But saying that I don't stick to regular pelvic floor exercises either. I suspect prolapse also.. never had it checked. But I too am worried to get pregnant again (i want to) in fears of it making this worse ! It is really annoying. I hope you manage to get it sorted OP

@lavenderdilly thank you so much for that link, I'll definitely try those exercises. I'm going to mention the possibility of a hypertonic pelvic floor when I see the physio next week as I just don't understand why given the amount of pelvic floor exercises I've done in the last 13 months I'm still having this amount of issues.

@AutumnalPumpkin it's so hard to stay motived to do the pelvic floors over such a long time with such limited results, isn't it? I know I haven't done them constantly, it's so easy to get disheartened after so long. I really want another baby though, so I'm determined to get this sorted

I had a similar first birth as what you experienced. I did have leakage but that cleared after 6ms. Felt like my pelvic floor was shot. I wasn't offered physio for it. Although, was recommended to have during my last pregnancy this year. It helped massively and only ended up with a second degree tear this time around and walked myself into the recovery ward after having a precipitous labour.

It took nearly a year for the episiotomy to fully repair itself and I was left with pain and a heavy feeling if I pushed myself to hard or had sex in certain positions. This went on for years. I did go to the gp but everything checked out so nothing further was investigated.

What helped get my pelvic strength back was sex. Lots of it. And pelvic floor exercises, several times a day.

After giving birth naturally again ( I wanted a c section due to the previous birth trama but baby had other plans and arrived early and super quickly) and being stitched up i felt amazing. Sore but lighter.

When I got the all clear at the 8 wk pp check, whenwe had sex and for the first time in years it didn't hurt, pull or feel uncomfortable. Whatever the midwife did when stitching me back up finally worked.

The short version: Get your scar looked at, it may not have healed cleanly and could be still causing issues. I wish I had known to push the issue further. And, definitely have the pelvic physio during your next pregnancy.