An episiotomy is a surgical incision made to enlarge the vaginal opening during childbirth to assist delivery of the baby. This incision can be midline or at an angle from the posterior end of the vulva. It should be performed under local anaesthetic and should, of course, be sutured closed after delivery. Proponents of episiotomies say it helps to lessen perineal trauma, minimize postpartum pelvic floor dysfunction, reduce blood loss at delivery, and protect against neonatal trauma.. Current medical thinking is that routine episiotomies are probably unnecessary and only bring about increased morbidity. There are studies showing that episiotomies did not, in fact, reduce the incidence of serious perineal lacerations but increased them. Having an episiotomy may increase perineal pain in the postpartum period. This can result in trouble defecating, much to the new mothers despair. It has been argued that episiotomies should not be a routine procedure. It appears that it will end up being ...
RESULTS: The study population included 2 570 847 deliveries. Episiotomy use declined significantly among operative vaginal deliveries (53.1% in 2004 to 43.2% in 2017, p , 0.0001) and spontaneous vaginal deliveries (13.5% in 2004 to 6.5% in 2017, p , 0.0001). Episiotomy was associated with higher rates of obstetric anal sphincter injury among spontaneous vaginal deliveries (4.8 with episiotomy v. 2.4% without; adjusted rate ratio [RR] 2.06, 95% confidence interval [CI] 2.00-2.11) and this association remained after stratification by parity and obstetric history. In contrast, episiotomy was associated with lower rates of obstetric anal sphincter injury among forceps deliveries in nulliparous women (adjusted RR 0.63, 95% CI 0.61-0.66), and women with vaginal birth after cesarean (adjusted RR 0.71, 95% CI 0.60-0.85), but not among parous women without a previous cesarean (adjusted RR 1.16, 95% CI 1.00-1.34). ...
No infant in either group required special care or had a 5-minute Apgar less than 6. Among primiparas, the episiotomy rate was reduced by one-third in the restricted group for both primiparas (57.2% versus 81.4%) and multiparas (30.7% versus 47.0%). The reasons given for episiotomy in the restricted group were severe tear anticipated (40%), fetal distress (29%), and perineum not distending (23%). "Accustomed to the liberal or routine use of episiotomy, and despite being presented with a population of healthy, low-risk women, many physicians had difficulty in withholding episiotomy in the [restricted] arm of the trial." Among primiparas, 52 (14.5%) had episiotomy extensions, of which 46 were third or fourth degree, six were tears into the upper vagina. Only one woman had a spontaneous deep tear. Among multiparas, 1.8% had third- or fourth-degree episiotomy extensions, and no one had a spontaneous deep tear. As measured by electromyographic perineometry, no differences were found between groups ...
TY - JOUR. T1 - Risk factors for the recurrence of obstetrical anal sphincter injury and the role of a mediolateral episiotomy. T2 - an analysis of a national registry. AU - van Bavel, J.. AU - Ravelli, A. C.J.. AU - Abu-Hanna, A.. AU - Roovers, J. P.W.R.. AU - Mol, B. W.. AU - de Leeuw, J. W.. N1 - © 2020 Royal College of Obstetricians and Gynaecologists.. PY - 2020/4/3. Y1 - 2020/4/3. N2 - Objective: The assessment of risk factors, including mediolateral episiotomy (MLE), for the recurrence of obstetric anal sphincter injury (rOASI). Design: Population-based cohort study. Setting: Data from the nationwide database of the Dutch Perinatal Registry (Perined). Population: A cohort of 391 026 women at term, of whom 9943 had an OASI in their first delivery and had a second vaginal delivery of a liveborn infant in cephalic position. Methods: Possible risk factors were tested for statistical significance using univariate and multivariate logistic regression analysis. Main outcome measures: Rate of ...
An episiotomy is an incision through the vaginal wall and the perineum (the area between the thighs, extending from the vaginal opening to the anus) to enlarge the vaginal opening and facilitate childbirth.. During a vaginal birth, the physician/midwife will assist the fetus head and chin out of the vagina when it becomes visible. Once the head is out of the vagina, the physician/midwife usually rotates the fetus to the side and eases the shoulders out, followed by the rest of the body.. In some cases, the vaginal opening does not stretch enough to accommodate the fetus. The physician/midwife may perform an episiotomy to help enlarge the opening and deliver the fetus. The episiotomy is usually performed when the fetal head has stretched the vaginal opening to several centimeters during a contraction. Although episiotomy was a very common procedure in the past, more recent studies have found that routine or preventive use of episiotomy does not benefit the health of mother or baby. The American ...
Perineal pain due to episiotomy is commonly reported and can be severe enough to disturb the mother-infant dyad during the postpartum period. Its incidence at day 7 postpartum varies from 63% to 74%. Recent studies have investigated the analgesic efficacy of perineal infiltration of ropivacaine after episiotomy but have only focused on the immediate postpartum period (at 24 and 48 h after birth). Large, adequately powered, multicenter, randomized controlled trials are required to evaluate the impact of ropivacaine infiltration on perineal pain and mid- and long-term quality of life before the widespread use of ropivacaine to prevent perineal pain after episiotomy can be recommended. The ROPISIO study is a two-center, randomized, double-blind, placebo-controlled trial being conducted in La Roche sur Yon and Nantes, France. It will involve 272 women with vaginal singleton delivery and mediolateral episiotomy at term (≥ 37 weeks). Perineal infiltration (ropivacaine 75 mg or placebo) will be administrated
Traditionally, physicians have used episiotomies in an effort to deflect the cut in the perineal skin away from the anal sphincter muscle, as control over stool (faeces) is an important function of the anal sphincter, i.e. lessen perineal trauma, minimize postpartum pelvic floor dysfunction, and as muscles have a good blood supply, by avoiding damaging the anal sphincter muscle, reduce the loss of blood during delivery, and protect against neonatal trauma. While episiotomy is employed to obviate issues such as post-partum pain, incontinence, and sexual dysfunction, some studies suggest that episiotomy surgery itself can actually cause all of these problems.[6] Research has shown that natural tears typically are less severe (although this is perhaps not surprising since an episiotomy is designed for when natural tearing will cause significant risks or trauma). Slow delivery of the head in between contractions will result in the least perineal damage.[7] Studies in 2010 based on interviews with ...
Episiotomy is obstetric procedure during which the incision extends the vestibule of the vagina during the second stage of labor. Episiotomy was extensively spread with gradual increase of rates in the first half of the 20th century and was performed medio-laterally in all nulliparous women with the idea to protect fetal head from trauma and pelvic floor from injuries. However, reports claiming that episiotomy had no such benefits were published. It was shown that routine medio-lateral episiotomy did not protect against the appearance of urinary incontinence after vaginal delivery, while the risk of anal incontinence could be increased ...
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Objective. Surgical repair of perineal lesions after delivery is frequently associated with pain and discomfort, interfering with the normal activities of the puerperium. The aim of this study was to compare perineal skin repair after episiotomy with adhesive glue versus a subcuticular suture, regarding the incidence of pain and wound complications. Study design. Randomized clinical trial. Setting. Tertiary care university hospital. Material and methods. One hundred women having mediolateral episiotomy at vaginal delivery were enrolled. They were randomized to receive skin adhesive (n = 53) or subcuticular suture (n = 47) for closure of perineal skin. The main outcome measure was self-evaluated pain in the 30 days following delivery. Secondary outcome measures were technical difficulties reported with the procedure, duration of surgical repair, wound complications observed at 42-68 hours post-partum and re-initiation of sexual activity by 30 days post-partum. Results. No significant differences ...
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Obstetric trauma is among the most common adverse events in Canada. Obstetric trauma, including third-degree lacerations and greater in severity, may result in longer lengths of stay for mothers and chronic complications such as fecal incontinence, dyspareunia, perineal pain and other pelvic floor disorders.. Risk factors for obstetric trauma include maternal age, large fetal size, prolonged pregnancy, long labour, malposition, episiotomy extraction and instrument assistance.. The obstetric trauma indicators are intended to be used as flags to identify areas for improvement and to help identify processes of care that require hospital-level evaluation. ...
There is a lack of research reporting on the physical and emotional experiences of women who sustain severe perineal trauma (third and fourth degree tears). When the researcher identifies with the group being researched, autoethnography can allow an insight into the experiences of the marginalised group through the telling of a personal story. The aim of this paper is to share the journey travelled by an autoethnographer who on examining the issue of severe perineal trauma came to understand the challenges and rewards she experienced through this reflective and analytic process. A transformative emancipatory approach guided the design, data collection and analysis of findings from this study. For this paper, a multivocal narrative approach was taken in presenting the findings, which incorporated the words of both the autoethnographer and the twelve women who were interviewed as a component of the study, all of whom had sustained severe perineal trauma. As an autoethnographer, being a member of the group
Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors - BJOG: An International Journal of Obstetrics & Gynaecology - Vol. 120, 12 - ISBN: 1471-0528 - p.1516-1525
I am always interested in saving women from unnecessary surgical procedures, so I was particularly intrigued by a recent piece of research that questions the need for routine episiotomies during
Let Your Design Medical help you become the best medical professional you can be, today! This set of three episiotomy suture training models are made with lifelike
Question - Stools and gas coming through vagina post forceps delivery. Diagnosed to be gaped episiotomy. Recovery time? . Ask a Doctor about diagnosis, treatment and medication for Obstetric fistula, Ask an OBGYN, Gynecologic Oncology
Hysterectomies should be considered for uterine cancer, but most procedures are done for other reasons. - Episiotomy is a surgical incision to enlarge the vaginal opening prior to childbirth. The reasoning behind this procedure is to ease delivery and decrease perineal tears.
A model made of special soft, tissue-like synthetic material for development and training of episiotomies and perineal suturing. All the main anatomical features are reproduced, including an open anus. The stand maintains the model in the correct position and has suction feet, which prevent slipping. The simulator includes a carrying case and 3 replaceable inserts. Each insert can be reused many times if the sutures are removed carefully after practice ...
An episiotomy is a surgical cut to the vagina during childbirth. A USA TODAY analysis finds a startling number performed despite guidance from 2006.
617. When to perform an episiotomy / What is the third stage of labor? How long should it take? What to do? What not to do? / Signs of placental ...
Doctors give trusted, helpful answers on causes, diagnosis, symptoms, treatment, and more: Dr. Kuhnke on episiotomy bleeding after bowel movement: Irregular periods are one of the most common problems obgyns treat. If this is one time problem it usually resolves on its own. If this is a recurring problem you should be evaluated. Infections & hormonal changes can cause spotting. If there is a concern for pregnancy then do a home pregnancy test . There are many options available to help regulate the menstrual cycle. Schedule a visit.
Good day, I am asking this question for a good friend: The doctors were very close to performing a C-Section, however, they did not and performed and episiotomy. She has stiches and is healing. H...
So Ill walk you, very briefly, through the mechanics of how he does VBB. The mother pushes the baby out on her own with no traction or episiotomy, until the baby is out to the umbilicus. Dr. Hall rarely does episiotomies and, in those rare occasions, never when the baby is rumping or coming out to the umbilicus; if you do an episiotomy at those points, it will just create more problems. He kept emphasizing over and over: dont touch the baby, keep your hands off and be patient. When the mom is on her back, youll see the baby come out, back up, almost straight upwards. The legs will fall out on their own if youre patient. If the baby comes out to the side, rather than back up, that means it has a nuchal arm. If the arms do not emerge spontaneously, he gently releases the anterior arm, rotate the baby, and release the other arm. At this point he papooses the babys body in a warm towel and holds it slightly elevated. The last step is to gently push down on the perineum (i.e., with your fingers ...
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This birth was a birth full of firsts, even though its the second twin birth Ive done here. This birth was different, and honestly more challenging because the mother was a primip. 40 minutes into her second stage the head compressions I was hearing became honest-to-God, freeze-your-blood decels into the 60s. The first few were very quick, and rebounded to the 130s amost instantly, but green though I may be they had my antenna all sorts of tweaked. They persisted after each time she pushed, obviously late decels which grew in duration and were slower to recover. I cranked on some O2 and, during one particularly long decel, made the decision to cut an episiotomy (my first) to try to expedite this kiddos exit. Fortunately baby was nice and low at almost the textbook place for an epis to be cut (cant believe Im typing that). I quickly drew up some lidocaine and told her what I was going to do. I injected her perineum and then cut an inch long mediolateral episiotomy at about 7 oclock, ...
This birth was a birth full of firsts, even though its the second twin birth Ive done here. This birth was different, and honestly more challenging because the mother was a primip. 40 minutes into her second stage the head compressions I was hearing became honest-to-God, freeze-your-blood decels into the 60s. The first few were very quick, and rebounded to the 130s amost instantly, but green though I may be they had my antenna all sorts of tweaked. They persisted after each time she pushed, obviously late decels which grew in duration and were slower to recover. I cranked on some O2 and, during one particularly long decel, made the decision to cut an episiotomy (my first) to try to expedite this kiddos exit. Fortunately baby was nice and low at almost the textbook place for an epis to be cut (cant believe Im typing that). I quickly drew up some lidocaine and told her what I was going to do. I injected her perineum and then cut an inch long mediolateral episiotomy at about 7 oclock, ...
No one told me how much perineum pain would interfere with taking care of my baby. Its day 4 and I feel like today is the worst pain. I cant sit and I cant gauge what is normal and what isnt.
Methods: This triple blind clinical trial was performed on 114 eligible women at Ommolbanin Hospital in Mashhad، Iran in 2014.They were randomly assigned to two groups using random blocks. After delivery، mothers in the intervention group used 0.5 g of prescribed chamomile while the control group used placebo cream on the stitch twice a day lasting ten days. Episiotomy pain was evaluated before intervention and 12 hours after episiotomy repair and also on the first، seventh، tenth and fourteenth day after delivery by McGill pain questionnaire. Data was analyzed by SPSS ver.13 ...
In recent studies using virtual reality has been proposed as a non pharmacological methods for pain relief but until this time , its effects has not been assessed on pain and anxiety during episiotomy repair. To determine the effectiveness of virtual reality Glasses on pain and anxiety in Primiparity women during episiotomy repair ...
More specifically, Ive been trying to set up meetings with a few pediatricians in our area so we can have "our" Dr. be the one to discharge our baby from the hospital. Well wouldnt you know that our health care system is TOTALLY F-ED UP. Oh wait, you did already know that, everyone does. So it turns out that, after Ive spent hours on the phone and made fagillion calls, individual providers (the drs themselves) and the offices or companies they work for have different tax ID numbers. After doing research I found that if the physician Im looking at to be our babies dr. bills us under the offices name it will show up as out of network. However if he bills us under his own personal ID number it will show up as in network. WTF? So then I had to call the drs office and ask them how they bill, and from which address. Many physicians work out of more than one office, however it seems that the shidiots working at Anthem only show them as in network when they bill from one location, and out of ...
in the meantime does anyone know what i should put on these other than vaseline to take down the pain of these lesions? The Dr. How could genital herpes affect my baby? Some people have symptoms, such as herpes blisters, when the virus is active. Mathijis Bretjens, MD, University of Texas Medical Branch. Does anyone else know anything? The first symptom of genital herpes is usually a pain or itching, beginning with an infected partner within a few weeks after exposure.. IT IS VERY IMPORTANT THAT YOU PULL THE FORESKIN BACK COMPLETELY in order to clean under it thoroughly. "Episiotomy does more harm than good," says Katherine Hartmann, M.D., Ph.D., director of the Center for Womens Health Research at the University of North Carolina in Chapel Hill, which reviewed four decades worth of data on episiotomy for the Journal of the American Medical Association. I mean, I think he is an honest guy, but Ive been out with him 5 times so I really dont even know, and 2) Even if he is telling the truth, I ...
I am currently 30 weeks(tomorrow) with my second child. when I gave birth to my son in 2011 i had a bad episiotomy and it took forever to heal and gave me complications for over a year. Last week it started getting a little swollen and sore and i figured its because of all the extra blood and pressure from the baby like they warn you about. Then a couple of days ago a sore appeared right on the scar and yesterday it opened. I found out in the shower when it was realy friggin painful to clean myself and then when I went to the bathroom a little while later the pain made me cry. So i immediately called my OB and she scheduled me in two hours later to check it out. My husband and I figured it was just another problem with the episiotomy scar like Ive had in the past and that my OB would give me some ointment to put on it...but when she examined me she asked me if I had any history of HIV or could have contracted herpes..Im like WTF? um NO. Then she called in a nurse to get a culture kit and when she
I have to quote from my friend, Emma, who first posted the link below. She is an aspiring mid-wife, and here is what she says about this strange practice that seems....
Read 19 responses to: Hello all! I am pregnant with my second child and I... Find the best answer on Mamapedia - mom trusted since 2006.
I had a similar experience in that i had i really good birth but after had to have the placenta removed manullay in theatre and i lost a lot of blood too and wasnt mobile for a few hours and just wanted to cuddle my LO.Had two second degree tears also but Im recovering now though quicker than i thought. My Full birth story is on here if u want to read it anyway. Sorry to hear u had a time of it afterwards... especially as u had a long enough wait like me in the first place! Anyway, take care and will speak to u when ur on ...
Most of the above will be short lived, such as the perspiration, breast engorgement, gas, and urination problems The rest will be resolved in their own time, such as the Lochia, healing from the episiotomy if you had one, or healing from a Cesarean incision, and emotional highs and lows.. Also, your cervix takes about six weeks to close after a vaginal delivery, so no douching, no tampons, no sex right away, nothing in the vagina that might increase the risk of a vaginal infection. In six weeks after a vaginal birth, 8 weeks for Cesarean, you will have a postpartum check-up with your care provider.. The postpartum period in the hospital is also a very busy time, and a short stay before you go home. You will be visited daily by your obstetrician, and/or Midwife, nursery nurses, dietary, pediatrician, family, friends, the florist, Lactation nurse (if you are breastfeeding) and so on.. Lots of questions will be asked of you to discuss with your partner, such as circumcision, or breastfeedng verses ...
This sounded very similar to my first birth. It was "mostly natural", no epidural, pitocin, monitor, or IV, mainly because I arrived at the hospital at 7 cm and quickly transitioned. I made 2crucial mistakes. One, I allowed the doctor to give me a local anesthetic before pushing "just in case" I needed an episiotomy. Two, because of the local, I pushed very enthusiastically. My baby was out in 25 minutes. I needed a couple of stitches, but what I didnt realize at the time, I also had many tiny tears in the perineal tissue. Four days later and I was clutching the walls and gasping for air whenever I urinated. It was more painful than the birth. In tears, I asked to be taken to the emergency room. Hours later and I was diagnosed with a bladder infection. I blamed it on the tissue damage which opened my body up to infection. My next birth was at home and was actually harder. The baby was poorly positioned and the midwife put me through all sorts of gyrations to loosen him up. Still, when it came ...
This sounded very similar to my first birth. It was "mostly natural", no epidural, pitocin, monitor, or IV, mainly because I arrived at the hospital at 7 cm and quickly transitioned. I made 2crucial mistakes. One, I allowed the doctor to give me a local anesthetic before pushing "just in case" I needed an episiotomy. Two, because of the local, I pushed very enthusiastically. My baby was out in 25 minutes. I needed a couple of stitches, but what I didnt realize at the time, I also had many tiny tears in the perineal tissue. Four days later and I was clutching the walls and gasping for air whenever I urinated. It was more painful than the birth. In tears, I asked to be taken to the emergency room. Hours later and I was diagnosed with a bladder infection. I blamed it on the tissue damage which opened my body up to infection. My next birth was at home and was actually harder. The baby was poorly positioned and the midwife put me through all sorts of gyrations to loosen him up. Still, when it came ...
Thanks Henci,. Actually I dont know if my natural contractions were similar to the induced ones because I also had epidurals and other pain medication. So it was my first time to experience what natural contractions felt like for me.. I have been reading many other posts here, which have been so very, very helpful. I guess I should have been more specific or more clear about my personal experiences. My first two births were induced for no particular reason with epidurals and pain medication. I just thought that was how it was supposed to be done (hadnt educated myself yet) both pregnancies were very healthy and deliveries were good with minimal tearing no episiotomies (2nd baby just 1stitch) However, I wanted a different experience for my third pregnancy and labor. I thought if I had a midwife that I could avoid unecessary interventions. I had hoped to have an empowering birth, but what I got was minimal feedback and support during that labor which left me with a third degree tear and the ...
Four weeks ago today I brought my daughter Coralai into this uncertain, but beautiful world. This is her story.. Coralai is my second child. My first, Leland was born 42+3 in June 2018. He was 10lbs 11oz. Had a 15" head, a 20 chest and was 22 inches long. He was huge. But beautiful, and so was his birth. This isnt his story, but their stories seem to intertwine and affect each other. My pregnancy with Cora was lovely. I didnt have large complaints. Other than being huge, really uncomfortable and emotional. Mild nausea, and exhaustion, but nothing unbearable. Due to Leland being so late and large, and eventually needing to be induced with him, my OB and I planned on inducing early with her. 39 weeks. Both my husband and I felt comfortable with this as she was measuring well and we didnt want for me to have a hard recovery with her. As well as having a toddler at home to chase. With Lees birth I tore past my two episiotomy incisions, and ended up with fecal and urinary incontinence in ...
The next thing is the episiotomy. The bane of childbirth. My Achilles heel. My doc "gave me the extra room" during the delivery. I was pushing out an eight pound baby with a head the size of a pumpkin, so at the time I didnt mind. After Doc stitched me up (which took an inordinate amount of time), a nurse came and gave me an icy-cold diaper to put on my hoohah. It was amazing. The next day, I felt like I had been hit by a truck. My whole body was sore. Now, usually, when my entire body is sore from my twice yearly attempt at "getting in shape" I dont have to even think about my private parts. This was different because my vaginal area was the sore-est part of my body. I was given prescription strength Ibuprofen every 12 hours, even though I needed after 8. I also was given these pad shaped ice packs to sit on intermittently. They were heaven. (Later, when we were in the hospital with Maggie, I continued to ask for these, even though the nurse told me that they were useless after 12 hours.) She ...
Girls that have sare lumbar pain previous to being pregnant are 2. Throughout this kettlebels all major inner organs begin growing. One frequent use of laparoscopic surgery is for diagnosing and treating endometriosis, but it has other makes use of as effectively. Perceive what constitutes a cramp. Your present password has not been modified. This may occur when the egg implants itself into your womb, and it is more likely to happen across the time youd have had your interval. Im tired. Dont coo on the stomach. We have topics and questions all the time about what to eat if youre pregnant, so I wished to share this charming story of an experience I aee while pregnant with my second daughter. It helps to outline the location of the attached egg. Subscribed Calendars. Good pointers state that an episiotomy should only be carried out in case your baby is in distress, theres a need to make use of forceps or ventouse to help supply, your baby is in the breech place the place its head is just not ...
Delivery requiring minimal or no assistance, with or without episiotomy, without fetal manipulation [e.g., rotation version] or instrumentation [forceps] of a spontaneous, cephalic, vaginal, full-term, single, live-born infant. This code is for use as a single diagnosis code and is not to be used with any other code from chapter 15 ...
Fast as fast can be, baby girl makes it into the world. Contractions for a few days, on and off changes from the norm but nothing indicating actual labour. This evening contractions were very strong abdomen hard as a rock and gradually getting to be almost exactly every 5 minutes with small peeks in between. A good pattern is determined on the monitor at the hospital and the nurse comes in and says yes you are contracting in a good pattern, let me check you. Oh, youre only 1cm I must send you home. A shot of demerol in the bottom and off to sleep at home for mom. Only within about an hour of getting home Splah!!! a huge gush of amniotic fluid comes out. Its midnight now and suddenly the contractions are intensified.12:30 arrive at hospital. 1 am epidural. 1:40 6cm (at 10:30 she was 1cm) 2:05 fully dilated start pushing. 2:23 baby born! 13 minutes of pushing, 2.5 hours of active labour. No vacuum or forcepts no episiotomy no stitching required, just a beautiful baby happy at the breast. This ...
... - English: This article discusses the implications of episiotomy / episiorrhaphy womans life and emerged from work undertaken to acquire a masters degree
Results 210 women met the criteria. 63 (30%) had an elective caesarean section and 147 (70%) opted for vaginal delivery. 10/147 (6.8%) required an emergency LSCS. 14/137 (10.2%) women who had a vaginal delivery sustained a further OASI. When comparing the women who had OASI to women who did not sustain an OASI in the subsequent pregnancy, there was no significant difference between the mean birth weights or the mode of onset of labour.. ...
Gynecological pain can impose physical limitations on new mothers, making child-care, sitting, walking, and other activities extremely difficult and painful.