Pelvic organ prolapse reconstruction or hysterectomy...?

[dollysocks]

Hi there,

This is a bit of a long one.

I'm 37, I have a dd aged 6 and ds 3. (I had a still born d in between the two) so 3 vaginal births. My ds's birth was prolonged and he was reasonably big.

Nov 2015 I had some problems with heavy bleeding, polyps and so in January last year I had a hysteroscopy, TCR Polyp and mirena coil inserted.

In March and then May last year whilst the mirena was in I had two prolapses, front and then middle and back. I suspect the mirena had weakened the area generally but I have had problems with my lower back since having my son anyway. (Prolapsed disc S1 Oct 2013). And after the op in Jan my consultant said I had already had a small prolapse of the uterus.

Mirena out July - it reduced blood loss but really mad me miserable and I had lots of other side effects.

Being seeing physio since March. She's good and I have been strengthening my pelvic floor but there's just too much weight on it for me to lift it much.

Fed up now, have a pessary in to help but I can't poo normally, I have a lot of back pain and I can't do the exercise I like (running and high impact pilates with weights). I don't feel like having sex much and when we do it sometimes hurts and we have to fuss about to make it work. I can't lift my son and in that whole department I just feel wrong.

My consultant has suggested a partial hysterectomy and reconstructive surgery of the rectocele and cystocele. I didn't want a hysterectomy so young and had things worked out differently I would probably have had another baby. But I've had enough of feeling rubbish all the time and I've had most of 2016 to accept the fact that I'm not having more. I am lucky to have the two I've got.

My consultant has agreed to do reconstructive surgery of the front without the hysterectomy but I know it's against her better judgement. I'm just so nervous about the mess my hormones will be in if I have a hysterectomy. I won't have my ovaries removed so I'll probably get a few years before I have to have HRT but I just seem so sensitive to hormone crap that I can't see it working out well for me.

I'm feeling especially crappy today because my sisters just had her third baby. I want to be happy for her, and Im sure I will when I've had more time, but mostly I'm sad for myself.

And my appointment with the consultant is on Friday.

[PollyPerky]

I'd get more opinions to be honest. I had a repair 25 years ago - front, back and uterus. It was 'only' grade 1 so not severe.

I've always been worried it would reoccur so I was advised never to run, lift etc again. So I don't run or lift or carry heavy bags etc ever.

I've been on HRT for several years (post meno) and hope this will help keep things in place.
There are different opinions on hysterectomy for prolapse. some drs say they make further prolapse more likely- vaginal vault descent- whereas others think they are what's needed.

I'd not worry about having to use HRT. Without a uterus you'd need only oestrogen, and there are loads of options for that- pills, patches, gels- and you'd probably be fine. It's the progesterone part of HRT that is a PITA and causes side effects.

Without knowing how bad things are, it's hard to advise you. If your uterus is pretty low down (grade 2 or 3) then you would get some improvement having it hitched up but you need to ask HOW much!

You also need to ensure the dr doing it all is good, experienced and has a good record / good results- they all aren't the same!

[StillMedusa]

I had a very similar profile... mild/mod prolapse of all three. Had a hysterectomy at 35 (kept ovaries)
I haven't missed my womb.
I didn't have reconstruction for the cystocele/rectocele... the hysterectomy took most of the pressure off. However I still need assistance to poo... suppositories, but I am used to that now. I'm now 49 and am having a few issues with what I suspect is slightly more prolapsed bowel but nothing I can't live with .

TBH whatever you chose , high impact exercise of any kind is a no no. Sorry but it will just damage any repair. I know... I have been stupid with running and it has done me NO favours.

BUT my sex life is ok, I only ache inside after a long day, and life is defo better wombless!

[dollysocks]

Thank you StillMedusa and PollyPerky.

I will ask what my grade is, but I'm pretty sure it's 2 or 3.

I am confident about my consultant, her ability and track record. I'm seeing her privately but she works for the NHS where I met her whilst having my son. My GP talked to me before she referred me. The thing I find hard is that she has quite a fierce manner. I think it's because she's so well recognised she's not great when people question her.

And I'm all about the questions....

[Threesoundslikealot]

Dolly, do you see Professor C? That description sounds familiar.

I have a rectocele and a slight cytocele. I've been told I need an op 'once I'm finished with my family' but in the meantime she has told me off for being 'seriously overweight' and asked why on earth I breastfeed past six months. So I do rather dread the day I go back to her, however expert she is.

[dollysocks]

Hi there,

Polly Perky I am grade 2. The pelvic floor exercises I have done have helped the front but the back is really no different.

I had a go at removing and re-inserting the pessary, in the appointment but although my consultant checked it I don't think it is as well placed as when she did it. It hurt as I walked home after school run and my front tummy is a bit wrong. I'm seeing GP on Wednesday, so I will have another go, with her. I lack the confidence to do it on my own.

I'm booked in for a rectocele repair surgery mid Feb. After examining me and chatting consultant said it's best to fix the area giving the most problems. If the repair does enough I will have an ablation. If it doesn't I'll think about vaginal hysterectomy again.

I feel better than last week. I feel like the consultant is going to look after me really well, whatever happens next.

I have also ruled out hysteropexy, which is a step forward.

Threesoundslikealot I don't see Professor C, I think consultants can often be like this. Sure of their opinion, well qualified 'no messing' types..it's a shame they don't tap into empathy more often

[dollysocks]

Also I'm going to be trying the mini pill, not so keen after my track record with the merina and my history of migraines, but my periods are really heavy and frequent so the consultant has said give it a try.

[mumsiedarlingrevolta]

Hi dollysocks
I had a prolapse-I carried DC3 with ring pessary (which was horrible)
About 7 mos after DD I had hysterectomy (but kept ovaries) as I could not bear the prolapse issues-bladder problems etc
Obviously no idea how different menopause would have been but it was such a relief to have it done.
And I think the pros outweighed the cons for me-I am naturally loosely ligaminted and am a prolapse waiting to happen
Good luck

[dollysocks]

Thank you mumsiedarlingrevolta,

I get to keep my ovaries, so I shouldn't go into the menopause for a couple of years - more if I'm lucky.

I'm just scared about the whole thing, but I really dislike the pessary. It helps and I can't manage without it, but I just don't feel like myself anymore.

[Fauxgina]

Glad to read so many positive stories here about feeling better after a fix. What pessary have you tried OP? If you'd like to have leave option open for another baby could you try another pessary see if it relieves your symptoms? Looking back I can't believe at how long people kept suggesting a ring pessary - it was totally inappropriate for my prolapse and if I had the right one perhaps I could postpone surgery.

You could ask for a Shaatz, or a Gelhorn.

There's a really lovely private support group on Facebook, it's a little bit histrionic as a lot of people on there are in the USA but if anyone wants the link send me a PM.

I'm due my operation soon, I have quite a severe prolapse so I'm getting a hysterectomy and a further vaginal repairs. Nervous but really ready to move on with my life now.