PN diagnosis after childbirth... help

[H0ff0211]

Hi there I am new to this group. I am a 25 year old female. I was diagnosed with PN after giving birth to my daughter 5 weeks ago. I had a hard delivery (pushed for 3 hours and then a vaccuum) and then had an infected hematoma develop high up in the vagina 5 days postpartum which needed to be drained and stitched up. After waking up from the draining surgery, I had intense blood curtling sharp pelvic pain that lasted 3 days. I was on a hydromorphone PCA in the hospital, catheterized, and couldn't even bare to lay on my back because the pressure in my vagina and rectum was too overwhelming. After my pain was more manageable on oral narcotics I was sent home on gabapentin. I am now 5 weeks postpartum, I have better days and bad days.. but the bad days are really bad. I cannot stand for more than 15 minutes at a time. It is painful to sit to breastfeed my baby, and I have a constant urge to pee that never goes away, even after trying to empty my bladder over 15 times in 15 minutes. I am finding it very difficult to do anything, and I not only have to take care of myself but also my newborn baby. I have bad guilt for taking the gabapentin as it is not completely proven to be safe while breastfeeding. After doing some research I have booked in with a pelvic floor physiotherapist. I am trying to be optimistic about the future but i am becoming depressed. I am finding it difficult to understand if what I have is PN or PNE? My OB GYN has never seen this before. I am wondering if anyone else has been diagnosed with PN after childbirth and did they ever make a full recovery and when did symptoms improve? Any advise would be helpful.

[Andy_Pablo]

Hi there. I am so sorry that you are struggling so badly. They certainly diagnosed you quickly, which could be quite positive as catching this early can help with any potential healing. I just hope they haven't misdiagnosed in their haste. Getting into a PT is a positive step. Any efforts you can make that arent surgically invasive is a good thing. Hopefully, the PT will help calm things down & put you on a road to recovery. I wish you good luck.

[Violet M]

It would extremely difficult trying to take care of your baby when you are dealing with dreadful symptoms yourself. Yes, there are other women who have been diagnosed with PN after childbirth. Celeste, who used to post on this forum recovered well. Wendy7 who used to post here is doing better but isn't cured. I can't say for sure if you might have PN or PNE but hopefully it is something that will settle down over time with the right treatments. I think you are on the right track getting an appointment with a pelvic floor PT although be careful to make sure it is someone who also treats pelvic pain and who is familiar with PN/PNE so they won't have you do things that could make the problem worse.

I'm curious where the sharp pelvic pain was after the stitching from your hematoma being drained. Is your pain primarily on one side? Your PT should be able to determine from the pelvic landmarks if it is anywhere near the pudendal nerve. There have been cases where the pudendal nerve has been accidentally stitched. I am just wondering because your pain was so immediate and severe right after the procedure. I don't know how deep your hematoma was or at what location in the pelvis but hopefully your PT will be able to tell you if it is anywhere near where the course of the pudendal nerve is -- at the ischial spine or in the alcock's canal. That is a question I would ask of both the PT and the obgyn who drained the hematoma and did the stitching.

Violet

[H0ff0211]

Thank you for the replies. Short update on my case - I am now 8 weeks postpartum and my PN symptoms have drastically improved. I'm off all pain medications, including gabapentin. I am able to tolerate intercourse and sitting (as long as the seat is sufficiently padded). The bladder urgency and frequency has slowed down. I'm still feeling heaviness in my pelvis and a sense of pressure in my vagina and rectum. A few times a day I feel a "zing" of pain up into my vaginal and down into my groin. Some days are better than others. I have also been feeling a tender tail bone.

Violet - I did ask my OBgyn about the location of the stitches, she said it would be extremely difficult to suture the nerve based on the location of the tear. In 3 weeks I think I have made pretty decent progress in my recovery however i am still feeling the effects, and I am nervous about the future. I have started to see a pelvic of physiotherapist. She claims to be familiar with PN. She has me doing 9 kegel exercises a day due to my bladder "hanging lower" after delivery. Are kegels safe with PN? I have read that they can make the problem worse which I am worried about. Also, if I do make a full recovery... in 2 years or so, do you think it would be wise to have another vaginal delivery? I have yet to find a PN specialist around where I live. From what I've read, c-section is reccomended, but if I do recover I wonder if this will happen again.

Thanks!

[Violet M]

H0ff,

Glad to hear you are feeling somewhat better.

I started having prolapses after my 2nd child and started doing kegals. I worked up to 300 a day. I can't say they ever really helped with the prolapse symptoms. I was told by my gyn that most likely I had a genetic collagen deficiency causing the prolapses. I have since seen peer reviewed literature confirming that prolapses at a young are likely due to a genetic collagen deficiency. It wasn't a weakness in the muscles as much as it was bad ligaments not holding things in place. I don't think the kegals caused PN but they certainly aggravated it once I developed PNE.

So, I guess what I would ask your PT, is whether your pelvic floor muscles are tight, tense, or overly contracted. It they are already tight and overly contracted I would be very cautious about proceeding with kegals which are only going to make those muscles more tight and contacted. The goal is to get the muscles to relax if they are overly tense. If your muscles are already relaxed then maybe it won't be a problem to do a few kegals but I can't say for sure.

There aren't any studies that I am aware of that show the risk/benefit analysis of whether c-section or vaginal delivery is safer for women with PN. Personally, I would probably go for the c-section after experiencing what you described above. I would not be brave enough to risk having that kind of pain come back, but maybe I am just a pansy.

Take care,

Violet