The other "end" of my Pelvic Floor/Core rehabilitation

Okay, survey says:

Tell us specifically what you learned in physical therapy!

All right, all right! I'll tell you, I promise...

But first, you really should know that you still haven't read half of what's been bothering me. I didn't want to overwhelm you, but even I didn't even realize how many symptoms I had that could be addressed in Pelvic Floor/Core rehab until I was asked to sit down and fill out the new patient questionnaire.

I have already told you about my urinary issues, but not the um, my rectal difficulties. "Thank goodness!" I thought several times while checking boxes on the survey. I didn't have to check off a lot of the boxes next to any of the problems concerning sexual activity. I felt grateful not to have to admit to peeing on myself while sleeping or having sex, and thankful not to suffer from chronic pain of any kind, or to have parts of me hanging out that shouldn't be.

I had noticed that several things were not returning to "normal" after my third child was born, including some issues with my rectum. This is so uncomfortable for me to write about that I feel the need to indulge in a tangent before I proceed.

The baby himself was practically perfect in every way. Actually, his eyes were very bloodshot at birth and the pediatrician who saw him his first office appointment said it was because I had pushed him out so hard and fast. When I tell people I pushed my ten pound baby out very rapidly because I was very angry, they usually say something like "No doubt you were, honey!"

This is a misunderstanding I usually don't bother to correct. I hadn't been angry at the usual suspects: not at the baby for being so big, nor at myself for getting into this situation a third time, not at G-d, my husband, or life in general. No, it was a very specific anger directed at one D. Schwartz, M.D. who, 6 hours after I had checked into Christ Hospital in active labor, began his on-call duty by sticking two latex covered fingers into my vagina, first, to break my water and then, to measure how dilated I was: "only 8". Next, he palpated my belly to estimate the size of the baby I was about to deliver, and rather breezily announced that he was going to scrub up and would see me across the hall, because the baby was "too big" and he was going to perform a Caesarean section.

My birth plan was to deliver this baby naturally. I was a big fan of the Bradlee Method, having used it to deliver 9 pound, 12 ounce Sam two years previously, and I had been looking forward to a repeat performance. The two pregnancies had been virtually identical, and the babies had almost the same exact due date, just two years apart. The only differences I could detect were that this baby was a bit more vigorous in his movements in utero, and he seemed to be in much less of a hurry to come out. Sam had us racing to the hospital almost two weeks before my due date, and then he was born within two hours of our arrival there. Now, Isaac was four days past due, and so big and heavy that I had been going in for a check every other day for two weeks.

I had deliberately met with and been examined by everyone in the obstetrics office but Dr. Schwartz, so naturally the one doctor in the practice who was unfamilar with my pregnancy was the one to show up for the birth. Now, I was so upset by his casual dismissal of my birth plan that I became enraged. I announced my decision: I would stay put and continue to labor naturally. Then, a moment later, I said "I'm going to have this baby now," to which Paul and the nurse replied sweetly, almost in unison, "that a girl, yes, you are, now that's the spirit" or something to that effect. "No," I said, "I mean RIGHT NOW! I mean I have to push. Please, help me! Hold my legs! The baby's coming out right now!"

Someone was dispatched to tell Dr Schwartz to put on his catcher's mitt and get back to my room. Indignant, I decided I would have someone else catch this baby before he even had time to double back down the hallway. And then, in a sort of tantrum, I pushed with all my might and pop, out came the head of an angry, ten pound two ounce brand new baby boy. I only knew Dr. Schwartz was there because he said "this isn't a newborn, it's a three month old!", and I said "maybe in YOUR family, Dr. Schwartz, but in my family, that's what a newborn looks like." Then he told me that he had cut me "just a bit" to help the baby come out and that he was sewing me up and apologized if it hurt. "Believe me," I said "what you are doing is NOTHING compared to what just happened" which led to this part of my story being misundertstood for the first time.

When you first return home after having vaginally delivered a baby, you may have stitches, as I had. But whether or you not you have had a episiotomy or a tear, or simply stretched yourself to the limit and beyond, you are certainly going to be very tender. Passing the first bowel movement after childbirth is consequently a rather dreadful thing. Mine was no exception. It was not only scary; it was stuck. Very gingerly, I inserted a finger into my vagina and felt my bowel pressing against my vaginal wall. I pushed tentatively and was relieved to feel the obstruction give way, as the bowel movement continued in a proper, downward direction.

The next day, I repeated the same maneuver, helping to guide the bowel movement down and out of my body by gently applying pressure from inside my vagina.

Eventually, waste began passing out of my rectum without manual assistance. But now and then, by which I mean very often, the obstruction would reoccur, and no matter how much I strained, it seemed the stool would not pass through my rectum unless I stuck a finger into my vagina to help it along. It is almost unbelievable that I continued to utilize this "digital" system for so many years without telling a doctor about it. I think we generally have so much shame about our bowels that it is difficult to talk about them. Considering that I am one of those people who doesn't let my spouse enter or remain in the bathroom when I need to use the toilet, it makes sense that I would be reluctant to have a conversation about my toilet related activity with anyone.

Certainly, it is very odd and uncomfortable to be writing about this now, but I am inspired by the idea that I might help someone (or more than one) who is silently suffering as I recently was, unaware that this is a common condition called a rectocele.

When I returned home from seeing the urogynecologist, I didn't even know how to spell rectocele. I typed "rectoseal" into the search bar on my computer and eventually discovered the following definion on the Mayo Clinic website:

A rectocele occurs when the thin wall of fibrous tissue (fascia) separating the rectum from the vagina becomes weakened, allowing the front wall of the rectum to bulge into the vagina.

Reading more, I felt fortunate to understand that my rectosele was fairly mild. Some more severe rectoceles require surgery. In some cases, rectal tissue may obtrude from the vaginal opening, and some are quite painful. While I cannot entirely reverse or "cure" the damage caused by the tremendous pressure that was exerted on the fascia during childbirth, I hope to effect a significant improvement through my work in physical therapy. In addition to tightening and strengthening the muscles that control the sphincter of the bladder, I also hope that by doing repeated pelvic floor exercises, I will strengthen the pelvic floor muscles that wrap around the underside of my vagina and rectum, giving support to both.

I promise to tell you about the specifics of my first pelvic floor therapy appointment, and my homework assignment, in my very next post. Please stay tuned.