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 14:23:58 -0500 (CDT)

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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

--
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: R. Daniel Braun, MD: "Re: When do your breasts start feeling 'heavier' and 'fuller'?"
Previous message: Michele: "Pelvic pain at 26 weeks"
In reply to: Mandy: "Query - pelvic nerve damage"
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Reply: concerned: ": Query - pelvic nerve damage"

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