Monday, October 29, 2012
Wednesday, November 16, 2011
There can still be a little bit of bladder prolapse feeling, not real bladder prolapse, if I carry lots of heavy stuff. So I try not to carry my 10.7kg DD2 whenever possible. It's easier now since she can walk.
What I did for my recovery? Not much. I didn't exercise. I didn't go to any therapy. I did see a physio for bladder prolapse though and thanks to her tremenous efforts I can hardly feel the discomfort unless I over do myself. What I did was just rest as much as I could, used the belt when needed, knew what I should do and what I shouldn't, and that's pretty much it. I would say you really need to look after yourself, take it easy, let the pain be your guide and listen to your body, if you're lazy like me who don't like going to any medical appointments and who don't like exercise at all.
Monday, February 28, 2011
From what I was told, it doesn't affect sex, it doesn't affect another pregnancy. To me, the above statements are true. Bladder prolapse is simply due to the weakened muscles on your vagina wall. When the muscles are weak, they cannot support the bladder above it, hence bladder falling a little bit down, causing the discomfort. It doesn't cause any problems, just discomfort. Of course mine didn't protrude so I don't know what'll happen if the bladder "falls out".
However, the bladder prolapse can become worse when you're pregnant because the hormones will weaken the muscles further causing the bladder to fall even more. BUT don't worry, here's the good part: after I suffered from a lot worse bladder prolapse during my 2nd pregnancy, I started pelvic floor exercises straight after the birth (of course I was doing them when pregnant too but the exercises could hardly beat the speed of the muscles' weakening), and STAYED IN BED AS MUCH AS I COULD for the first month after the birth, and have continued doing the pelvic floor exercises and now I can hardly feel the bladder prolapse. I think it's almost recovered, just waiting for the last bit to finish after I wean my 2nd baby (which will be in 7 months hopefully).
The key is, you need to get a special physiotherapist who specialize in pelvic floor exercises. Maybe ask your hospital. My current physio is one of them. She sticks her finger/s into my vagina and tells me how to do the pelvic floor exercises. It's "squeeze, lift, lift, lift, hold, relax". If your physio does this to you then you've got the right one. Then she can tell me whether I'm doing it correctly or not. If not, the exercise can hardly help you. But if you do it correctly, you can see improvements in days. I benefit from this special physio and thanks to her efforts I'm now rarely feeling any discomforts in my vagina.
Although no one would admit it to me, I agree with you that prolapse could be part of the side effect of the separation. I have this theory but no one agreed with me, probably because they've never had a separation in their lives.
So in summary, my answers:
yes to sex,
yes to another pregnancy,
a good physio for pelvic floor exercises,
keep doing the pelvic floor exercises
About exercises for PSD: from my experience, core strength and pelvic floor exercises are the only exercises that I could do when I had PSD. No other exercises can help, if they don't aggreviate the condition. I was given some exercises by various physios who seemed confident in what they're doing but only felt more pain after doing them. Only symmetrical exercises can be done under this condition.
Monday, February 7, 2011
Having another baby after suffering PSD saved me. Now my second baby is 4.5 months and I feel I'm healthy again, after 5 years of pain, discomfort, desparation and limited mobilty.
2.5 years after I had my first baby PSD finally settled down and I felt I could live a pretty normal life again. Although my mobility was still limited due to PSD and minor prolapse and incontinence, I had learned how to life my life with them.
3 years after I had my first baby I fell pregnant. One of the reasons I wanted another child was because I heard a new birth will give my body a chance to reshuffle and possibility to solve all my old problems from the first birth. And it turned out to be true.
Diary of my second pregnancy is here: http://pubicsymphysis.blogspot.com/2010/05/psd-diary-for-second-pregnancy-to-be.html. In summary, I had a lot of pelvic pain, a very shattered unstable pelvis, much worse prolapse and incontinence, controled constipation through diet, very very limited mobility during the second half of this pregnancy.
But now 4 months after the birth I feel I'm the healthiest person in the world.
Here's my story in conjunction with what I would say to people who've had PSD and want to have another child:
During the pregnancy,
1) rest AS MUCH AS YOU CAN,
2) do AS LITTLE AS YOU CAN.
3) Ask your hubby to look after other children.
4) Do all your house chores (if you can do ANY!) in a sitting position. I
bought a kitchen stool with adjustable heights and castors so I could "walk
around" on it in the kitchen.
5) minimal lifting!
6) minimal walking
7) no exercise at all apart from pelvic floor exercises, which still didn't
help much with the prolapse due to baby growing heavier. But I would imagine
the prolapse to be much worse without it.
8) As soon as you start to have the symptoms, wear the belt! And wear it as much
as you can.
9) Try to avoid hills, stairs, and walk in small steps instead of large steps,
meaning separate your legs as little as you can.
I used on all fours position, as advised by a few medical professionals, which protected my pubic symphysis area. It worked. My pubic sysmphysis wasn't damaged this time. And this position made the birth very quick. Do not separate your legs too much during birth. On all fours make it only about your shoulder's width so it wouldn't separate your pubic area.
Ceasarean is an option. But I was too scared to go through it. I thought it would be easier for me to do what I'd done before. :) But one main reason I still did natural birth was the possibility to heal the old problems through natural birth. The 'reshuffle'. :)
The birth was still painful and my pelvis felt like broken into hundreds of small pieces. But I could still WALK, which was a good sign. Last time I couldn't move at all.
Now After birth:
1) Start wearing the belt as soon as you can and as much as you can.
2) Start pelvic floor exercise as soon as you can and do as much as you can.
3) Stay in bed as much as you can. Rest as much as you can. I stayed in my bedroom for at least 1 month after birth. Apart from going to the toilet and having meals, I didn't leave my bed at all. And we have an ensuite so the toilet is in the bedroom; I had all my meals brought to my bedroom so I didn't need to walk out of the bedroom for meals. My parents came from overseas to help me so I could afford to do this. So if you can, get someone to do everything for you during the first or even the second month.
4) I was still in pain (painful unstable pelvis) 1 month after the birth of the 2nd baby so I still controlled my activities. I only did very limited activities such as very gentle walking for maybe 5-10 minutes each day, and then still rested as much as I could. This lasted for about 1.5 months.
5) I started seeing a physio at 10 weeks. I didn't do any exercise at all before this, apart from pelvic floor exercises. I still felt very weak, pelvis very unstable, and very bad back pain. Physio gave me very gental exercises to strengthen my tummy muscles. It was very difficult at first. But I found very soon I started to feel stronger and stronger. The physio also taught me how to do pelvic floor exercises correctly so I started to see a lot of improvements on prolapse and incontinence.
6) About 3 months after the birth I was pretty much pain free and during that time I gradually increased my activities (walking, shopping etc), using pain as my guide.
7) Now 4 months after birth I'm a normal person. I feel I'm healed. No PSD. No prolapse. Minor incontinence. No back pain unless I do too much.
I never imagined a life like this, pain free, can do anything I want. It's like I'm alive again, free again.
Sunday, August 22, 2010
Everyone who knows my history has asked me: do you want a natural birth or caesarean this time? And will you ask for epidural?
The simple answer is: natural birth and no pain relief if everything goes ok. That’s pretty much the same as last labour. I didn’t really plan anything last time. So the natural birth happened as it happened, and I forgot to ask for any pain relief…This time I have done some planning, and my decision turned out to be the same as last time.
I haven’t changed my mind about pain relief. I did forget to ask in last labour and I wish I remembered. I heard if the pain has lasted for too long, it may affect the opening of the cervix due to the muscles being too tense. And then it’ll cause an unnecessary longer labour. Maybe that’s what caused my three days of pain before I had the baby. And probably the reason my pubic symphysis was torn was because I was too tired to push and the force from outside was too much (three people pulling my legs back).
This time I told DH to remember to remind me of pain relief options during labour. At least I can remember I have choice. Maybe this time things will be different.
About caesearean or natural birth, I have changed my mind. The lady who had similar experience to mine told me to have caesearean and not to breastfeed, based on her success experience of having another baby after PSD. I did want to do that. And I did ask in the baby forums and was told I have every right to ask for a caesearean in a public hospital. So I decided to have another baby, following everything she told me.
But since pregnant I have gradually changed my mind. One important reason is what a Chinese doctor said 3 years ago in a Guangzhou hospital. He said if I have another baby and my pubic symphysis is torn again, and if appropriate measures are taken, all my problems can be fixed. My parents are pro this idea. This has affected my decisions. I haven’t been able to walk like normal for 3-4 years due to my pubic symphysis and back problems. I used to walk from morning to night when I was traveling somewhere. Now I can only limit my walks to 10 minutes. This has affected my life. I don’t like the idea of my mobility being limited for the rest of my life. So I want to have a chance to fix up all the problems and go back to the old me. I love traveling. But I haven’t been able to in the last 3-4 years due to my mobility. I hope I can be up and walking again and travel around the world.
So I decided to have another natural birth.
Some good friends have been trying to persuade me to have caesearen. They don’t understand why I want to risk since I had such a trauma last time. I think this can be difficult for others to understand. It was huge. Who wants to experience it again? But for me, I think the thing I’m afraid of is not the pain, but my mobility. I’d rather have relatively short term pain than long term limited mobility.
Since March 2006 when I had my back injury, it’s been 4.5 years that the pains are part of my body. I think I’ve got used to it and don’t really mind much whether it’ll go away or not. Maybe it’s these pains that made me brave enough to have my first baby without any pain relief, and then think I don’t need it this time either. Pain is hard to hear with but limited mobility is harder. I cannot bear with the thought that I’m gonna have to live the rest of my life with such limited mobility. I want to walk, travel, do house chores. I want to change. This second baby might give me this chance.
Tuesday, June 8, 2010
I guess everyone will have to go through this whole process. It's natural.
Some could be as lucky as me, can live almost like normal, although have to be still careful every day, after 2.5 years (or even better!). Some (only a few) may be disabled for the rest of their lives.
In fact, these are what we can do.
From what I gather, physios can give you some advice, such as what you need to note in your daily life, and how to live with PSD. This is mostly included in my other blog entry: Tips on PSD, compiled 15/03/2007.
Other than that, physios may introduce some gentle exercises, mostly about 'core strength'. But I've found it's best for me to do no exercises at all. Of course pelvic floor exercises are a must to do, and it doesn't normally affect the pubic symphysis. I don't find any other exercises have done any help. As matter of fact they actually can make things worse. I don't even walk much. I find when it's severe I'd better limit activities to minimum. When mild, I can increase my activities just to keep my body and mind alive and fit and functional.
Conclution: physios can only tell us how to live with PSD for the rest of our lives. I don't think they can cure it.
1. Almost always, they encourage 'conservative treatment', which means rest, be careful and wait for the natural healing. Most of the time (from statistics and research) it DOES heal naturally, or at least heal till it doesn't affect our lives too much (I belong to this category).
2. In extreme cases they might mention 'surgery', which means putting stuff like nails to bind the pubic bones, which is said to have very low successful rate, and takes a long time to heal and involves a lot of pain as well. So doctors would never recommend a surgery, as sometimes you might heal naturally faster than having a surgery done. So a surgery is the last resort. If you can still bear with PSD, it's best to keep conservative treatments (even if it means for the rest of your life).
Sometimes doctors make you feel they're indifferent on this matter. I think it's natural. From their point of view, if there's nothing they can do, they don't want to worry about it. They have things that they can help to worry about. So in these cases they usually use only a few words to 'get rid of' us.
So personnaly I don't think there's need to make further queries to the doctors once they've made an conclusion.
Wednesday, May 12, 2010
This is a record for my current pregnancy, for my second baby.
At 17 weeks I started to feel my pelvis was falling apart. I felt all the ligaments started to loosen, including my pubic symphysis. Not really any pain but just the feeling was scary.
At 18 weeks I went to see my physio Sue, who I saw after I had my DD1 at the hospital. She suggested belts, and very gentle exercised in bed, including pelvic tilting, drawing in my belly button to strengthen my tummy muscles. She said this might help strengthen the area so less pressure on the ligaments. She said there’s not much we can do and I will end up on a walker. I mentioned crutches but she said it’s not as good as a walker.
I mentioned that the normal maternity belt was too hard and it presses my growing tummy which made me feel uncomfortable. Sue said they were gonna get some softer ones later and asked me to call a few weeks later to come and try them. I showed her the elastic tube that was given to me last time and said this one is softer and better than the maternity belt. She said this one will do. So I continued wearing this elastic tube when I know I would be walking or standing for some time. Lying in bed or sitting are not good positions to wear it either because I bend my pelvis area and the tube can still press my tummy.
At about 20 weeks I suddenly felt my pelvis was getting a lot better. It seemed that everything held back again. It wasn’t perfect, but good enough to get rid of the belt.
I was thinking one of the reasons might be that I changed my mattress. I remember last time when I had PSD I hated lying on a hard mattress because it made it easy for all the bones to move and crack apart. This time after I felt my pelvis was getting worse I felt the mattress made it worse again. So I changed to a softer mattress and started to feel better.
I think the other reason might be hormone changes, only because my morning sickness settled a lot at the same time, and my hayfever settled a bit at the same time too. Well all these annoying symptoms settle at the same time, you can’t help thinking it’s because of the hormones.
Now at 21 weeks, I’m ok. No obvious pain, pelvis still ok, just a bit more back pain, which I guess is due to bigger belly.
100520: now at 22 weeks, I'm still ok. No pain, nothing from pubic symphysis. Only problems is for a few times when standing up and walking I feel the clicking of my spine bones at lower back which is a bit scary but not too much worrying. I can't walk very fast, otherwise get tired easily. If I walk or stand for along time I tend to have back pain. Other than that everything is manageable.
100603： now at 24 weeks, I'm still ok. Not much to update from last entry.
100608: now at 25 weeks. From yesterday I started feeling like there's a palm sized wooden board stuck in my lower back which makes walking a bit more uncomfortable. And the clicking feeling when walking is worse. It doesn't feel like two bones are rubbing each other. It feels like more bones are rubbing now. But there's no pain caused, just discomfort. And I still have my normal back pain which is managable, a lot less than last pregnancy.
So I called Sue, my physio today. She said it should be the same problem. The pubic symphysis is connected with the back of my pelvis and if one part is not stable, unstability could happen to other parts too. So she suggested I restart wearing the belt.
100610： Now end of 25 weeks. Lower back clicking and stiffing is getting worse. Pelvis starts to feel scattered again. Walking is more and more difficult. Very light weight carrying (bag and lunch box) can make me feel a lot of pressure on pelvis which affects my walking. Climbing the hill out of the station to my car becomes more and more impossible. Lower back and whole pelvis can become painful and strained and I have to sit down sometimes. I started using the MPS in my car yesterday because I felt desperate every day when climbing the hill. Now I use the card to park a little bit closer to the station so I can climb less of the hill. I've gained about 7kgs so far.
100616: tomorrow will be 26 weeks. Things deteriorated a lot last week. I couldn’t work on Friday due to difficulties walking. It was even very difficult to walk around in the house. It’s difficult to stand too. I’ve started to wear the elastic tube, in two layers. I used to wear it in four layers to be more tight but being afraid of pressing my big tummy I’m wearing two layers. It still puts pressure on tummy but not as bad as four layers. It seems to work a tiny bit. It’s a tiny bit better to wear the maternity belt because the belt is tighter, but it puts more threat on my tummy when sitting down.
No matter whether I wear anything or not, I still can’t stand for long (I mean even more than 1 minute I’ll feel lower back is very very tired and sore), can’t walk for long. The worst is the hills. I have to walk between my car and the station and no matter where I park, even using my MPS, there’re always hills involved.
I can’t walk fast. I have to walk very slowly, and in small steps.
More problems present at the back of the pelvis. The front is not as obvious as the back, although sometimes the pubic symphysis can feel some pain. The bones at the back of the pelvis seem to be falling apart. The middle part, most likely the spine, clicks and rubs when moving. I have to walk in a very wobbly way, trying to minimize the rubbing of the bones. It’s very easy to feel sore and pain, when walking up the hills, even small hills; when climbing stairs, when standing for a little bit longer.
Prolapse is coming back. I can feel it with my fingers when taking the shower. I can feel something seems to get stuck in my vagina, making it full. It’s trying to pop out. I’ve been trying to do pelvic floor exercises all the time. But it doesn’t seem to work much.
I’ve got my crutches out. I’m thinking of using them when needed.
Nausea seems to want to come back too. It’s not too bad, just occasionally. If I eat something it can easily go away. So I’m thinking if it’s the hormone changes that makes everything worse again.
100618: today seems to be a little bit better. bones clicking thing is minimum. back pain is minimum as long as don't walk for long. now i only do essential walks like between car and station, between seat and toilet etc. any other walks are limited to minimum, unless i feel i need them due to constipation. i find recently constipation is very normal.....my diet has already got mostly veggies and fruits and not much meat....
100622: now at 27 weeks.
I find resting has helped with my pelvis in the last few days. I find if I lay in bed for ¾ of a day (like 18 out of 24 hours), I could feel much better the next day. My pelvis seems to be more stable, less rubbing of bones, less pain. If I keep moving around during the day I would get worse. I’ll continue monitor this pattern.
Belt/elastic tube hasn’t helped much. It CAN help a little bit when I move around by help holding my pelvis together a little bit better, but it’s just too much trouble to put it on and take it off coz I don’t really move around much every day. The trouble can even outweigh the relief it provides. Sometimes I get more pain from getting on and off the belt/elastic tube.
My prolapse (or the like) has shown up again and I can feel it getting worse every day. It’s one of the reasons I want to stay in bed as much as possible. I think all the weight from inside my tummy has pushed it down and now I can see the bulk at the opening of my virgina. It’s trying to come out. I keep doing pelvic floor exercises but it doesn’t seem to keep up with the speed of it getting worse. I just hope it doesn’t come out before the baby is born. After the baby is born I’ll stay in bed and try to hold everything back. I’m hoping to have a strict bed rest for 1 month this time round to see if I can recover from all the legacy problems.
100701 I'm now 28 weeks.
Things are better than expected. During the last week my pelvis has been doing well. The crackings and pains are minimum, although still feel I need to be very careful when walking. I guess the bed rest I had for 4-5 days last week due to my headaches had helped. And prolapse has made me trying to minimize walking and standing too.
100712 I'm now in week 30.
Everything is still quite stable. It doesn't mean it's all good. It means everything can still be under control.
The thing that worries me most now is the prolapse. I try to sit down and lie down whenever possible to stop/delay it. I know it's prolapse and I don't really need to get a diagnose. I believe by the time a doctor confirms it's a prolapse it would be too late. And really, all they can say is 'there's nothing we can do'.
I saw some information about prolapse. It seems that having more children and start working too early and lifting cause prolapse. So I'm gonna be careful about all these things. Having a third child may not be possible so I don't worry about having more children. Then I decide to have really good rest after having this baby. Then I'll try to lift less in the future.
I also saw a video about a surgery of a 3rd degree prolapse. It's terrifying. I decide to try everything I can not to have 3rd degree so that I never need a surgery. It's just terrible.
Other than prolapse, my pelvis is holding ok. Lying in bed too much make it lose too so I need to balance activities and resting all the time. Back pain is ok too. Driving for too long makes it worse so I decided to still take the train at the moment and maybe try driving to work after the ticket runs out after end of this month. If driving makes back pain too bad I'll buy train ticket again.
There're so many things to balance right now.
100722 week 31 done
I'm still going strong.
Still trying to limit movements to minimum and most of the time I would be sitting or lying down.
Back pain is minimum. Lying in bed sometimes has more back pain.
Pelvis is loosen, unavoidably, especially when rolling in bed I can feel bones moving and rubbing, quite scary. But sleeping in one position is hard so I have to roll very often. I just hope the bones won't get injured during the next 2 months.
I'm still cooking, while sitting. Other than that I can still do some simple house work like filing, sorting out clothes etc as long as I don't have to stand or walk much.
I'm quite positive I can work longer than during last pregnancy. So I'm planning to take part time leave (1-2-3-4 days a week) from second week of august, 9/8/10 for about 5 weeks and start mat leave 2 weeks before due date. I feel I can even probably work till due date....
100728 tomorrow week 32
Pelvis has become very bad since last week. It's been about week now. It's terribly painful to roll in bed. I have to hold my pelvis using my hands to ensure the bones don't fall apart. The bones rub each other vigorously when rolling in bed and the pelvis and thighs can be very very painful. It's also hard to get up from bed. It can be very painful to get up and I'll have to hold onto something to stand for a few seconds to put everything in place before I take my first step. The first few steps after getting up from bed can be painful and difficult. Then everything goes back to where it should be and walking can become easier.
100805 today 33 weeks
The pelvis has been very unstable when in bed. Now sitting is almost the only preferred position every day.
Walking is kept minimum, even less than before as I started driving to work this week so I don't have to walk to the station.
Rolling in bed at night is the scariest and most painful. The bones in my pelvis seem to have shattered into pieces and I have to hold my pelvis and move really slowly to minimize rubbing of bones/bones falling off/pain. I now wear the elastic band to help hold my pelvis together when in bed. It helps a bit as it tightens the pelvis and makes less room for the bones to play around. My spine seems to have difficulties supporting everything when in bed so lower back is even more painful when in lying position than in other positions. I have to change positions in bed frequently to manage the pain. The other night I had to get up to take Panadol because other wise I can't get to sleep.
When getting up from bed I have to hold my pelvis. When standing up from bed I can't move for a few seconds. I have to wait for a while for bones to go back to where they should be and it's normally difficult and painful for the first few steps as my legs (joints of leg and pelvis) don't seem to have prepared to support my body weight. If I start walking too soon it'll be painful and impossible to walk.
Driving to work makes my lower back more painful. But I don't seem to have much choice here. I can't walk much which leaves driving to work the only option. I've planned to take days off every week so my lower back and spine can have some rest from the driving so I don't have to have too much pain. From next week I'll work every other day to manage the pain.
Saw a midwife last Thursday and she was quite serious about issues I raised. She arranged me to see doctor next Tuesday to talk about the bladder prolapse. I can feel the ball in the vagina is getting lower and more obvious when showering. I hope I can keep it inside until I have the baby and then I can try to take a big rest in bed to make it better.
I saw an OB in China when DD was 9 months old and she gave me some advice this Tuesday:
1. Your PSD should be able to recover better after you have this second baby. You can try using pelvic belts or tight pants after birth. They'll help. If it's too bad you can only rely on the hospital on solutions. Three years ago we talked about fixing your pelvis and hanging it up for a couple of days. It can only done by professionals in the hospital. So do not try it at home.
2. It would be better if you have a natural birth this time.
100814 34 weeks 2 days
I've been sitting on a castored kitchen chair for cooking for over 10 weeks now. And Thursday night when I was 34 weeks DD pulled my chair away while I stood up to see my cooking. I sat down without knowing the chair wasn't there any more and sat onto the floor. It was very painful and I cried out with tears. It took me quite a while to be able to stand up.
My lower back has been very painful since last week's fall. The tailbone can be sore when irritated such as pressed. The lower back pain is there all the time now, unlike a few weeks ago I could bearly feel it. I think it's partly due to my driving to work, sitting in the car for 2 hours on my working days. Although I do rest every other day the back pain is still unavoidable. Then the growing belly is putting more pressure on my lower back too. And plus the fall.
I've been trying to rest as much as I can but even lying in bed is painful. Rolling is still terribly painful too. So sometimes I prefer getting up to do something so I can move around. It's still painful but maybe a slightly different type of pain so I don't get too sick of the same pain.
I know all I've been talking about is my pelvis and lower back pain, not the pubic symphysis pain. But the physio Sue said any problem from the pelvis area can be related to the pubic symphysis so I'm recording everything here.
My mobility: it's been limited to from one room to another, or from my desk to toilet, or from work to car, or similar distance. if walking more will feel obvious increase of pain.
and change of my back pain. the back injury in 2006 caused my tailbone and surrounding to be painful during the whole pregnancy and 1-2 years after birth. So sitting was most terrible. But during this pregnancy my tailbone hadn't been painful (until I had the fall last week). It's the part that is above the tailbone that started to be painful and worse and worse since beginning of August. So sitting hasn't been the most terrible position. Walking, standing and lying in bed are more painful postures.
100827 36 weeks 1 day
There hasn't been much change in the last week. I think the tailbone is getting better compared to the first few days after the fall. My lower back is still painful. Rolling in bed still makes me feel like the bones are rubbing each other and I have to hold the pelvic while doing it. Sitting position is still my most preferred posture.
I did receive a call from Sue my physio on Tuesday after she came back from holidays and she said the tailbone pain can be managed by heat or swimming. Other than that there's not much I can do. She said she wouldn't be able to see me in 3 weeks (well that's what's called public hospital).
I thought I updated last week....There's not much change. I still cannot walk much, cannot stand for long, and try to sit down whenever I can. It's still difficult and painful to roll in bed. But I seem to have got used to this condition and feel there won't be any damage even if I feel pain or discomfort when rolling. It's mostly soft tissue pain. There can be bone-rubbing every time I roll in bed, probably due to a lying position and the weight of the baby. Sometimes I could feel some bones are falling down or off its position.
I've been trying to roll without my bottom leaving the bed, like sliding over, and using my hands to hold my pelvis together as tight as possible to prevent bones moving. It's more a hope than an effect really, as the bones could still move. I try to roll as slowly as possible, using pain and discomfort as guide. I guess that's how much I can do about it.
I'm usually lying on my back when I wake up, no matter what position I was in when I lied down.It's kind of strange....
In the last few days the pubic symphysis seems to get loose, coz it feels like not connected well when moving in bed, and it can be sore.
100918 39 weeks 2 days
Not much difference recently. Maybe just a bit worse. I still try to limit walking and standing. Positions like walking, standing and sitting won't make me feel too painful. But lying in bed sometimes can be worse, especially (still) when turning. Every time I roll in bed it has to be very very slow as it can be very painful, not just from pelvis, but also from legs. It seems the soft tissue in my legs are having a lot of trouble too. If I only lift one leg, I can feel a tearing sensation in the pubc area, not horribly painful but still it can hurt. Maybe I've been in too much pain and discomfort, I feel pains are not so terrible to me any more. Sometimes I have the feeling that it's just pain and won't really do any damage. So I roll in bed bearing with the pain. In fact I really have to roll, because I cannot lie on my back and I have to lie on my side. When the leg underneath feels swollen and painful I have to turn to the other side to give it some relief. Every time it's a very painful and slow process. Whenever I have to do this I wish the baby could come out soon coz when there's no baby in the belly at least I can lie on my back or even tummy.Every time I want to stand up from a laying position I always have to test how to do it without too much pain. It's also a very slow and difficult and painful process. When I finally stand up I'll have to stablize a few seconds for all the bones and soft tissues to go into a better position for me to be able to lift the first leg, otherwise it might be impossible to lift the leg or very very painful. It's usually very hard for the first few steps.
I think it might be the bigger baby that's causing it so much more difficult for me to move. And also lack of activities could contribute too. Maybe the bones and soft tissue are not active enough to handle movements any more. But I don't seem to have better choice. I don't want to be too active to make things worse. At least I can still walk at the moment. I still don't need crutches or walkers to walk around the house.
Tuesday, April 20, 2010
I called physio Sue who called me last week and went to see her this afternoon. There's not much she can do. It seems that a soft belt such as the one I'm wearing is the best I can do now. The belt is actually the elastic tube that the physio Tracey gave me 3 years ago. She sold me a maternity belt but it's too hard for me at the moment because the belt is pressing against my tummy which is growing. The tube is softer.
I showed her the x-ray that I had when 15 months postpatrum which showed I still had 1.5cm gap. She was surprised that the gap was still that big at that time.
I also gave her an updated diary of my PSD history highlighted with major points, and a print out and some highlights of this page.
Sue also gave me some suggestions:
1. minimum bending, lifting, stairs (actually 2 hours later I did laundry which involved all of these...)
2. try small steps
3. pelvic floor exercises and pelvic tilting exercises (lying on back and pressing back against bed) to toughen tummy and pelvic floor muscles.
4. wear belt as much as possible when standing, walking
5. I'll be in pain later on and will probably go on walkers
She said the hospital will buy some new belts in the near future and I can call her a few weeks later and come and try to see if they fit me.
Thursday, February 18, 2010
I finally got some time to do more research. I've learned quite a bit from the following links, such as conservative treatments are almost always recommended, bed rest is most important, be very careful in subsequent labours. They're mostly research articles. I have copied some stuff that I think important under the links, and highlighted the most important parts. I'm happy to know that caesarean is not a 'must' for my next baby. I'll wait and see.
external pelvic fixation
rupture of the symphysis pubis in spontaneous labouris is caused by marked intensity of the uterine contractions plus marked rapidity of labour
Pregnants with lack of pelvic flexibility in the absence of other predisposing factors, are at increased risk for development of rupture.11 Furthermore multiparity, difficult forceps delivery, precipitous labour, congenital anomalies, rickets and tuberculosis may implicate symphysis pubis separation.
With a seperation of more than 4 cm must be checked for sacroiliac joint pathology. Below 2.5 cm of separations must be treated conservatively by restrictive pelvic binder and absolute bed rest on lateral decubitus position
conservative treatment with bed rest and binders for 3�4 weeks in separations greater than 2 cm
The incidence of symphysis pubis separation is reported to be between 1:600 and 1:3400 obstetric patients
Treatment should generally be conservative and symptomatic.
Recurrent separation of the symphysis pubis could occur during subsequent deliveries but generally is no worse than the first occurrence.
All the cases in our 11 patients suffering peripartum pubic rupture occurred after spontaneous vaginal deliveries. Maternal age, parity, clinical pelvimetry and fetal weight did not play a clear role in the development of symphysiolysis. Rapid descent of the presenting part in the second stage, however, was a common feature. Nonoperative treatment of pubic diastasis and expectant management of subsequent deliveries seem advisable.
http://www.childbirth.org/articles/pubis.html a collection of a few articles' abstracts
problem isn't even mentioned in my Maternity nursing textbook
can be managed successfully with absolute bed rest
Saturday, February 6, 2010
I don't quite understand the rest of the report but I can clearly see the 1.5cm...
Friday, February 5, 2010
Don’t miss out on precious time with your daughter though to do this internet stuff. Trust me, I have a 14 year old and you never get those cute innocent first months back. Before you know it, 10 years will have passed and you will long for those first early days of discovery and sweetness. So please, try to put your thirst for info on the back burner whilst your daughter is awake and just make the most of those moments together.
I understand your anger with the medical profession. I was so angry with my obstetrician I wanted to sue her. My husband kept saying “just let it go” and this angered me even more because he of all people is supposed to be the person who sticks up for me the most and here he was just telling me to drop it and basically “shut up” about it (he didn’t literally say that, but that’s how I took it). I emailed some lawyers, had a few conversations with some of the big medical negligence law companies and did eventually decide just to let it go. I got to the point where this anger and resentment was consuming me. So I also advise you to find some coping mechanism to help alleviate this anger in you. Because at the end of the day, there really isn’t anything they can (now) do about it and you’re the one home suffering with these constant negative thoughts which are only in the end doing you harm. So try as hard as you can to let go of that pent up “argggggggghhhhhh!” feeling towards the medicos.
This condition is very rare. My obstetrician had been delivering babies for 50 years and she had only ever seen one other case, back in India. You are only the second person I’ve come across who has suffered DSP. I guess you can take pride in the fact that you are trying to reach out to others and help others with this condition (via your website) and that is a positive step you’ve taken towards emotional healing. Once you let go of the anger, hurt and resentment you can work towards acceptance, positive helping of others (which you’re already doing) and eventually emotional closure. I am still not at the emotional closure stage, but I am feeling a lot better about things. This is only since my recent positive birth experience though. It’s like it was an eraser that wiped out the rawness of the memories of the other birth. This one just went so well and smoothly and this time I chose to bottle feed so it was a breeze compared to all the breast feeding complications. It was just so easy and it helped me heal. A lot.
I too had no pain relief during my labour. None at all. And I tore really badly. It was the most unbearable pain I’ve ever experienced, all of that – labour, the head getting stuck in my pelvis, the head ramming through – splitting my ligaments in half on the way. OUCH. I took Panadeine Forte afterwards too, but only for a week or so. They made me constipated and that was hurting me too. Everything bloody hurt and then the mastitis on top. Not a happy time.
As for the spd UK link – it used to be a fantastic website but the UK govt. pulled funding on it a year or so ago and yes, I realize it now only has those ads.
It sounds to me like you went through the public health care system. In regards to having another baby, my advice to you is 12 months before you get pregnant next time, take out private health cover. Choose your own private obstetrician. Do research on EB to find one in your area that doesn’t mind doing caesars if you choose to do it that way. Talk to everyone you know to see which doctor they had and see who is a popular choice. Choose your own private obstetrician. Be proactive in your own health care. Be your own advocate. Stick up for yourself, nobody else is going to unfortunately. Tell them right from the outset that you want a caesarean. Email that woman in UK whose email address I gave you and ask her for some advice. I emailed her and asked her advice and this is what she told me:
Yes if it was me I would demand a c-section in order to prevent any further damage to my pelvis, plus the delivery would be organised and controlled, and with a c-section you get to spend some additional time resting in hospital before being discharged, so any worries or concerns about pelvic pain, etc can be addressed.
Hope that helps
Just be really demanding and persistent. Tell them you can’t take care of yourself, your toddler and your infant with pelvis problems. Don’t worry too much about a second pregnancy. I know it is the downright scariest thing I’ve ever decided to proceed with. Everyone around me – EVERYONE told me I was insane to consider having another baby after what I went through. I took my Xrays and my story to a private obstetrician (obviously a different one to who I had the first time) and asked them “could I have another baby? And what are the implications for the pregnancy and the birth?”. He said I could have another, but the pregnancy would be painful because the ligaments would stretch again. But they would not tear again, just stretch. So not as much pain as you’re going through now, but still…some pain. He said I may be wheelchair bound or back on crutches/walking frame towards the end of the pregnacy (which I was on the frame but mainly at night). It was a scary, risky decision but I decided to proceed. I figured if I never had another baby I’d regret it forever and I knew even if it was painful it wouldn’t be as bad as the actual pain from last time and if I could handle that I could handle anything! And here I am…4 months post birth with a beautiful girl (after 2 boys) and I’m absolutely fine. So my advice to you is if you really want another baby, have one. Don’t take the pelvis issue into account with your decision. Just decide “do I want another baby or not?”. If the answer is yes, then go for it but be prepared. Like I did, enroll as much support around you as possible: Coles Online, a cleaner (mine was $40 per week) and I’d wait until your current baby is at least 2.5 before I’d try to conceive, just to give you ample time to heal. It is possible and it is worth it in the end.
And you said “. I wouldn't want to get pregnant if I know for sure this is gonna happen again”. This will NOT happen again if you have a caesar. It can’t. You may very well (and it is highly likely based on what I’ve read and experienced) that you will experience SPD during a subsequent pregnancy but only for the last half of the pregnancy (at the most I’d say) and nothing like what you’ve experienced with actually tearing your ligament. I know reading the SPD support thread on EB is scary as some of the women in there really struggle, but if you do all the preparatory things like I’ve suggested you should be OK. And the time does eventually pass and I’d say all my SPD was gone after about 6 weeks this time. That’s not to say I was in agony all that time. It was totally bearable and manageable. NOTHING LIKE WHAT YOU AND I HAVE GONE THROUGH WITH THIS BIRTH OK??? You can do it!
I’ve noticed you’ve said a few times that “they” (the medical profession) can’t do anything about this condition. There is one procedure they can do, which is to have an orthopaedic surgeon put a screw in to bolt your pubic symphsis bones together, but this is really risky and they only do it to footballers with osteitis pubis (similar condition) that have half a million dollar careers at stake. My friend who had terrible SPD (and I mean the worst case I’ve ever heard of without actually having total rupture like you and I) really looked into this and was told by everyone she saw that it wasn’t worth the risk as it can leave you very stiff and in more pain than before you started.
Yes, you can get disability stickers for your car. Get your GP to apply for one for you. You can get a temporary one. My friend did this too. You can also get home help from your local council to help you with housework, but it depends on your local area. I didn’t qualify as I had a husband (even though he was away at work from 7.30am until 7pm every day).
Please don’t think that I’m saying you’re going to have 5 years of pain like you’re having now. I cannot say how long you’re going to be in pain for – nobody can. All I can do is tell you the facts of what I’ve learned on my journey and that is that my physio (who specializes in women’s birth problems) has seen a few cases like ours and she said in most of those cases her patients said it was 5 years before they were 100% pain free. For me, it’s been 3 years and 9 months since it happened and I carry on my usual life as though nothing happened. There are just some things that can be painful and only sometimes – things like really vigorous sex with your legs spread for ages (sorry if I’m being too graphic, but you get what I mean) – this can leave me a bit sore the next day; also if I trip over something I can be sore for a few days; if I slip on water where one foot takes off and the other stays put – this can tear it a bit; if I move the rug with my foot, it can feel that old twinge of pain (but only subtle and mild not excrutiating); if I crouch or kneel or get on the floor for too long I get a bit stiff but I am probably just not used to doing it for so long. So I’m not really in agony – just some mild achey kind of pains. Nothing that even requires panadol. Totally bearable. You will be over the worst of your pain by the 4 month mark and will improve every week after that. The more you can rest, the quicker you will heal. Do not wear your support belt whilst sitting down, only when standing or walking (at least this is what I was told) and I know this is a pain in the butt as you have to take it on/off/on/off all day long.
I know how frustrating it is to think that you want your life back. You have every right to feel angry and sorry for yourself. What I try to do when I feel like that is, I try to think of all the women who can’t have babies, or those whose babies were born with serious disabilities; I try to think about women who are on dialysis every day for the rest of their lives; or who are waiting for lung organ transplants, hooked up to ventilators. You, just like I did, will get over this. Yes, it will take time. Yes it will drive you to the point of frustration and depression in the meantime, but you WILL get over this. Some people aren’t that lucky. Just reading on EB alone you can see women who’ve had such bad tearing during birth that they now have colostomy bags or are permanently urine and faeces incontinent. DSP is excrutiating. It’s horrible. It’s awful. But it is something that does heal and you will have your life back. Try and focus on the end goal. You will one day feel fit and ready to take on the world. Just don’t “blow” this special time you have now with your baby daughter. You never get this time back and if you spend the whole recovery period wishing she was asleep 24/7 so you can go on the net to research this then that really would be the worst possible thing this injury could have done to you – not only robbed you of your physical capabilities for a few months, but robbed you of that special time of motherhood that is so very very precious. Do you really want this injury to cost you that too?
Feel free to vent any time. Any time at all OK? I work from home so I’m at the PC most days.
Hang in there, another day has passed. Another day closer to full recovery.
Perhaps read this out to your husband so that he knows you are not exaggerating.
Dear Rowena’s husband,
You don’t know me but your wife and I met over the internet as a consequence of having both experienced traumatic births that resulted in diastasis of the symphsis pubis ligament. I just want you to know that this injury is such a painful one. It is agony, I mean actual agony just to roll over in bed; to swing your legs out of a car; to move something on the floor with your foot. Rowena is going to recover fully, but this will take months and during this time, she needs your 100% support, not just to help with the housework and shopping and things like that (and yes I do realize you work full time), but mainly your emotional support. She needs you to stroke her hair at night and say how proud you are of her, how very sorry you are that this happened – that she is so very brave and it is really unfair that this happened, but you are there for her, to help her get through. You understand how frustrated and angry she is. You understand that she is going through a whole range of emotions: anger, self pity, resentment, guilt (that she isn’t the “perfect”, able to do everything Mum) and disappointment. You love her, are proud of her and that you and her will just take this one day at a time and get through this together.
I know this is the kind of thing I really needed to hear from my husband so I’m giving it to you now so you can pass it on to Rowena.
And Rowena, even if you don’t feel like showing that to hubby, I wrote it mainly from me to you to show you that I understand all those feelings you are going through and that I know deep down that those are the words you are longing to hear. And if your hubby doesn’t express them to you, then I’ll just have to do.
I hope I have helped in some small way.
Thursday, February 4, 2010
Things that I heard that re-tear the pubic symphysis are like:
1. running for bus
2. bending down to pick up toddler
Tips on PSD, compiled 070315
I've collected some information from internet and my own experience on how to deal with SPD. Hope this helps you.
1. Wear a special pelvic belt to help hold your pelvis together. Try to wear it all the time. I find it impossible to wear it all the time because it causes other problems like upset tummy or numb legs. It does help sometimes because your pelvis feel more stable.
2. Suck in tummy muscles as much as possible when changing positions.
3. Toughen your tummy muscles.
4. Abdominal exercises: core strength
5. My physio asked me to use an exercise ball to do the following exercises (which turned out making things worse and another physio who experienced PSD advised me to stop):
1) Sitting on the ball, lift one foot a little bit, and hold for a while, then the other.
2) Sitting on the ball, gently tilt pelvis.
6. Pillow between legs when lying on your sides
7. Pillow between knees when rolling in bed.
8. Pillow under knees when lying on your back
9. Stand with feet together.
10. Keep your legs together all the time.
11. Symmetrical all the time.
12. Avoid lifting, twisting, standing on one leg only, sitting with cross legs, tailor position, vacuuming, squatting.
13. Limit vigorous activities
14. Allow joints to heal while remain as active as possible.
15. Be extra careful not to slip!
16. Adapt your stride length to your pain.
17. Take one step at a time on stairs.
18. Rest as much as possible.
19. Sit with your back straight all the time.
20. Some people say supportive running shoes help handle the condition.
21. Some people say swimming makes them feel better. But do not do breaststroke. (I don’t know how to swim so this doesn’t help me.)
22. Some people recommended try Pilates.
23. I’ve been referred to an Orthopedist and due to see him next Wednesday. If he helps I’ll post more info here!
24. Some people find Osteopath + Chiropractors are effective.
25. Someone mentioned was referred to a Reumotologist. I don’t even know what a Reumotologist does!
26. (updated 100608) Physios may introduce some gentle exercises, mostly about 'core strength'. But I've found it's best for me to do no exercises at all. Of course pelvic floor exercises are a must to do, and it doesn't normally affect the pubic symphysis. I don't find any other exercises have done any help. As matter of fact they actually can make things worse. I don't even walk much. I find when it's severe I'd better limit activities to minimum. When mild, I can increase my activities just to keep my body and mind alive and fit and functional.
1. Which pregnancy did you have PSD? Was it during the pregnancy or after birth or both?
I got Diastasis when I was giving birth to my daughter. I didn’t know anything about PSD before the birth.
2. Did you have injuries BEFORE the pregnancy that you think might affect your pregnancy or PSD? (For example some people hurt their back by pulling a boat or lifting a lot of boxes) If so please provide details.
Back injured when lifted a lot of boxes at work. Was diagnosed as ‘soft tissue strain’ Lower back pain till now. Thought this might be related although was not pregnant then.
3. Did you have injuries DURING the pregnancy that you think might affect your pregnancy or PSD? If so please provide details.
4. Do you think there’s anything else that might have affected your pregnancy or PSD? If so please provide details.
My back was painful during the whole pregnancy so I didn’t have much exercise, only about 20 minutes walk every day. In the late pregnancy I was mostly in bed because my back was too painful to walk or sit. The doctors said it was the hormone or relaxin produced by pregnancy that caused this pain not the injury any more.
5. When did you go into labour? How? How long was your labour?
I went into prelabour (contractions) on early am of 23/12/6 and first stage on am of 25/12/6. The midwife broke my waters because my cervix was dilated too slowly. The baby was born early am of 26/12/6
6. Do you think there’s anything in your labour that affected PSD?
Yes definitely. I was pushing with 3 people pulling my two legs. I heard a cracking sound in left thigh/groin area when pushing. Then after the labour I found I couldn’t walk. I believe this caused my PSD.
7. What were the symptoms when you were diagnosed with PSD?
I couldn’t lift my legs hence couldn’t walk. I could only move my toes so I could move to the toilet.
My husband had to lift my legs to help me get into bed and out of bed.
He had to lift my upper body to help me sit up on bed
I couldn’t roll in bed. I couldn’t actually move in bed. I couldn’t lift my legs in bed.
8. What were the treatments you received?
The doctors in the hospital said they were going to do nothing about it.
I took Panadine Forte for 2 weeks then Nurofen and Panadol for about a month.
The physio from the hospital saw me while I was in hospital and gave me some bands to hold my pelvis together (it was public holiday period so she couldn’t get a pelvic belt). She sold me a pair of crutches so I could walk. She also gave me a sheet to tell me how to take care of myself in activities, such as keeping my knees together all the time and going backwards when on stairs.
A week later I went back to see her and she sold me a pelvic belt so I could hold my pelvis all together.
I went back to see her at 6 weeks, 7 weeks and 9 weeks postpatrum for my back pain.
I went back to see her at 10 weeks and another physio suggested very gentle ball exercises. And suggested to see Registrar.
The registrar referred me to see Orthopedics surgeon. I’m due to see him at 13 weeks.
9. How have your recovery been?
Week 1: I could walk very slowly with crutches. I could walk on stairs by going backwards one step at a time. It was very difficult to get into and out of car.
Week 2: I could manage to get in/out of bed myself, although very very painful. Tried to sleep on tummy for a little while, because too hot/painful to lie on back for long time. Except for toilet and meals, all my time was in bed. With the help of the pelvic belt, I could lift my leg for like half a centimeter from the floor and had to put it back onto the floor in half a second. Still in a lot of pain from the very swollen vagina area and the pelvis. Really difficult to cope with the pain without pain relief (even my labour was a drug free one). Have been having Panadine Forte since the childbirth. End of the week I was able to walk without crutches or belt, like a penguin. When coughing still very bad pelvic pain.
Week 3: I started walking without crutches as physio said better not rely on crutches so can recover sooner. I walked downstairs for the first time (except having to go to the appointments). Walked without crutches all day. Found the two sides of the pubic bones were not even: one seemed to be more out than the other. GP said no lifting, and the uneven bone maybe due to swelling or bone sliding during birth.
Week 4: I can walk forward on stairs now!!!!!
Week 5: I can walk on stairs continuously, not one step one rest, and don’t have to hold my breath. First time to wash dishes after the childbirth. And went to the shops across the street for a little walk
Week 6: still too painful to do pelvic floor exercise. Went to shopping mall. Very very tiring and painful. There’s still a long way to go.
Week 7: stopped pain relief. Painful lower back. I believed it was because I was trying so hard to walk, that I pull the muscles in my back too hard and they got strained. Physio did some treatment and gave me an exercise to toughen my tummy muscles. For the first time after the birth, I drove to my friend’s place which is 10 minute away and stayed there for 1 hour.
Week 8: can sleep on my side for a little while. The lower back pain got better.
Week 9: admitted to hospital for mastitis. No progress in pelvis this week.
Week 10: Upper back was painful. I guess it was from the tummy muscle exercise: lying on my back and bending my knees, lifting my head and trying to touch my knees with my hand. Was told to put a rolled towel under upper back when lying for 2-5 minutes a couple of times a day.
Week 11: physio advised to try exercise ball to tighten my tummy muscles. Still not much improvement.
Week 12: lower back very painful. Read some articles and realized that it might be a symptom of PSD. I feel when I walk without the belt it’s like my pelvis is wiggling. I finally decided to get a disability sticker.
Week 13: it’s less painful to roll in bed now and I can sleep on my sides for most of the night. Lower back is still very painful and hard to sleep because of this pain.
Week 14: I’ve been able to sleep on my sides most of the nights. Lower back pain has been less because I haven’t slept on my back a lot. Walking is better too but long walk (eg. 1 hour) can still cause sharp pain in pubic area. It would still feel like something’s trying to break/tear that area and come out. Once I make more movements like up and down stairs a lot carrying bub this sharp pain can come back too.
10. What have you found helpful for your recovery?
My physio’s advice: to try to walk without crutches when possible, to keep my knees together, to wear the pelvic belt.
11. What do you think aggravates your condition?
Doing housework, like washing dishes, doing laundry.
Parting my legs.
Tripping over something.
Being too tired.
The ligament between my Pubic Symphysis was torn. It was what I was told by my physio over 3 years ago after I had my first baby. Months later when I found I was still in pain and disabled, I found this 'Pubic Symphysis Diastasis' on my discharge sheet from the hospital. I started doing my research, found little information. I met a few people over internet who had similar problems, only one had exactly the same experience as I did. I started a yahoo group and invited all these people to join and discuss these conditions. Then I started to feel really depressed so I gave up talking about it.
Now I'm setting up this blog aiming to help others who experience the same or similar problems. I also have another blog in Chinese which I aim to have exactly the same information as this blog. http://blog.sina.com.cn/allawahj
My plan is to post all the information I collected on this blog so anyone can view it.
I'm also thinking of doing more research and posting new information and links in the blog, but it's a daunting task which I might need to find a lot of time to do. So it's just a thought at the moment.
You're welcome to post comments, with your collections of information and experience or discuss anything related to Pubic Symphysis problems.