PINEHURST, NC -- Following pelvic floor injuries sustained during the birth of her second son, former FirstHealth of the Carolinas nurse Laura Fong, R.N., BSN, thought enduring pelvic pain, discomfort and incontinence would be part of her life. After meeting with FirstHealth urogynecologist Janet Harris-Hicks, M.D., she realized that was not the case.
Fong tells her injury and recovery stories now as part of Pelvic Floor Disorders Awareness Month, an effort in October to make women and their families aware of issues concerning the pelvic floor, the muscles, ligaments and connective tissue that support the bowel, bladder, uterus, vagina and rectum.
Fong encourages other women that relief is possible after a pelvic floor injury. “I want women to know that the symptoms they are living with do not have to define their future,” Fong said. “With help from experts and work on your part, you can reclaim your body.”
Home from the Hospital with a New Baby, Pain and Unanswered Questions
After giving birth to her first son by emergency Caesarean section, Fong opted for a vaginal birth for her second. Vaginal deliveries can result in injury to the muscles of the vagina and rectum. Injury can occur from pressure as the infant passes through the vagina causing direct injury to surrounding muscles, direct injury to surrounding muscles during an episiotomy or extension of vaginal tears into the rectum. Laura sustained multiple injuries to her pelvic floor. Even her obstetrician said he had never seen tears like hers.
Fong went home from the hospital with a new baby, stitches and intense pain. Just walking across the room took her breath away. However, since this was her first vaginal birth, she thought the pain was normal, and she was simply, in her words, a “wuss.”
“Many of my friends had experienced vaginal births and seemed to hop up and get back to normal within a few days,” Fong said. “I swallowed my discomfort and truly thought my pain was a ‘me’ problem and not an actual, significant pelvic floor injury.”
At her six-week postpartum visit to her OB/GYN, she learned that her tears had healed, and everything looked fine. However, the pain remained. She couldn’t sit on a bicycle or wear jeans. “Anything that put pressure on that area was unbearably uncomfortable,” she said. Her lower back and hips were also horribly tight and painful.
Fong requested another appointment with her OB/GYN with similar symptoms. After another exam, she was sent away with a clean bill of health and no answers. “I was so discouraged and figured I would feel like this forever,” Fong said. “I wondered if many women experience this and just silently deal with it.”
She also “felt off” and thought perhaps her bones had shifted during pregnancy and birth. She went to a chiropractor for several adjustments, hoping to start feeling like herself. No luck. “At four months postpartum, I was really struggling,” she said.
As a registered nurse, Fong is well acquainted with human anatomy. “Externally, I could feel that my vaginal wall had collapsed,” she said. She later learned that her bladder had prolapsed, meaning the support between the vagina and the bladder had failed, causing the bladder to fall from its original position. The vagina, which is usually a canal, was almost closed.
After maternity leave and coming back to work on FirstHealth Moore Regional Hospital’s pediatric floor, Fong explained her situation to fellow nurse Alexandria Ross. Soon after, Ross completed graduate school to become a nurse practitioner and joined board-certified urogynecologist Dr. Harris-Hicks. Urogynecology is a medical specialty that combines urology and gynecology, focusing on evaluating and treating non-cancerous conditions of the female pelvic organs and their supporting muscles and tissues.
At seven months postpartum, Fong received a text from Ross, “Laura, about your situation. Dr. Harris-Hicks and I can help you. This is the lead you’ve been looking for. Make an appointment now!”
Dr. Harris-Hicks completed a full pelvic evaluation, looking at the pelvic organs and how there were positioned in Fong’s body. She also evaluated Fong’s pelvic floor muscles and determined they were hypertonic, meaning that they were constantly rigid and tense.
Fong learned that her internal tear extended from her cervix down the full length of the vagina. She also had sustained tears on both sides of her labia. This tearing resulted in substantial injuries to her pelvic floor. “I learned that the connective tissues supporting my bladder, uterus and rectum were just obliterated during the birth process,” Fong said.
Dr. Harris-Hicks diagnosed Fong with pelvic organ prolapse of her bladder, uterus and rectum. Prolapse means these organs had dropped from their original position. Now her pain, discomfort and feeling “off” were making sense. Dr. Harris-Hicks laid out a plan for Fong’s recovery.
“That first appointment with Dr. Harris-Hicks didn’t alleviate any pain, but it was so healing to be validated that my discomfort was actual damage from the birth and wasn’t just me not being able to cope,” said Fong. “It was actually my body begging for help.”
Understanding Pelvic Floor Disorders
Pelvic floor disorders (PFD) like Fong’s are common, affecting close to one in four American women. Many women suffer from more than one PFD. Types of PFDs include:
- Urinary incontinence or leakage
- Fecal incontinence, also called accidental bowel leakage
- Pelvic organ prolapse
- Overactive bladder, a frequent and sudden need to urinate
- Painful bladder syndrome, also called interstitial cystitis
A PFD can result from weakened pelvic muscles or tears in the connective tissue due to excessive strain on the pelvis from childbirth, strenuous activity, menopause, chronic disease or pelvic surgery. Other factors that can weaken the pelvic floor include repetitive heavy lifting, tobacco use, obesity, genetics and the natural aging process.
Treating Pelvic Floor Disorders at FirstHealth
“Pelvic floor disorders can cause embarrassment and negatively impact a woman’s quality of life,” said Dr. Harris-Hicks. “It doesn’t have to be this way. Options are available for relief.”
FirstHealth Urogynecology, comprised of Dr. Janet Harris-Hicks and Alexandria Ross, FNP-C, cares for pelvic floor disorders with a wide array of treatments, including:
- A pessary, a soft, flexible device placed in the vagina to help support the bladder, vagina, uterus, and/or rectum. Pessaries are made of silicone and come in all shapes and sizes for comfort.
- Pelvic floor physical therapy, which can improve the pelvic muscles’ strength, endurance and flexibility. “Physical therapy can help to release any trigger points or taut bands of tissue, which may be causing pain,” said Harris-Hicks. “It can improve the stability and support of the pelvis, allow a woman to have more normalized sexual function and give her the ability to void regularly and/or have regular bowel movements.”
- Medicine injections to relax overactive muscles.
- Surgical procedures that can effectively and permanently treat some types of PFD. Many procedures are offered using minimally invasive techniques.
Fong’s Return to Normalcy
The first steps of Dr. Harris-Hicks’ plan for Fong’s recovery from pelvic organ prolapse included dry needling of her hips and physical therapy for her pelvic floor. “Because my pelvic floor muscles weren’t functional, my hips kicked in to support the organs,” said Fong. “The hips aren’t designed to do this job, so they became very tight and painful.” Dry needling helped her hip muscles calm down.
Fong could then focus on restoring her pelvic floor through physical therapy. Since her pelvic muscles were hypertonic and always in a spasm, her physical therapist showed her exercises to relax them. Other exercises helped strengthen the muscles.
“With physical therapy, I was feeling 70% better,” Fong reported. “My body felt so much closer to the one I had prior to birth.” However, she still had some tender places in her pelvic floor.
Dr. Harris-Hicks located several pelvic floor trigger points and injected them with pain medication and anti-inflammatory medication. “Just like dry needling for my hips, the trigger point injections were able to take those super-tense, knotted-up portions of my pelvic floor and tell them to calm down,” Fong said.
At her son’s second birthday party, Fong finally felt whole. “I didn’t have any pain for the entire day, and I was just so thankful,” she said. “It was a long journey, but I’m so grateful because I know there are so many women who feel this sort of discomfort after birth and don’t know that helpful resources exist.”
Fong’s bladder is still prolapsed, so in the future, she will undergo a minimally invasive surgical procedure to permanently restore her pelvic floor support. However, now she isn’t experiencing symptoms, so there is no immediate need for surgery.
“I want women to know that they can feel like themselves again,” said Fong. “It might be a process, but women can reclaim what they once were. There are resources that can help in the journey. For me, the gateway to healing was FirstHealth Urogynecology.”
FirstHealth Urogynecology is located at 108 Endo Lane, Suite 1, Hamlet, NC 28345. For more information, call (910) 205-8909 or visit www.FirstHealth.org/urogyn.