Wednesday 20 March 2019

Dear Dr Nina: 'I gave birth two years ago and the scars from my stitches still hurt'

Photo posed
Photo posed

Nina Byrne

Dr Nina Byrnes answers your medical queries in her weekly column.

Q: I gave birth to my son three years ago and it was quite a traumatic delivery. I tore significantly - or I was cut; I had an epidural so don't really recall what happened. As a result I had to get stitches post-delivery. I don't know how many stitches, but I do remember that it took a long time to stitch the wound up, and the doctor had to call in someone else half way through as he got tired. Three years later and it is still sore around the scarred area at certain times. When I have sex, it hurts and also when I have my period. It feels like the scars are not only on the perineum but also into the vagina. Is there any surgery or laser treatment that could make me normal again?


A: Vaginal birth carries with it a risk of a number of complications, all of which can have short- or long-term consequences. Immediately after childbirth the vaginal and perineum (the area between your vagina and anus) tissue are traumatised, swollen and sore. Some women may not need any stitches but many do.

An episiotomy is a cut performed by the midwife or doctor to increase the diameter of the vaginal opening, allowing the baby's head to pass. This will require several stitches and it leaves a linear scar.

Thankfully, in most women, the tissue heals over time and they suffer no long-term consequences from the birth trauma. Recovery for most is within two months. For others there may be ongoing issues.

The first weeks after childbirth can be particularly uncomfortable while the scar is healing. Passing urine may sting and bowel motions my be difficult.

It is important to avoid getting constipated as straining is not only painful but stresses the healing wound. Infections may also occur. If the wound becomes increasingly painful or if there is unusual discharge an infection may be present. This can reduce healing and needs to be treated. Your GP can examine you and prescribe antibiotics. Rarely, readmission to hospital is required.

Urinary or faecal incontinence is relatively common immediately post-childbirth but it can be prolonged or persist in some. Doing Keggel exercises or using devices such as Innovo that help strengthen the pelvic floor will improve pelvic tone and can help incontinence issues. If you have had a significant muscle tear then incontinence is more likely.

Prolapse of the bladder womb or bowel into the vagina is most common in those who have had very large babies or multiple births. Those who are obese are also more at risk.

With each pregnancy the pelvic floor muscle gets stretched. If pregnancies occur close together the time to heal and tighten is reduced, increasing the chance of pelvic floor issues. If this has occurred, surgery which lifts the pelvic floor or repairs the front or back walls if the vagina may help improve the problem.

Sexual problems post-childbirth are not unusual. Many women are quite traumatised by the process of childbirth and it may take some time for them to even think of trying to have sex again after giving birth. Libido may also be strongly reduced in new mums, who find their days become a sea of feeding, changing and sleeping. It is a wonder how anyone turns around and does it all again, and yet we do.

It is important that you can feel back to yourself and engage in a healthy sex life. Feeling comfortable during sex and having a healthy body image is important for this. It sounds like your birth experience was traumatic. If you are finding sex painful and you feel there is significant scar tissue, do ask your doctor for referral. There is a procedure called a perineoplasty or vaginoplasty which can help repair perineal laxity, scarring and trauma, aiming to restore the tissue as near as possible to its pre-childbirth state.

Does massage really release toxins from your system? 

Massage therapy history dates back thousands of years to ancient cultures that believed in its medical benefits. The first written records of massage therapy were found in China and Egypt.

Massage therapy traditions were first documented in India, but the practice may have originated around 3,000 BC or earlier. Hindus used the art of healing touch in the practice of Ayurvedic medicine.

In the early 1800s a Swedish doctor, Pehr Henrik Ling, developed a method of movement known as the “Swedish Movement System”. It is regarded as the foundation for the Swedish massage technique. Japanese Shiatsu massage and Swedish massage are the most common types of massage practised in the western hemisphere today, where it is still a popular form of healing.

Who doesn’t enjoy a good massage? It can release tension, ease aching muscles and help you relax. Internally, massage therapy can help reduce blood pressure and stress hormones, and increase endorphins, our natural feel-good response. There is no evidence, however, that it releases toxins from the system. Our bodies cope with toxins in other ways.

The best way to avoid a build-up of toxins is to eat a healthy unprocessed diet, to exercise regularly and to drink plenty water. Avoid toxins such as caffeine, alcohol, drugs and cigarettes.

Our liver, kidneys and bowel are the body’s natural waste processing symptoms. Keep fluids going in and out and your kidneys will function well. Eating plenty fibre and being active will keep food moving through the gut, ensuring normal health bowel motions. If you really want to boost toxin-fighting power, focus on living and eating well.

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