Please help - itch and baby pain

[Maryslittlelamb]

Hi everyone,

I am new to the site and really hope you can share your experiences or offer me advice as this is making me feel suicidal at the moment.

I gave birth 4 months ago. It was a traumatic delivery as my baby had shoulder dystocia and a huge head measuring at 16 inches. My poor baby was stillborn. No instruments were used to deliver him but I had a 4th degree tear. It was fixed by a colorectal. Both obgyn as well as colorectal told me I would make a full recovery. However I'm starting to think that won't ever happen.

About 3 weeks after I started feeling a strange sensation like there was something up my rectum. Luckily that has subsided. However I get itching when I walk for for more than 15 minutes and sometimes when I walk at all. The other day I try to take a walk around town and I got anal stings. Like a salt in fissure or bee sting type sensation up my anus/rectum. It hurt so bad I didn't want to continue waking. I almost cried. I also experience a crawling ants type sensation when I sit down after I walk. I went to see a urogynacologist who dismissed me and said it was because I had surgery there and that I might have a hypertonic pelvic floor. She recommended me to see a pelvic floor fysio therapist, however the fysio therapist told me I don't have a hypertonic pelvic floor at all. I've been at it for 8 weeks now. The exercises are helping me become more flexibele but have done nothing for the itch/stingy pains.

It making me so horribly miserable and thinking I will never be able to go on a nature walk again, let alone have a living child.

Do you think the scar tissue from the tear or the stitching has entrapped the nerve? I'm only 32. I'm worried I will have this forever. I live in Belgium, Gent. Helpful for any advice.

[Violet M]

Dear Mary,

That is heartbreaking that you have lost your child. I am sending you hugs and my condolences.

Regarding the itching and the stinging -- is it all in the rectal area or does it include vagina, perineum, or clitoral area? The reason I ask is because there are 3 branches of the pudendal nerve -- the inferior rectal branch, the perineal branch, and the clitoral branch. If your symptoms are all in the rectal area, that could mean that just the inferior rectal branch is affected. If you have symptoms in the other areas that are innervated by the pudendal nerve (clitoris, perineum, and lower 1/3 of the vagina), then it is more likely that the main trunk of the pudendal nerve is affected.

Yes, it is possible that scar tissue or stitching could entrap the nerve. It's also possible that instead, you experienced a stretch injury or trauma injury of the nerve during the difficult delivery. When the physiotherapist presses on the pudendal nerve via the vagina, is it tender or painful there? That can be a sign of entrapment, especially if one side is worse than the other side. If sitting is painful, that can be a sign of entrapment.

Regarding your question on whether you will have this forever, the pudendal nerve is a peripheral nerve, so it can heal, but it might take a little bit of time. No one can say for sure, but I think there is a good chance you will heal, especially since you are so young, you have a better chance of healing.

You have several options for what you can do now, including just waiting to see if you will heal, or pursuing treatment by seeing a pudendal neuralgia specialist for their opinion. There are a couple listed on our website for Belgium https://www.pudendalhope.info/european-physicians/#BE although I am not sure if Dr. Beco is still practicing. The specialist might recommend a pudendal nerve block for further diagnostics. Sometimes MRI's are recommended but they don't always show anything helpful in the diagnosis. If the specialist tells you that you have an entrapment, you will want to ask a lot of questions, especially if they recommend surgery to release the entrapment. The reason I say that is because if you developed scar tissue from the original tear, you could be a natural scar tissue former. Before considering any type of surgery, you would want to know what, if anything, could be done to keep more scar tissue from forming.

It would be wise to see a specialist if you can, but if you decide to wait and see if you will heal over time, it sounds like you could use some pain management such as medications, including topical creams, and natural remedies like alternating hot/cold sitz baths which can be helpful in relieving the itch. Ice gel packs, heating pad, or vaginal/rectal suppositories can also be helpful. I used capsaicin (soothanol) to relieve the itch, but it can be pretty intense. It helped me get to sleep though. I think that you can get it in the form of a patch that you apply to your skin.

You do have some options, so please keep fighting. There was a time I was in such bad shape I didn't think life would ever be good again, but I am doing great now. So I think there is hope for you, but it might take a little bit of time.

Violet

[Maryslittlelamb]

Hey Violet,

Thanks for responding. It's only ano-rectal for me, not vaginal or vulvar or perineal.
And strangely it's only bad when I walk. Can it still be pudendal neuralgia?

[Maryslittlelamb]

Dear Mary,

That is heartbreaking that you have lost your child. I am sending you hugs and my condolences.

Regarding the itching and the stinging -- is it all in the rectal area or does it include vagina, perineum, or clitoral area? The reason I ask is because there are 3 branches of the pudendal nerve -- the inferior rectal branch, the perineal branch, and the clitoral branch. If your symptoms are all in the rectal area, that could mean that just the inferior rectal branch is affected. If you have symptoms in the other areas that are innervated by the pudendal nerve (clitoris, perineum, and lower 1/3 of the vagina), then it is more likely that the main trunk of the pudendal nerve is affected.

Yes, it is possible that scar tissue or stitching could entrap the nerve. It's also possible that instead, you experienced a stretch injury or trauma injury of the nerve during the difficult delivery. When the physiotherapist presses on the pudendal nerve via the vagina, is it tender or painful there? That can be a sign of entrapment, especially if one side is worse than the other side. If sitting is painful, that can be a sign of entrapment.

Regarding your question on whether you will have this forever, the pudendal nerve is a peripheral nerve, so it can heal, but it might take a little bit of time. No one can say for sure, but I think there is a good chance you will heal, especially since you are so young, you have a better chance of healing.

You have several options for what you can do now, including just waiting to see if you will heal, or pursuing treatment by seeing a pudendal neuralgia specialist for their opinion. There are a couple listed on our website for Belgium https://www.pudendalhope.info/european-physicians/#BE although I am not sure if Dr. Beco is still practicing. The specialist might recommend a pudendal nerve block for further diagnostics. Sometimes MRI's are recommended but they don't always show anything helpful in the diagnosis. If the specialist tells you that you have an entrapment, you will want to ask a lot of questions, especially if they recommend surgery to release the entrapment. The reason I say that is because if you developed scar tissue from the original tear, you could be a natural scar tissue former. Before considering any type of surgery, you would want to know what, if anything, could be done to keep more scar tissue from forming.

It would be wise to see a specialist if you can, but if you decide to wait and see if you will heal over time, it sounds like you could use some pain management such as medications, including topical creams, and natural remedies like alternating hot/cold sitz baths which can be helpful in relieving the itch. Ice gel packs, heating pad, or vaginal/rectal suppositories can also be helpful. I used capsaicin (soothanol) to relieve the itch, but it can be pretty intense. It helped me get to sleep though. I think that you can get it in the form of a patch that you apply to your skin.

You do have some options, so please keep fighting. There was a time I was in such bad shape I didn't think life would ever be good again, but I am doing great now. So I think there is hope for you, but it might take a little bit of time.

Violet

And is capsacin Spice?

[Violet M]

This article describes it and discusses possible adverse effects.
https://www.ncbi.nlm.nih.gov/books/NBK459168/
I used a diluted form of it and never had a problem. It was great for itch symptoms.

Violet

[Maryslittlelamb]

This article describes it and discusses possible adverse effects.
https://www.ncbi.nlm.nih.gov/books/NBK459168/
I used a diluted form of it and never had a problem. It was great for itch symptoms.

Violet

Did you use it in the genital area? Did it not burn like crazy?

[Violet M]

Did you use it in the genital area? Did it not burn like crazy?

Yes, but just externally - not internally. And yes, it burned for a few minutes but then there was a short window of time where it didn't itch and I was able to get to sleep. Alternating hot cold sitz baths were pretty effective too.

Violet

[onlysams]

I hope you don’t take this the wrong way but I wanted to tell you that I am really sorry to hear about everything going on with you. It is never pleasant to lose a family member or a friend and to add insult to injury, the itching and the pain sound so bothersome. That is so wrong that you are a subject of all these misfortunes.

Genuinely, I believe it’s imperative for one to insist on getting real answers. If it is not helping, go and see other doctors, the second, the third one, and so on. You need to feel good and be comfortable, and so it should be. Have you ever sought any treatments that succesfully made things a little better? It is quite often that one stumbles upon some sort of treatment for a problem before discovering what actually works.

[valentino88]

Hi everyone,

I am new to the site and really hope you can share your experiences or offer me advice as this is making me feel suicidal at the moment.

I gave birth 4 months ago. It was a traumatic delivery as my baby had shoulder dystocia and a huge head measuring at 16 inches. My poor baby was stillborn. No instruments were used to deliver him but I had a 4th degree tear. It was fixed by a colorectal. Both obgyn as well as colorectal told me I would make a full recovery. However I'm starting to think that won't ever happen.

About 3 weeks after I started feeling a strange sensation like there was something up my rectum. Luckily that has subsided. However I get itching when I walk for for more than 15 minutes and sometimes when I walk at all. The other day I try to take a walk around town and I got anal stings. Like a salt in fissure or bee sting type sensation up my anus/rectum. It hurt so bad I didn't want to continue waking. I almost cried. I also experience a crawling ants type sensation when I sit down after I walk. I went to see a urogynacologist who dismissed me and said it was because I had surgery there and that I might have a hypertonic pelvic floor. She recommended me to see a pelvic floor fysio therapist, however the fysio therapist told me I don't have a hypertonic pelvic floor at all. I've been at it for 8 weeks now. The exercises are helping me become more flexibele but have done nothing for the itch/stingy pains.

It making me so horribly miserable and thinking I will never be able to go on a nature walk again, let alone have a living child.

Do you think the scar tissue from the tear or the stitching has entrapped the nerve? I'm only 32. I'm worried I will have this forever. I live in Belgium. Helpful for any advice.

if physio isn’t helping as much as you hoped, maybe a pain specialist could offer different treatment options for the nerve pain and discomfort you're feeling

[Maryslittlelamb]

I hope you don’t take this the wrong way but I wanted to tell you that I am really sorry to hear about everything going on with you. It is never pleasant to lose a family member or a friend and to add insult to injury, the itching and the pain sound so bothersome. That is so wrong that you are a subject of all these misfortunes.

Genuinely, I believe it’s imperative for one to insist on getting real answers. If it is not helping, go and see other doctors, the second, the third one, and so on. You need to feel good and be comfortable, and so it should be. Have you ever sought any treatments that succesfully made things a little better? It is quite often that one stumbles upon some sort of treatment for a problem before discovering what actually works.

Thank you. I feel pretty unlucky too. It makes me wonder if I have some kind of bad karma. Did bad things to people that I am now being punished for by the universe. I don't know. It's unreal.

Nobody could have prevented my baby being stillborn, but my tearing could have definitely been avoided. My baby had hydrocephalus and an estimated 16 inch head. Obgyn insisted on a vaginal delivery because my baby had already passed and it would be better for healing. I voiced my concerns over his size but she seemed unbothered and told me scans are not always accurate. Well, they were. Combine that with coached, rushed pushing (don't know why they made me do that) and there was my 4th degree tear. I don't know if I'll ever get to a place where I can forgive my obgyn for her carelessness.

I haven't sought any treatment yet because I don't really know where to start. I've tried ointments but so far not working. Perhaps I should contact my GP and ask for a referral to a pain specialist.