Brenna (Moderator) - 10:56 AM:
Our chat will begin in approximately 5 minutes. You can submit questions now or at any time during the chat.
Dr. Roger Goldberg (NorthShore) - 11:01 AM:
Hello everyone logging into today's webchat, I'm Roger Goldberg, director of the division of urogynecology at NorthShore. Today's topic is a special one for me, as it's the subject of a book I wrote and also of a good deal of research we've done at our center. Look forward to your questions.
Maria (Streamwood,Il) - 11:01 AM:
Hello, It's been 2yrs after having my second baby with c-section, and I was wondering is it normal to still have an occasional sharp pain, almost like a pulling sensation at the incision site with certain movements? The incision itself healed beautifully externally but im concerned with how it healed internally and if its cause for future concern?? Thank You for taking the time to answer questons!!
Dr. Roger Goldberg (NorthShore)
Certainly any abdominal incision - including cesarean - can cause certain symptoms that are slow to fully resolve. This can include occasional pulling, perhaps a sharp pain on occasion. The likelihood of any serious issue with your described symptoms is small, and symptoms like you describe sometimes linger for some time, then eventually fade into the horizon. Certainly if it's getting worse, or happening frequently, or inhibiting your quality of life / activity, I'd have your surgeon re-check the area.
Katie (Chicago, IL) - 11:04 AM:
Are there techniques I can use or request from my care team during labor to minimize vaginal tearing, nerve damage, and improve recovery?
Dr. Roger Goldberg (NorthShore)
Great question, and a big one to answer in a small chat space! There are some strategies you should be focusing on: (1) tone your pelvic floor with Kegels before any childbirth-related damage is done, (2) perineal massage might help in some cases, (3) discuss a labor and delivery strategy including consideration of "passive" labor where you'd delay pushing for a while until the baby descends, and (4) trying to minimize the use of forceps and vacuum, though it's important to note that these are in fact needed in some cases. Finally, if you have a VERY large baby, or very small pelvis, or other risk factors, then in some case the "hotbutton issue" of elective cesarean is worth discussing.
There is a whole chapter on "preventive obstetrics" in my book (Ever Since I Had My Baby, Random House 2003), covers these topics in detail.
Dr. Roger Goldberg (NorthShore) - 11:10 AM:
For women recuperating from childbirth, keep in mind the option of pelvic floor physical therapy. We work closely with our physical therapists here at NorthShore, and they're a great resource for rehabilitating muscles and tissues that have undergone change due to pregnancy and childbirth.
Betsy (Highland Park) - 11:10 AM:
How long should you really wait after pregnancy to exercise? If you are 4 weeks post pregnancy and feel okay, is it okay to start exercising? What damage could it do?
Dr. Roger Goldberg (NorthShore)
There's not a great deal of science to "prove" the right answer to this question. Regarding walking and general aerobic activity, I agree that resuming earlier (e.g. around 4 weeks, assuming you're feeling well) is a good idea for your overall health and well being.
However: my concern would relate to heavy weightlifting, excessive squatting, and very high impact activities, during a time when your pelvic tissues are still recuperating. The pelvic tissues (in terms of strength and tone) look very different at 1 month postpartum, compared to 3 months postpartum. So as a doctor and surgeon who deals regularly with women that have prolapse symptoms (and many of these women look back and wonder whether they could have done something differently to prevent the issues) my recommendation would be to err in the direction of caution until 3 months postpartum for heavier / impact / weight-lifting type of activities. Check with your obstetrician for sure!
Anonymous - 11:18 AM:
My wife gave birth to our first child four months ago. She says that sex is still painful for her but she says her doctor says we should just stay patient and wait for pain to subside. Is pain four months out normal? Is time the only remedy?
Dr. Roger Goldberg (NorthShore)
Sometimes a 'tincture of time' really is what's needed, and for sure, the perineum (tissues between the vagina and rectum) can be very tender and require more time in certain patients. Studies have shown that roughly 25% of women after 'normal' vaginal birth will still have some sexual complaint at 6 months --the good news is that many of these spontaneously resolve with time and patience.
A few specific thoughts: (1) if she's breastfeeding, this can cause dryness / sensitivity, and can be improved with use of vaginal estrogen cream, (2) obviously if you can use lubrication and avoid painful positions, then do so, and (3) if it's an exquisitely tender area, then be sure it's carefully checked because even after stitches are perfectly placed after delivery, occasionally tissues heal incorrectly and become tender. In rare cases, a quick surgical revision is performed. But the vast majority of cases improve with time, patience, lubrication, and perhaps some estrogen cream.
Skokie ACC (Skokie, IL) - 11:25 AM:
What's your best advice on losing weight after baby or better yet in general?
Thanks, for help and advice!
Dr. Roger Goldberg (NorthShore) - 11:35 AM:
As a urogynecologist, we're looked to as experts on pelvic floor (incontinence, prolapse, even sexual) issues. What about weight loss? Though we're not the true experts in this area, we work with post-reproductive women on a daily basis. Here are my impressions ...
There is increasing evidence that true low-carb diets may work more effectively, for some individuals, than calorie restriction. There is also increasing evidence that short bursts of exercise may be a reasonable replacement for long, traditional workouts. For a busy mom? My advice would be to take a hard look at 'empty calorie' intake including hidden sugar and carbohydrates, focus on a 'real food' diet and integrate short realistic workout bursts that can be done even during the (painfully short) time that a baby might be napping. For some time, a 10-20 minute DVD workout in your living room might be far more realistic than the gym. And remember, weight loss is probably 90% diet-related, exercise less so.
MomToTwo (Evanston, IL) - 11:36 AM:
Hello, I suffered from really debilitating pelvic floor pain in my last pregnancy (I'm about 2 months post-partum.) I'm definitely improved, but I still feel a little sore/ weak down there. I would love to start exercising more. What do you recommend?
Dr. Roger Goldberg (NorthShore)
Sorry to hear about the difficult pregnancy. Overall, I'd want to emphasize that pain is NOT normal if it doesn't slowly but surely resolve on its own. If you're getting better and the pain is disappearing, then no problem -- in this case I'd recommend gradually resuming full exercise, and as previously mentioned, perhaps refrain from heavy weights, repetitive squatting and very high impact until 3 months postpartum.
But if you're experiencing worsening or persistent pain in the pelvic area, I'd consider eventually finding your way to a urogynecologist for a basic evaluation to be sure it's nothing significant, or something focal that would improve with treatment. The best advice, if you're having weakness and pain and you don't feel the need to see a doctor, is to see one of our physical therapists. Women are rarely disappointed with this approach, and if symptoms persist, then you can go ahead and see the doc.
- 11:42 AM:
3 years postpartum - is it normal to leak urine when coughing or sneezing? Is there anything that can be done to prevent this ?
Dr. Roger Goldberg (NorthShore)
This is called Stress Incontinence, and it's reported (to some degree) by up to 50% of post-childbearing women by age 40. Amazingly common, and amazingly treatable.
Treatment options include (1) Kegel exercises, sometimes with the help of a nurse or physical therapist to get you doing them properly, (2) 'pessary' is a device similar to a diaphragm, that is designed to reduce symptoms when it's inserted, and (3) the huge breakthrough over the past decade has been the "sling" procedure. It's a 15 minute procedure, that completely eliminates stress incontinence in over 90% of cases. I've performed thousands of these procedures over the past 15 years (as have other well qualified specialists like me), and although no operation is 'perfect', this has truly proven itself to be an amazing option for countless women. To get back to your question: NO, the symptom of incontinence is absolutely not normal, and it's not anything you have to just accept or live with.
Brenna (Moderator) - 11:47 AM:
Therae are 15 minutes left in this chat. The topic has been a popular one so we apologize in advance if we are unable to address every question.
Cameron - 11:48 AM:
When is surgery the right thing to do for prolapse? How long should you try non-surgical treatment before it is time to start to consider surgery? What is recovery like for surgery? Is it long? Is it painful?
Dr. Roger Goldberg (NorthShore)
It's truly a personal decision whether to have prolapse surgery, and when. Most importantly, it's important to realize that there's rarely any medical need to rush your decision. Some women try a pessary, but in truth, not all women are interested in this option. And with the advent of minimally invasive surgery options, it's not uncommon to see women proceed directly to surgery if the prolapse is truly impacting their quality of life. Recovery and surgical experience depend on what is performed; speaking for myself, today I perform 95% of surgeries without any abdominal incision, the vast majority of cases take less than an hour, and in many cases involve no hysterectomy. This has translated into a quick recovery for most, but as I always say, "surgery is not a magic trick" and we always need to acknowledge that a recovery can be slower than expected. In my current practice, nearly all patients go home the next day, strong pain meds for short # of days, and very high satisfaction
Dr. Roger Goldberg (NorthShore) - 11:58 AM:
Just a quick follow up to the issue of "when to have prolapse surgery".
These days, there are a lot of different ways to have surgery: vaginally, abdominally, laparoscopic / robotically, etc.
The surgical and recovery experience varies widely depending on the technique. My overall advice: if you're considering surgery, the most important factor is that your surgeon has a lot of experience (and hopefully surgical volume) with the technique being performed. Part of the reason we believe our pateints here at NorthShore excel with the techniques we perform, is that we've committed to being expert in these areas. Likewise, whereas other surgeons may offer completely different approaches, I believe the most important factor is that they've committed to being the best at their recommended surgical approach, and have the experience to back the recommendation.
Brenna (Moderator) - 11:59 AM:
As time is short, this will be the last question of our chat. Thank you everyone for you wonderful questions today and Dr. Goldberg for your time.
Dr. Roger Goldberg (NorthShore) - 12:00 PM:
We're nearing the end, just a practical FYI:
Our division has worked extremely hard to be a center of excellence for these often-overlooked and very important women's health issues. We hope if you have a problem, you'll seek help! Our physicians are available at 5 sites throughout the Chicago area, and are ready to help whether it involves a simple or complex problem. Thanks for joining today's chat!
Brenna (Moderator) - 12:01 PM:
For more information on pelvic health, go to our
Center for Pelvic Health webpage.