Any medics on here- I’m having a panic!

[Bluffyslummers]

I had a hysteroscopy yesterday and got diagnosed with grade 2 bladder prolapse.

this was very very surprising news as I have no symptoms. And I’ve had 3 internal exams over the past year (bleeding in between periods) and as many trans vaginal ultrasounds and nothing was mentioned.

is that possible? I’ve looked on the nhs website and it says that prolapses are diagnosed by internal exam- how could this have been missed.

im suspicious because im going private at the moment and this consultant keeps finding new avenues to investigate and now wants to do the mesh surgery for this prolapse and looking it up that is paused from the nhs.

surely 3 previous internal exams one done by the very same consultant it would’ve been mentioned?

Were the vaginal exams to check for prolapse? They might not comment on it if they weren't looking for it and you don't have symptoms (because nothing would be done about it anyway unless you're symptomatic) Ultrasound wouldn't pick it up as that's looking further "in".
I don't see why they want to intervene if you aren't symptomatic? What would be the point?

Well they were doing a general internal exam, I’d have thought it would’ve been visible?

I have no symptoms at all and they said it might get worse when I get older. But I’ve heard about the mesh surgery and it seems to have a disproportionate amount of adverse outcomes, I mean for the nhs to pause it pending investigation and reserve it as a last last resort.

i also would like another child. No discomfort in intercourse. But I’m confused as to why it wasn’t seen on a physical exam, surely it wouldn’t be missed by 2x platinum certified gynae consultants.

Well, I wouldn't have mesh surgery if I had no symptoms!

Get a second opinion.

It may not have been commented on, or may not have been there at the time.

I’d suggest considering an independent pelvic physio assessment. If it’s there, most advice is to start with exercises rather than jump straight to surgery.

Physios can’t do the surgery, and generally aren’t looking for repeat business - so you’ll get a different but relevant specialist opinion.

between his last exam and the hysteroscopy has been a matter of weeks. So very unlikely that it would’ve come up since. Esp as it’s likely the result of child birth. I just don’t understand why 2 consultants would miss it, one of whom being the consultant who performed the hysteroscopy looking for polyps he said he saw on a scan, that the dr doing the scan said was clear.

ive asked my insurer for a referral to pelvic floor physio- not sure if they cover it.

I’m not sure if my insurance covers second opinions

If pelvic floor physio doesn't help (and give it 6 months) you could see if you are suitable for Bulkamid which has been transformative for me. Takes about an hour to administer. No recovery time at all. Life changing. Had mine on the NHS.

What is it?

is it the pessary things?

ive seen them referenced on the nhs website before surgery

Ah I looked and its for incontinence- luckily I’ve not had that at all,

Ime some private consultants do jump straight to surgery without considering other non invasive options. Such as pelvic floor physio

Sounds wrong to me. Definitely get a second opinion. Speak to your gp, perhaps. I'm a nurse and midwife and ive had the mesh! I had it done 10 years ago and (touch wood) it's been really good for me. But I wet myself lots and had finished having babies. I wouldn't have considered otherwise. There are multiple risks, as you say. Seeing a physio is great advice, but why do anything, if you have no symptoms 🤔

Do not get the mesh! It ruins lives, my cousins life was destroyed by it. It’s banned in many countries

Most insurance will allow a second opinion. Cheaper than unnecessary surgery.

so in your experience of anatomy would a grade 2 cystocele have been visible on a internal exam? I just can’t wrap my ahead around the fact that 2 platinum consultants didn’t remark on it and it was only picked up via hysteroscopy surgery which was looking for polyps undetectable on a scan and a removal of cervical ectropian (the second consultant said it needed to be removed as it might cause issues conceiving again, but the first said we could remove it but might come back, up to me but it wouldn’t cause issues)

I’ll call them tomorrow and see if they do.

I’ve asked for a referral for pelvic physio will see if they cover it

Yes it’s very very strange to me that this was presented as the first option when it’s paused on the nhs and there are various options to try before hand.

i feel like the hysteroscopy was largely irrelevant, as was the removal of the ectropian as it can grow back and now this which was never mentioned before. Seems strange

Pelvic floor physio costs like £60 for a first appointment. Not cost prohibitive even if not insured

Can’t find anything under £150 where I live

Even if you can’t get your insurnace to cover it, just call up and book and pay for a pelvic physio assessment.

Theyre usually less than a tank of fuel, and I’m going to make the assumption that if you’ve got private health insurance you’re not budgeting to the nearest tank of fuel.

(you keep saying didn’t they see it. If you literally mean see, then the speculum would be acting like a splint).

I'm not a gynaecologist obviously... but in my experience anatomy after having babies can all shift a bit, at least. Sometimes a lot. It is only relevant though if it's affecting the person. I've never heard of an ectropian affecting fertility. Ectropians are often diagnosed in pregnancy when there's bleeding / spotting, and there is no follow up or treatment during or after. Are you anaemic?

Do you mean see it from the trans vaginal uss? The probe would probably push any prolapse out the way, as ScaryM0nster is alluding to.

GP here, OP; sorry you've been so stressed by this. To try to answer your questions - an internal exam usually refers to the doctor using their hand to examine the vagina/cervix, so nothing is actually 'seen' as such. If you're talking about a speculum exam to visualise the cervix, then as the speculum is opened it holds the walls of the vagina apart, which can actually mask a prolapse. So it's certainly not uncommon for it to be missed if it's not being actively looked for.

That said, I'd be extremely wary of having surgery for something which wasn't causing me any symptoms and may not get worse in the future - I think you're right to be really cautious here. Can I ask why you were having gynae investigations in the first place?

I have private cover through work and due to this surgery have to pay my sizeable excess- I’ll call around but I’ve seen nothing less than £150

yeab but didn’t see it, I’m not a medic, but from the nhs website they are diagnosed from an internal exam which I had 2 of, I don’t get how it was missed.

my youngest child is 3

I had a prolapse that was picked up by the nurse when I had a smear. I was having symptoms of not being able to empty my bladder and also wetting myself unexpectedly. I had pelvic physio and it’s now completely fine. There’s absolutely no way I’d want surgery for something that isn’t causing any problems.