Prolapse during Pregnancy? So many questions, needing reassurance!

[LoloMagic]

Hi all,

I am feeling a bit shook up and really could do with some reassurance and encouragement!

I am 17 weeks pregnant with my second child. Had a straightforward first pregnancy and birth apart from third degree tears (3a tears, so not bad ones, and I only pushed three times before ds was here, so never had any issues for long afterwards).

However, during this pregnancy I've had constipation and giant poops (sorry for TMI!), so I had been straining, and I was also on my feet a lot - I went on holiday a couple of weeks ago and on the last day I experienced an intense pressure, like dilating but without the pain, something I have never felt before or since, only to discover a walnut-shaped pink thing potruding from my vagina. I've no idea what it was because I went to an out of hours doctor and midwife who confirmed that baby was fine, and told me it was possibly just normal pregnancy swelling, because she couldn't see a prolapse when she checked my insides. She actually told me she thought it was a swollen inner labia.

However, I was still swollen down there (but without pain or pressure) after this (only noticable when wiping after having a wee), and so I rang my local midwives, who told me that this was not normal (!) - so I went to the doctors who told me that she couldnt see much, but could feel two protrusions and so she seems to think I have a rectocele and cystocele. She told me that she wouldn't like me to have a pessary with being pregnant, so she recommends stool softeners and pelvic floors. I tried to tell her that at times I have seen two 'lumps' inside my vagina, but they disappeared and at other times I've seen a donut-shaped protrusion inside my vagina that looks more like my cervix. Has she got my 'diagnosis' wrong because at the time everything had gone back up, so she couldn't see/feel much?

I have been doing my pelvic floors religiously since this and until my doctor prescribes me long-term stool softeners, I've been taking lactulose. I also have an appointment with a specialist in a few weeks - but until then my mental health is shaken because I'm struggling to understand exactly what kind of prolapse I have, and what its implications are. On the odd occasion after being on my feet for a while and then using the toilet, I could see the cervix-like shape again, but mostly I cannot see this at all, and the only prolapse 'signs' I have most of the time are that when I go to wipe myself after using the toilet, I can 9 times out of 10 feel a swelling at the back end of my vagina. But how can it be a rectocele when this swelling seems unaffected by me needing a poop and only the actual action of sitting on the toilet, where everything is encouraged to 'hang out' makes it swell more? - I have no other complications or symptoms from this at all, and am trying to keep off my feet as much as possible and keep on top of pelvic floors to strengthen down there.

1. So, that's my first question - what on earth do I actually have?
   My other questions are as follows:

2. I spoke to a seasoned midwife about uterine prolapses during pregnancy, and she told me that prolapses during pregnancy often go away and have no complications when the body has healed after pregnancy and hormones go back to normal. She said many midwives are cautious because they haven't seen this before, but she has encountered it many times and knows it will most likely heal on its own. I'm confident that this can be the case with uterine prolapses, but would this be the same for rectoceles as well, or is that something different?

3. Can rectoceles get better with pelvic floors alone, even when I'm on the toilet and do a pelvic floor, my urine flow stops but the 'bulge' remains unmoved? (I do feel it moving upwards when I clench and am not on the toilet but am lying down though!)

4. Will I need to be on stool softeners forever? Really, how bad is it going to be if I get a cough or strain, will the rectocele get and remain worse forever, or, even if it gets worse, will it get better again with pelvic floor exercises?

5. Will I eventually need surgery ie. when I hit menopause, or if I keep on top of pelvic floor exercises, is it likely to just get better and not worse? I am terrified of the thought of any surgical intervention, especially as I have no significant problems with this bulge

6. After having third degree tears and now a suspected rectocele, can I still have a natural birth? Will that make it worse in the long run?

7. Has anyone else had a rectocele during pregnancy or just after birth that got better and now causes no issues?

Sorry for all of the questions. I read so much conflicting and oft negative stuff online that I'm SO anxious, and just want to be able to enjoy my pregnancy!!!

Hello. I’m sorry you’re experiencing this, it sounds horrible. I’m not qualified to even hazard a guess at most of your questions - only one I might be of some help with is 3) - when I saw a women’s health physio who specialised in pelvic floor stuff after the birth of my son, and she was talking me through the correct way to squeeze, she said that the research suggests it doesn’t matter whether you consciously squeeze the back passage or towards the front to stop urine flow, any squeeze in the area activates the pelvic floor muscles throughout. Which might suggest that they could help rectocele? But I don’t know for sure. If you can get a referral to a women’s health physio, or find one privately in your area if you can afford it, they would certainly be able to answer with a lot more expertise!

Thank you so much for responding to me, that was so sweet and also encouraging. I am feeling a bit better and more positive today and from what I have read elsewhere online, discovered that rectoceles seem to often improve significantly after hormones and bodies have regulated just like other pelvic floor muscles, and all are improved with pelvic floor exercises.

I have a meeting with a specialist on the 18th and a phonecall with the doctor tomorrow (as well as needing to ring physiotherapy), so hopefully will get some further reassurance and clear exercises!

Hi OP, sorry I can't help with many of your questions but I just wanted to say you are not alone with your worry! I have a cervical prolapse from pre-pregnancy which has gotten much lower as the baby grows/womb stretches so I feel it more as it's closer to the entrance to my vagina (I'm worried it could eventually come out). It's a horrible "heavy" feeling sometimes as well as some discomfort when urinating and defecating. But along with the pelvic floor exercises, my physio suggested putting my feet on a low stool when sitting on the loo so the body is in a more natural position (as well as the usual lactulose like you if prunes/more fibre and liquids don't help).

I'm hoping to have a ELCS and the doctors/consultants I've spoken to so far seem happy with that - but it might be because it's my first/only baby at 40 after multiple IVF's, as much as the prolapse and pelvic floor issues (although a GP did mention that a natural birth could make the prolapse worse so I might need it operated on after birth, which I'd prefer to avoid if I can ).

Hi OP! Didn't want to read and run. But I too have rectocele, exactly as you describe. Basically it's the rectum protruding into the back wall of the vagina that causes the buldge. I got mine after the birth of my first child (was pushing at all the wrong times during my very fast labour) mine causes me no major issues as such but I do notice it more if I'm constipated, so I currently have numerous boxes of Laxido in my cuboards and I take maintanance doses daily to keep my motions soft.

I had my 2nd baby 4th of this month and I'll be honest with you, I opted for an elective section as there is basically a 50/50 risk of the prolapse worsening with a subsequent vaginal delivery, I wasn't willing to take that risk myself and I'm so glad I didn't. My section and recovery has been a total breeze and my prolapse hasn't got worse.
What upset me the most was how many midwives I came across during my pregnancy didn't know what a 'rectocele' was and therefore was constantly being told, "well things change down there after having a baby" I did end up refering myself to a gynae doctor in the end who did indeed confirm I have a grade 2 rectocele. I religiously do my pelvic floor exercises but sadly it is probably the surgery route in the future if it gets worse.

Congrats on your pregnancy btw! X

Thanks so much for responding to me, hope everything improves for you! Apparently things can pretty much go back to normal around year after you have given birth, so let's hope it all improves for us! :).

Thanks so much for this, it's so horrible having a rectocele because it seems that most people - even health professionals - don't know much about it! I have read some very positive stories on here about them improving though, so I'm hoping we can avoid surgery! :)

Hey. I don't know the answers to your specific questions BUT I had something similar when I was pregnant and I was freaking out. I was diagnosed with a minor uterine prolapse during my second pregnancy which has totally resolved itself 3 months since I've given birth.

The thing protruding is actually a granuloma from my first birth - could this be what yoy have? As far as I understand it, that's a skin growth.

Anyway, I was freaking out but it's turned out OK. My sister actually had a serious prolapse after her first baby. She wen ton to have 3 more kids then the surgery and js fine now.

Finally, if you can afford it I'd recommend seeing a private women's physio to get a clearer idea of what's going on.

PM if you want x