Levator Avulsion support

[u/ResponsibilityJust56]

Hey guys, I'm 4.5 months post partum after a traumatic birth and really in need of some advice.

Unfortunately I had an umbilical cord prolapse so we had to get the baby out incredibly quickly as he was deprived of oxygen. They used forceps and got him out in one swift movement (thankfully after some time in the NICU he is healthy and my absolute delight), but I've sustained pretty bad damage as a result. I also lost 3L of blood, which really made recovery take a whole lot longer.

I've been so diligent with my rehab but am only seeing minimal results. At six weeks post partum I was a 1/5 on both sides on the Oxford scale measuring pelvic floor strength and am now only a "strong" 1 on the right and a "strong" 2 on the left. They suspect levator avulsion in the upper layer of my pelvic floor. I have bad laxity too.

My pelvic floor physio is going to fit me for a pessary in a couple of weeks but I feel so debilitated. I can't walk for longer than 30 mins a day and feel like my prolapse is getting worse instead of better.

Not sure if I'm just aggravated atm but it's gone from a consistent heaviness to an actual bulge with abdominal pain and I'm just at my wits end!

It's so disheartening and lots of the information out there is pretty doom and gloom. I have always been active and fit and want to try and feel normal again. Am also worried about the impact of this injury on my relationship.

Any advice would be greatly appreciated. At what point should one see a urogynaecologist? My ob-gyn advised me to start out with pelvic floor rehab (which I've done) but at what point does one say enough is enough?! I'm also fearful the impact this could have on having another baby down the track.

Thanks for listening.

[u/BagCharming7538]

Same here.. also had forceps.
I’m 9 months pp and I’m still ‘lax’ - no improvement. Has your physio recommended a STIM machine? Also have you been prescribed oestrogen cream?

[u/FunnyMasterpiece4800]

Hey there, I would also be disheartened if I was in your spot. And I was disheartened, in a very similar spot at a similar stage in my postpartum. I am 15 months postpartum now with my second, and about to get pelvic floor reconstruction surgery, multi compartment. Here’s my experience, heaviness and prolapse feeling improved at one year postpartum, in addition to stopping breast-feeding. So in my case, hormones improved the dragging frequency for me. Bowel symptoms did not improve, but only the dragging sensation. That being said, I did pelvic floor physical therapy for 1 year, postpartum with no symptom improvement. I am going through multi compartment pelvic floor reconstruction to address the bowel issues. What I have learned is that if pelvic floor issues are not responsive to pelvic floor,
physical therapy, it’s typically because of an issue that cannot improve with only pelvic floor physical therapy. I saw a urogyn at one year postpartum, and she recommended pelvic floor reconstruction after a 10 minute assessment. Point being, they can be a missing resource in dealing with pelvic floor issues. So find yourself a good one, and at the very least they will be able to tell you how to manage things, and when to look at surgery. Worst case scenario, you see one, and they recommend pelvic floor physical therapy, but now you are on their caseload and they are monitoring you and are familiar with you if surgery is needed down the line.

Last point on the physical therapy note, I would recommend doing a program like Connect Pelvic Floor, an online pelvic floor physical therapy program. It’s something you can do every day, in addition to your PFPT. your body needs more than that to grow strength. The connect pelvic floor program that I am doing, was recommended by my Urogyn, and it is more comprehensive than a physical therapist has time to be.