PREGNANCY-BIRTH Messages for September, 2000: Re: : Query

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Re: : Query - pelvic nerve damage

From: R. Daniel Braun, MD (anonymous@obgyn.net)
Sat, 30 Sep 2000 19:41:15 -0500 (CDT)

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In reply to: concerned: ": Query - pelvic nerve damage"

At Sat, 30 Sep 2000, concerned wrote: >
>At Sat, 30 Sep 2000, R. Daniel Braun, MD wrote:
>>
>>At Sat, 30 Sep 2000, Mandy wrote:
>>>
>>>Over 8 years ago I had a traumatic delivery of my firstborn. This ended
>>>with a major left lateral episiotomy cutting through the pelvic floor
>>>muscles.
>>>Afterwards I was aware that the left pelvic floor muscle was not
>>>working. 18 months later I found a competent gynae who prescribed
>>>electrical stimulation of the pelvic floor. This worked and once again
>>>I had full muscle control.
>>>After normal birth of my second child muscle control of the left side
>>>has gone again. RESULT - one pretty fed-up female. In addition a
>>>certain amount of sensation on left vagina has also disappeared.
>>>Treatment so far. 1. Condescending treatment by a gynaecologist who
>>>put my reactions down to PNI and being female (???!!!!). 2.Visits to a
>>>physio with interest in incontinence. Her prescription of electrical
>>>stimulation of muscles plus biofeedback gave no results and SHE gave up.
>>>3. My purchasing an expensive electrostumulation machine. After 6
>>>months no result.
>>>Am about to see another gynae and would appreciate some INTELLIGENT
>>>guidance as to 1. Am I talking about the correct nerve?
>>
>>A mediolateral episiotomy seldom cuts any nerve but it does cut some
>>muscles. Once muscles are cut they seldom can be repaired well. The
>>exception to that is those muscles that have a fibrous sheath around
>>them. The ones cut by a Mediolateral epis. do not. This is one reason
>>most of us went from mediolateral to midline episiotomy many years ago.
>>However midline can be associated with fecal incontinence and other
>>problems as well. Every time one does something, there is a bad effect
>>as well as a good effect.
>>
>>2. Any other
>>>questions I should be asking?
>>
>>Possibly referral to a urogynecologist with training in pelvic floor
>>disorders.
>>
>>RDB
>>
>>I'm not being sarcastic here but, what does "seldom can be repaired well" mean? How would one know if they were repaired not well? Would it be worse with each delivery?
>What is a fibrous sheath?
>

It means that no matter how hard one tries, it is very dificult to get the muscle to heal together. A sheth of fibrous tissue on the outside of the muscle. If there is one, you can sew the sheath back together and this will hold the muscle edges together so they will heal.

RDB

>
>--
>concerned
>>--
>
>>R. Daniel Braun, MD FACOG FOG
>>
>>This is for educational purposes only, and is not intended to be replacement or substitute for consultation and examination by an appropriate medical professional. Due to time constraints, private e-mails cannot be answered.
>>

--
R. Daniel Braun, MD FACOG  FOG

This is for educational purposes only, and is not intended to be replacement or substitute for consultation and examination by an appropriate medical professional.  Due to time constraints, private e-mails cannot be answered.

Next message: Kelly Shanahan, MD: "Re: Pain/Pressure."
Previous message: R. Daniel Braun, MD: "Re: swollen left breast on 31 weeks pg"
In reply to: concerned: ": Query - pelvic nerve damage"

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