QuestionSome years ago I had a foot of my intestines removed, and was told by my dr that I have pelvic floor disorder. I had bio-feedback physical therapy at Mayo Clinic to stengthen my pelvic floor, and continue to do the exersizes daily. I am only 21, but i am wondering what is the damage that even carrying the weight of a baby will do to my pelvic floor? (ps, i do plan to have C-section when I choose to become pregnant)
AnswerIt's hard to answer in your specific situation, because it is unusual and not something I can reference studies on. I can tell you that the fact of the removal of those intestines will have weakened the integrity of your pelvic floor. All the organs inside your pelvis are held together by a very intricate network of ligaments and fascia. Whenever any element is removed, it weakens the rest of the structure. This is why women who have had a hysterectomy often go on to have other pelvic prolapses.
Again, it's hard to say what the outcome will be in your situation. But you can mitigate the consequences by continuing your exercises. I don't know what the Mayo Clinic taught you to do, but if it doesn't include Kegels and pelvic rocks, add those into your daily routine. Aim for 100 Kegels and 200 pelvic rocks a day, split into 4 sessions.
Before you consider an automatic c-section, there are some facts you need to be aware of that could affect your decision. First, c-sections do not prevent pelvic floor prolapses. Studies following women many years after childbirth have found little difference between women who gave birth vaginally and women who gave birth by c-section. It is believed that it is the weight of the child, combined with the hormones of pregnancy (which are designed to weaken and stretch out your ligaments, in order to allow your pelvis to expand during birth) which are responsible for any pelvic weakness, not the act of giving birth itself.
Second, you already have a more delicate pelvic structure than most, due to your history. A c-section will create another incision through the fascia of your pelvis. The muscles will be dissected and pulled apart, the bladder will be cut away from the uterus, and often the uterus is completely removed from your body and placed on your legs or the table for repair, then replaced. All of this will create even more damage to the remaining support structures in your pelvis, and in your situation could potentially put you at even greater weakness for pelvic prolapse down the road. A vaginal birth, on the other hand, especially one in which you avoid active pushing as much as possible, will not displace, dissect, or otherwise rearrange your pelvic organs; it will merely stretch parts of your body that are highly elastic and meant to be stretched. It is possible to give birth vaginally with little or no active pushing on the part of the mother, allowing the uterus to do all the work with only involuntary pushing efforts to assist. Birthing in this way spares the extreme stress on the pelvic floor that active pushing creates, and allows time for the vagina and perineum to stretch gradually, decreasing the risk of tearing and decreasing postpartum recovery time.
Continue to do your own research, and be sure to consult multiple experts so that you can get a full range of opinion. Childbirth and pelvic health in particular are areas where practices and recommendations can differ wildly from doctor to doctor, and much of the practice is based on "we've always done that" or "this is hospital policy" (or worse, "if I do this I won't get sued") rather than actual medical evidence. When you have an unusual situation, as you do, you need to become as fully educated as possible on your own, so that you can be an active participant in your health care decisions.
I just wanted to add that there is a book that might interest you called Saving the Whole Woman, by Christine Ann Kent. It discusses the mechanics of pelvic structures and support along with natural ways to strengthen the pelvic floor and deal with weakness and prolapse. There are also forums connected with the book online where women can help each other.
