Any old prolapse! Uterus/womb prolapse, rectocele, cystocele, enterocele, urethrocele, incontinence, pelvic floor, anterior and posterior repair, TVT etc part 5

[Piplysmelie]

This is thread 3 of a long-running series of posts from ladies suffering from pelvic prolapses to support each other through the process of diagnosis, repair and recovery.

Here are the previous threads:
Thread 1
Thread 2
Thread 3
Thread 5

Info from BBC Health

What is a pelvic prolapse?

As the muscles, ligaments and supporting tissues in the pelvis become weaker, they are less able to hold in the organs of the pelvis such as the womb (uterus) or bladder.

Gravity pulls these organs down and, in the more severe cases, may appear through the entrance to the vagina.

A variety of problems can occur, depending on where the weakness lies and which organs are able to descend, but in every case there is some degree of prolapse of the vaginal wall, which begins to invert (rather like a sock turning inside out).
Prolapse of the womb or uterus is the most common prolapse, affecting as many as one in eight older women to some degree
Prolapse of the bladder, known as a cystocele, is less common.
Prolapse of the urethra (the tube that carries urine out of the bladder) is known as a urethrocele.
Prolapse of the intestines is quite rare, and known as an enterocele or rectocele.

Symptoms

Symptoms depend on which tissues descend, and how severe the prolapse is.

They may include:
A sense of heaviness or pressure in the pelvis.
The appearance of a bulge of tissue in the genital area, which can be quite alarming, and is often red and sore.
Urinary problems, such as having to urinate more frequently, feeling the need urgently, being incontinent (losing control of the bladder) or, conversely, being unable to pass urine when you need to.
Pain in the pelvis or lower back.
Sexual problems, including pain and decreased libido.
Constipation.
Vaginal discharge or bleeding.

Treatment and recovery

Once a prolapse has developed, surgery to fix the affected organs is usually the only way to cure it effectively.

However, another option is to use a device known as a vaginal ring pessary. This is rather like a contraceptive diaphragm or cervical cap. It's made of silicone or latex, and placed in the vagina to push back the prolapsed organs and hold them in place. Many women happily manage their prolapse this way.

Hi I am after some advice. I went to see my gp today. I have been worried that things have not been right for some time. After having 3 children things have got progressively worse. I had noticed an obvious bulging on the back wall and would say after consulting google that it is a rectocele. I have had worsening symptoms when going to the toilet and sex certainly is not what it used to be. My gp had a very quick look and said I had a mild prolapse that certainly would not worrent surgery yet. She did not give me a chance to tell her the symptoms. Should my gp have got me to at least bear down or something? I was expecting a referral. I left really upset. Can anyone advise on weather this is normal diagnosis from a gp? She did say she will refer me to physio but I'm not sure if this will help as I regularly do my exercises already. What should I expect from physio?

Gingerbread, I'm not really knowledgeable on the wee side of things - but didn't want to pass through and appear to ignore what seem to be considerable issues for you.

Kenmill, how bad are the poo symptoms. I think you'll find that they have to be pretty bad before you'll get a referral on the NHS. Do you have to splint or manually evacuate?

FWIW, my consultant was of the view that there is very little physio can do for a rectocele, as it is an actual tear in the tissue between the rectum and the vagina. No amount of PFE will repair that tear, all you can hope for is that you are retaining muscle tone in the surrounding area to provide support.

Did the GP talk to you about eating lots of veg to ensure you are getting plenty of fibre & ensuring that you have bulky stools and not small constipated nuggets, which get stuck much more easily?

I told the gp it was not constipation, I end up going to the toilet regularly so more like not completing the stool each time. I tend to have to put pressure on my perineum to help things along.

I have a feeling that just having to apply pressure to your perineum will not be sufficient to warrant surgery.

Hopefully, some of the others who've also had rectocele repairs may be able to say differently, but I think you have to be encountering more difficulties than that to get an op via the NHS.
I would go for the physio that has been suggested, so that at least you will be able to go back and say it hasn't got any better & please can you now be referred to a consultant.

Ginger - - I only really developed problems after the birth of my last DC so didn't have any problems in pregnancy or the immediate aftermath of birth, so I don't have any direct experience of this. I have no idea for example if this would be grounds for elective C Section. Who did your review yesterday? I would suggest going to your GP if it wasn't them and ask to be referred to your consultant obstetrician for advice. I would be interested to hear if anyone else has got any other ideas though. Also, when I had DS, which admittedly was a few years ago, you could phone the hospital afterwards (even years later) and a midwife would go through all your notes with you in detail which may be helpful in thinking through your options to avoid further damage this time.

Kenmill I was similar to you, I went to the GP with very similar symptoms a few years ago and got the same response, although I was referred to gynae they made it pretty clear they weren't going to offer surgery at that stage, just exercises. To be fair it is a major bit of surgery with a considerable recovery time. My main problem was a combination of heavy periods and the inability to retain a tampon (or get one in properly in the first place), which was largely solved by having a Mirena coil fitted. I occasionally had to help my poos along as you have described. Mine got much worse suddenly this year and I was referred for surgery. My symptoms at this point were considerable discomfort when sitting or standing for long periods, discomfort when walking, discomfort when lifting anything remotely heavy, having to give up most forms of exercise, having to do a lot more frequent poo interventions. Although I tend to think that pelvic floor exercises won't make things any better, they may slow down deterioration, and a physio can probably give lots of advice on how to avoid straining and making things worse. They also aren't keen to consider surgery if you are planning to have more children or even are just under the age of about 35 in case you decide to have more at some point.

HI Ginger, welcome. I am really hoping that this time around someone monitors you more responsibly. Giving birth naturally to a first baby of 11 lbs doesn't seem like a very good idea. My first was big and was back to back which literally pulled everything out with him. As you say, you are never really the same again. My second came shooting out whilst i was still standing,
(sounds unlikely I know!) and i might as well have given birth to a samurai sword, again...lots of new damage. I developed septicaemia after the third which did it's own damage. Each one left it's own bit of history!!!

I would think that Who know's advice regarding a caesarian is wise under the circumstances, obviously that isn't the home birth you are planning, but it would protect the area and reduce the chance of further damage. Once you have finished breastfeeding you would know what you are dealing with and get the appropriate help. Could you ask for help now regarding the back end, I can understand the weight of the baby is forcing it out all the time but it must be very sore, and the longer it is out rather than in the more fibrous it seems to become, which takes a good while to recover from. I have used schleroproct gel and pessaries which work a treat, but I don't know if you can use them whilst pregnant?

As for the doctor saying nothing was wrong...they are only there because we need them and get paid HANDSOMELY to do so. We pay for their training, they get a brilliant salary, and then they look after us, that is the deal and it seems fair enough to me( after all they are not likely to get shot at, unlike our police officers) My usual rant, but honestly, how dare they infer that these things are not important or a problem. We deal with the aftermath of poor decisions, trying to put a brave face on the situation for our children's sake. Please ask for some help as you haven't got long to go and they need to be taking the issues seriously and protecting your future health.
Try not to worry, put some plans in place and then you can enjoy the rest of your pregnancy knowing that everything is under control as much as possible under the circumstances. Please stay put on this site and keep us posted!!
Xxx
Welcome ken mill, this site is a mine of information regarding poo issues, you've come to the right place!!! Xx

Thanks for the replies. I will give the physio a go. Can't make it any worse!

Hello to Ginger and Kenmill.

A few q's for you posterior repair / perineal repair ladies, the first about pre-op...
I know the answer to this might be 'don't be so ridiculous' but here goes anyway - I'm trying to put my garden to bed for winter (I do have someone who comes to mow the grass but is no gardener by any stretch of the imagination and seems not to see the weeds in the gravel / the flower borders that need to be edged etc!) I've been doing a lot of hoeing and raking and find that it REALLY makes me hurt after - should I not be doing it or thinking 'what the hell' as it's getting fixed soon anyway? The truth is I want to put the house on the market and hate looking out at the mess.
Moving on, how much embroidery is visible afterwards? Is bending over difficult? Do you need to protect the stitches when having a BM or wee? Is the pain or recovery different to an anterior repair? Sorry for so many, but I'd like to get the real version as I doubt I will at the pre-op!
Hoping everyone is moving onwards and upwards, or can soon.

Fen - I am asking myself the "what the hell" question this week (mine is definitely worse now and I am due for my op on Weds. I have concluded that I really ought to play it safe because I don't want the repair to be any more major than it already is.

Everyone else, please answer Fen's other questions about afterwards for me too (by Weds!) as I would like to know as well!

Also, for all the post-posterior repair people, please could you give me any last minute tips that I ought to be remembering, I'm sure I have seen it all before on this thread but my mind has gone blank at the crucial moment.

Whoknows - thank you for the thoughts.
Youll have to keep me updated as youll be a week ahead of me.
And thank you to everyone who sent me good wishes for dd2. Trying not to think about it - hence the gardening!

Hi Fen/WhoKnows - I also went through what the hell, if I mess it up further it's all going to be fixed later so a bit more won't make any difference. It did make my back ache like made though, and made me feel sick with a lot of pressure going on down below!

In answer to some of your questions:
Most important, stock up on lactulose and glycerine suppositories (available at all chemists - I used boots) and I would probably start taking 5-10ml of lactulose in the morning a few days before the op (and drink loads of water) so your stools are already softish or you will have a BM from hell afterwards!!!

Sewing on the outside is a small line (about 10cm in my case) which goes from your vagina towards your anus, just like an episiotomy scar, but very neat and once the stitches have gone, doesn't show at all. You will also have the stitches continuing along that line into your vagina and up it. How far they go up depends on the extent of the operation (mine went all the way up the first time and about half way up the second). To start with everything will look black and blue and you will feel that your vagina has been sewn shut due to all the swelling. It does take a long time for the swelling to go down and for things to feel more comfortable. Cold water and drying the area with a hair dryer really help.

When it comes to moving about etc. Do NOT bend over (bad for scars and it kills). I used one of the litter collecting things to pick stuff up off the floor (highly recommend you get one) for about 4 weeks, and then and even now go down on my knees to pick anything up. Standing still is a big no no but walking isn't so bad. Therefore, cooking needs to be done sitting down (that's another story!!) and get someone else to empty the dishwasher and do the washing up. No hoovering and pushing supermarket trolleys either. Don't carry anything slightly heavy either.

The pain is most noticeable when you try and sit down. I used a neck pillow to keep some of the pressure off and also found that sitting on the edge of a seat, on my thighs, was less painful. The best position is lying on your side in bed (not good for trying to type though!!)

Fen - do not be tempted to do any gardening for about a month afterwards as you will do yourself a damage!

I can't think of anything else to write just now, but I'm sure I will think of more things. Any questions please ask. Fen - lucky you have had a hysterectomy as the first period or two afterwards absolutely kills!!!

Best of luck to you both xxxxxx

Bye the way - just got a letter for my post op check up, which was cancelled last week - for the end of November!!! (5 months post op!!!) - am obviously going to try for an earlier one as I would like to know what I can and can't do now!!! Oh the NHS!!! I could still be waiting to go back to work!

Sure - that's a bit rubbish abut your checkup. Was it you who was in the hospital where they closed down the department just after having your op?

Thanks for all the advice, I have just ordered a litter picker from Amazon. A bit nervous about taking lactulose or similar (surgeon recommended Fybogel) in case it gives me the shits over the next couple of days (provided I stick to my 5 a day I don't generally have too many problems apart from the u bend thing, which is generally only a problem about once a week, I've never really had constipation). I'm ok for periods as I have a Mirena coil which the surgeon says can stay in place, so that's one less thing to worry about.

As for the day to day managing afterwards, well, cooking sitting down is not an option, so someone else is going to have to do that (I am stocking the freezer this weekend). I already kneel as much as I can for floor related activities (I keep a foam kneeler by the washing machine for example) so I am going to just have to keep on with that.

This last week it is twinging at even the slightest exertion which is good in a way as it is showing me very clearly all the activities which are likely to be problematic.

Post thank you for the advice about returning to work. I am seeing the GP this week and the consultant advised that the most important thing for me was not to rush back to work to soon due to what he had to do because I could do myself some damage quite easily. I will be going back on a phased return. Sitting still bloody uncomfortable.

Gingerbread, it is difficult to advise because we all have such different bodies. I had significant damage during the first birth and then significant damage to a different area during the second but this was down to the babies position during delivery. However my last DC was delivered by CS due to that damage so I can totally understand how you feel. I elected for the CS because I was told that the damage that I had was not repairable which was clearly not the case. If I could turn the clock back I would have not have had the CS and had the repair done sooner.

Kenmill sorry to hear about your troubles. It seems to be a current theme with us ladies that we have to go through lots of tick boxes to get the diagnosis and treatment that we need and it makes me so mad. I agree with Post in that damaged tissue is not really helped by PFE's but they do help in other ways.

Hi Fen you do sound busy! I have to say that my body has let me know when I am doing something that I shouldn't. Bending is difficult as is getting in and out of cars. I don't think that you would be able to do much more damage in a week or two but it might affect how quickly you recover after the op. Other things that I still cannot manage is bathing the younger DC's, changing beds and lifting/pushing anything heavy.
As for embroidery I have quite a lot but had a rebuild so hopefully you wont have to have that. Pain wise I am far more aware of the posterior than the anterior repair (sorry) and it feels really quite raw still so I would make sure that you have something comfy to sit on and stock up on painkillers. I also still cannot wear trousers and am living in Pj's and dresses to avoid any pressure or pulling down there.

Whoknows the tips that I found really useful (sorry that I cant remember who said them) was to put a washbag next to your bed with toothbrush and facial wipes etc so that you can reach them that first night. Have easy meals etc in the freezer you really will not feel like cooking for quite a while and be knid to yourself it is a major thing to go through x

Surewoman I agree that lying on your side is the most comfortable (and still is!) and that the first BM and period were just awful. My next check up will be at 4 and a half months Sure but I was seen after two weeks and can contact the cons if I need to. Hope that you manage to get yours moved.

Phew this is a long post!

It's just starting to sink in what the next few months are going to be like. I've done virtually nothing today, DH decided to take the DCs swimming while I stayed at home. As they were about to go DS started crying and saying he wanted me to come. I decided it would be fine so long as I took it easy but DH just said no I really shouldn't, he was worried I would catch a cold or something there and he's probably right, that would be the last thing I need, but it is so depressing. I feel useless .

Anyway, he has left me with a nice fire in the woodburner and I am making a shopping list to take to Boots tomorrow, thanks for your tips ladies.

List is as follows:

Homeopathic arnica tablets
Paracetamol
Ibuprofen
Lactulose
Glycerine suppositories
New toothbrush

The nurse at the pre-op warned me about needing jogging bottoms or similar, I've only got one pair (apart from lots of lycra running trousers that are sadly redundant) so I might buy some more. I've got quite a lot of leggings but only one pair of PJs. My jeans were uncomfy yesterday.

Also need to have a look at the (sadly rather small) freezer and see what I can fit in. Although I'm by no means a gourmet cook and use lots of shortcuts I do normally cook from scratch (I have a DC with extreme food issues so cooking / meal planning is hard at the best of times). We have Ocado though, which I think will be very handy.

Another question - I've been told my the nurse that I have to do a DIY enema at home the night before, with a little bottle of stuff with a pointy lid. Have any of you done this? The lid is really long, I'm scared I might damage myself (I just can't believe I'm talking about this stuff on a public forum ). How do you see what you are supposed to be doing? I'm all clenched up just at the thought of it.

I have no idea whoknows it was not required by my hospital but wanted to wish you goodluck!

Whoknows, proceed with caution and good luck!

Sorry for the tmi but might give you a chuckle anyway:
There has been some discussion on here about 'the u-bend'.... Suffice to say I've discovered the true meaning of that term today as that's the shape one if my bm's came out today....

WhoKnows - I was told I wouldn't need an enema beforehand as they empty you out manually on the operating table! The mind boggles as to how, but I suppose it must be like squeezing playdoh out or similar, lol! . With regard to your kit, I would suggest a bit of KY jelly on the end of the long pointy bit and maybe try squatting over a mirror, so you are in a more natural pooing position. Good luck!! XXX
Thinking of the cooking, I used to sit at the kitchen table and the DCs would bring me the ingredients which I would then chop and hand back for them to cook. It did all take a lot longer but the DCs definitely learned a lot about preparing meals and are better for the experience now!

Ooh - wet wipes are good to have, especially if you are sick like I was!!! Oh, and ear plugs in case you have a snorer in the room; also music to listen to such as i-pod etc.

Thanks Footle, I'm trying to get knowledge together, ready for the next round in the battle.

Hi all, Hope you're all progressing (I'm still waiting to see the urogynae chap again). I was sorry to see that so many were having problems post-op, but I'm still jealous! I've got the orthopaedic surgeon tomorrow, so maybe a little more progress??

Not getting on here much, as the home situation is difficult, at present, and the computer is not working that well either.

Hugs, and good luck to all.

XX

Good luck for tomorrow Nannasylv. I hope you continue to weather the storm of your other problems too. X

Anyone had sacrospinous fixation? They said they might do it last time and didn't - it's now back on the cards.

Ok, been to Boots (knew that double points voucher would come in handy), just need to stick a load of podcasts on my phone (prefer them to music) and sort out some old clothes etc then I'm ready.

NannaSylv - good luck tomorrow, I was sorry to hear about your problems at home when you posted a couple of weeks ago.

Sure - my two are too young to do any actual cooking but at least they can make toast for me!

Fen - arf at the u bend poo!

I also went for "what the hell" in the run up to the op. I organised everything as far as I possibly could, including an online order of food for about 5 days post-op.

Wet wipes are good to take, as is lip salve (I found the hot hospital dried my lips really badly). Make sure you have a supply of painkillers at home, in case you don't get sent home with any. I wore a skirt, so I didn't have to worry about being uncomfortable in trousers, slip on shoes too. I had to buy some big pants, as I didn't own anything other than strings and I had to buy STs too, as I never use them either. Take a book / kindle and an ipod. I couldn't sleep the night after, and the book was a lifesaver. Make sure you have a gentle driver to take you home, as you'll be bracing yourself over every bump.
Get as much help as you can possibly get and be prepared to feel completely wiped out for at least 2 weeks afterwards.
GOOD LUCK - will be thinking of you all. XXX