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.

I have a cystocele and am seeing the consultant who fixed my rectocele in March tomorrow to find out the way forward. To be honest I'll be gutted if he says I don't need surgery as can't imagine staying like this. I have a spongy lump at the front. The back wall is slightly ridged, presumably where the stitches have been but it thankfully feels good and firm. I too feel sore and am constantly aware of it - and yes, it does feel like it is going to pop out. Worse in the evening when it feels lower. I have found the cystocele more tolerable than the rectocele - distressing to deal with splinting etc. as have had no continence issues with the cystocele (yet!) just have to give myself a bit more time in the loo to make sure I've finished. I can also feel a round smooth bulge at the top - this is new and I guess it is my uterus but don't know. I've also got a feeling of pressure in my bottom by the evening.

I'm really keen to see the consultant tomorrow. I knew as soon as I was told at the ward round that I had a slight cystocele things would slip further so it came as no surprise to me. Many in this thread and a good friend of mine experienced further prolapses shortly after surgery - it's a shame that they haven't done a study to support multi-repairs if at all possible.

I've mentioned it before but a ring pessary was invaluable whilst waiting for the rectocele repair. They thought I was too young at 52! but I got the hang of taking it in and out and honestly it took away the symptoms to make things tolerable. I think it is the issue of sex as to whether they consider you 'too young' but I think they should be offered with support as they can really, really help. Depending on the outcome tomorrow I may ask about the suitability of one for what is happening to me now.

Great to read such positive earlier posts - skinikki good to hear that you are able to be so active and positive on the run up to further surgery. Fen - hopefully this is it....

Sorry to read about more complicated cases than mine and the distress they cause. I'm sure like most on hear I'd never heard of this before - it's great to have this forum to share experiences. Big hugs to everyone.

Aargh, just lost a long post.

Tink my cystocele is quite high up, about2", they wouldn't do it with the rectocele although I asked several times. I'm only a week post rectocele op so too early to tell how the cystocele will be. The thought of another 6 weeks of this degree of disruption is a nightmare, I'm going to be constantly worrying about the cystocele as I start getting more active again.

Those that have had more than one op, did you have to go through referral again or did you stay on the books as it were?

Sorry, that first it was to Skiing not Tink. I'm confined to my phone and I think this thread is getting a bit long for it.

Hi Sure - so glad you're back and hope you're feeling good today x

Tink - I have a ridged area on the back wall following my repair back in June. It feels like a line, with a softer area at the back, and I have a lot of pressure in that area. On the front, immediately at the entrance I have a small area of tissue hanging down from a urethrocele. Behind that there is another separate ball of tissue which comes down to the entrance sometimes too, which I've been told is a mild cystocele. Surgeon doesn't want to do anything with the front wall other than the tape for incontinence since he thinks this could make things worse. I get quite a lot of pressure in that area too, which is worse at the end of the day and around the time of my period.

Sorry meant to say Fen, not Sure - but thinking of you both lol

Hi, Thanks for the replies, guess I will just have to wait and see what he says tomorrow. But my cystocele sounds similar to yours Roseanna and I dont know about you but to me mine is large yet to them it is mild to moderate....I would hate to see what a grade 3 one looks like.

Hope tomorrow goes well for you, Wouldrather, I will be thinking of you, my app is at 11.

Whoknows - I had to go through the whole process again, i.e. back to GP who referred me back to Conssultant. This was because they dismissed the cystocele as a small bulge. At the time I was happy for the appointment to take a while as wanted to ensure the rectocele had healed well.

Tinksxxx65 we'll compare notes tomorrow! I'm in at 9.00am.

On a brighter note we have just got a dog from a local rescue. He's adorable and taking my mind off things.

Best of luck wouldrather - let us know how you get on.

Know exactly what you mean Tink - to me the cystocele seems like this huge balloon inside, but seems kinda incidental to everyone who's examined me. Was beginning to think I was going crazy at first, because it seemed like noone could see what I was talking about and yet it feels much more prominent to me than the rectocele ever did, although I agree with wouldrather that the splinting issues were more distressing.

Interesting what's been said about pessary use too - its never been discussed with me by anyone as an option, and maybe it is because of my age (39). Tbh, would prefer a permanent surgical fix if possible anyway, but if they are not going to fix the cystocele, I would've though it might've been suggested as an alternative. Despite all the research I've done, I often feel like I'm completely lost with all this stuff and not sure what to do about everything. Lucky I have a surgeon I trust, but am a bit of a control freak at the best of times so it would be good to have a clear idea of my own what I actually want!

Good luck Tink and Wouldrather for today. Let us know how you get on.

Whoknows, I discussed my rectocele at my 6 week check after my anterior repair and TOT and he booked the op date there and then. Didn't even have a look just took my word for it although I think he was probably aware of it himself as he had just had a good rummage around in there whilst repairing the anterior wall!!
I am using private medical insurance so he is probably rubbing his hands together!! I am just glad I don't have to wait an age for another date. The discomfort of the rectocele and the splinting issues are not particularly easy to live with.
Fen, hope today finds you recovering and comfortable.

Good luck Tink and Wouldrather xxxx

Make your consultant examine you standing up whilst you cough!! My cystocele was not visible at all lying down and the consultant didn't believe me, so he made me stand with my legs apart, stuck his finger in and made me cough - lo and behold "Oh, yes, I see what you mean!" (just goes to show we know our own bodies!!!) and I got fixed xxx

Good luck today Wouldrather and Tinx

How are you doing Fen? And Who knows hope that you are both getting lots of rest!

It has really struck me reading the thread over the past few days how many of you have ongoing troubles after the first repair and difficulty getting diagnosis and treatment for prolapses that are really affecting your lives. I knew nothing about this subject until this year and have found these threads and shared experiences invaluable. Thank you ladies of the fallen and fixed fanjo club

Morning! I hope all appointments today have gone well. I was very interested to hear what you had to say about your urethrocele Roseanna, as mine was never mentioned to me until after my first surgery (it was one of the lumps I could see all along and was convinced I hadn?t had an anterior repair at all). Like you, my current surgeon refused to touch it in case I couldn?t wee ? which is fine, as long as having it doesn?t stop me weeing anyway as time goes on as that is part of my problem ? it takes me ages to get my bladder anywhere near empty which is very embarrassing when I?m out?
Anyway, back to tell you all the trolley story as promised? I duly arrived and reported on the day, only for a nurse to start leading me round to the ?cabins? that day patients are in? As you can imagine, I started to panic a bit as I thought this meant I would be sent home the same day, so I asked the nurse why we were going there ? to be told they didn?t have a bed for me. She went on to say they might be able to get me a bed IN THE MORNING!! Those of you who?ve already had the op will know how important a proper bed is (I particularly need the bottom to raise if I?m on my back) so I was in a quandary as to what to do ? if I genuinely was going to have to spend the night on a trolley post-op I wasn?t sure if I was going to be able to do it. At that point I decided to keep my mouth shut as I wanted the op over and done with (I really couldn?t face the thought of going home and making all the arrangements all over again.) I went round, put gown and stockings on and waited?.. and waited?. Wondering if my op was going to be cancelled or if maybe they?d forgotten me or couldn?t find me as I wasn?t on the ward . Eventually I was taken down to the waiting area outside theatre ? and waited again. I didn?t know whether to laugh at the ridiculousness of it all or cry! It was over two hours past my op time when I finally went in (and I was only third on the list). You can imagine my horror when I came around still on the trolley and thought ?oh no..? I couldn?t remember the way back from theatre, but realised I was being taken to the ward, which was quite a relief ? until they told me I had to transfer myself to the bed (pack and catheter in place), which I duly (and gingerly did) . Thankfully that was the end of that ? except they brought my things round and put them where I couldn?t reach . The rest of my stay went reasonably well (except the three hour wait the next day for more pain relief) and I have to say I feel completely different this time. They either used an anaesthetic intended for elephants last time or I was already brewing the infections I had before I left hospital as I feel much more alert and with it this time. BM?s are so far not an issue although I don?t recommend diarrhoea with stitches where I have them! I am also admiring the bruising which is quite spectacular and much more widespread than I expected (when I can pluck up the courage to have a look!) Looking past the ?car crash effect? I think I might actually end up with a normal-looking fanjo somewhere down the line which is very cheering!
Sorry for the epic post but had to share!

Oh Fen what a relief it is all over. I know the feeling of waiting and worrying about cancellation having been cancelled myself once; all dressed up in gown and surgical stockings and nowhere to go! A bit of communication goes such a long way instead of this moving from pillar to post without reassurance I'm pleased you're feeling positive at this early stage - it really does sound like this is finally it for you and hurray to that.

Well, my appointment was at 9.00 and my consultant asked to examine me standing up without any prompting from me. Sure - as per experience on here he said my cystocele was not actually that big. Talked about pelvic floor exercises, he asked whether I'd had physio, asked about topical oestrogen. He was pondering when I put forward a clear case of how much this is affecting me. I mentioned the pinching feeling and he said this may not go with surgery. Thought some more .... I could feel it was going either way - I put in a bit more about how intimately this is a disaster for me and he then agreed to surgery. He said my uterus has descended a bit so I am down for anterior repair +- hysterectomy.

Asked about activities - mainly skiing and horse riding. He said these are fine. Talked about the relapse percentage being 25-30% but said doing things that are good for fitness/wellbeing were outweighed by the risk. However, he did say he would be concerned about running or other high impact sports!

I have oestrogen cream for the run up to surgery. Forgot to ask about a pessary. If things worsen I'll consider one.

Even though I knew this would most probably be the outcome I suddenly feel a bit shell shocked - however, I do feel relieved that an end may be in sight.

roseanna1 - I'm with you - however much I read I feel it is hard to get a proper grip on what's what. It all feels very text book and I wonder how much advice is based on real women's experience. I was never offered a pessary but a friend had found using one amazingly helpful whilst waiting for surgery. When I asked about one I was given a quizzical look. Once fitted there was an immediate relief of the rectocele symptoms. I would also have never thought of taking it out but my friend was taking hers out every night. I couldn't quite manage that as could only shift it after a few days when it had moved slightly, otherwise it was too high for me to get a grip! They are put in for 6 months which to me is surprising as quite liked the fact that I could take it out and clean it. The reason I'm not rushing to get one now is that this bulge is much lower so I'm not sure what effect it will have and I think I may have read they are more effective for rectocele or uterine prolapse. My friend also had to have an op for cystocele within a year of a rectocele repair and was straight back with the pessary which she found helpful - she did need a hysterectomy though so I can see it would work for that. Sorry to ramble - adrenalin has kicked in!

Fen you deserve a medal for retaining your sense of humour. Huge sympathy with the diarrhoea - been there & done that too & it isn't fun. Glad you are feeling brighter. Sending you some virtual flowers, because you definitely deserve them!
Wouldrather - glad you got your referral for surgery. Not sure if you are pre or post menopausal, but if pre - try & hang on to your uterus.

Hi all, glad to hear things are going well for you fen.

Well had my appointment and it is mixed news. Like you Wouldrather he said both my prolapses were mild (this is slightly a different view as to the colorectal man who said my rectocele was large to moderate) anyway he was really good and explained everything to me, I asked whether the cystocele would get worse and he said yes, so I have decided to get it done. But next came the big worry, he explained that I had low anal pressure and as I have said in previous posts this means that there is a real possibility that I will be fecal incontinent afterwards, but he said he had no way of knowing if that would be the case, but that I had to understand that it could happen and base my decision on that as to whether or not I want the operation......He said he would not have it done!!!! However I just cannot poo, and every morning is a nightmare for me and distressing. So at the moment I am now booked in for both posterior and anterior repair in December and he has sent me home to have a think about it all. I really dont know what to do, I would be more than upset to be incontinent, but then can I live like this, I dont think so :(

tinkxx, how is he proposing to do the posterior repair? If he is approaching it vaginally, it won't damage your anal sphincter any more - I'm presuming that this is what he is referring to by anal pressure.
I was really worried about faecal incontinence and opted for a vaginal rectocele repair, rather than a colorectal repair because of the higher risk of damage to the anal sphincter.
Forgive me for asking, but when your rectum is full now - can you hold the poo inside? If you can, then repairing the rectocele shouldn't lessen your ability to not poo yourself - if that makes sense.

Postbellum, I had some tests done by the colorectal man and it came back that I had low pressure at rest and squeeze, one of the muscles is an involuntary muscle and there is no amount of exercise that can improve it, he said it was damaged and nothing could be done to improve it. The sphincter muscle at the entrance to my bum is also weak, but that there is room for improvement (I now spend many hours squeezing it together lol) To answer you question, I can sort of hold it in, I have no real sensation until the last minute and if it is a bit on the soft side then no I cant, some starts to come out :( but I never leave the house until I have been, but would not like to be out and feel the need to go. I also suffer from a little bit of mucos leakage :( :( now and again.

Anyway I have had a coffee and a think and have decided to go for it, my life is constricted anyway and he did say if the worse does happen, they can do something about it.

But I have to go back and see the colorectal man anyway about this red mass that protrudes when I go to the loo, so the plan might change anyway.

I guess if you have a weak sphincter, it is possible that by repairing the wall that supports the rectum and allowing the poo to pass more easily, it could put more pressure on the sphincter.
That's just me guessing though, rather than anyone who has any medical qualifications!
I was terrified about feacal incontinence too, as I am definitely not diarrhoea proof and have to be really careful about not farting when I don't want to either!!!
The physio who taught me how to do my PFE, also showed me how to squeeze my sphincter & it has defnitely helped - so keep squeezing!

Post - I think I can class myself as post menopausal but have still read it is beneficial to retain the uterus as a structure. I feel it has slipped quite a bit. Before the op I'm going to say if he's in any doubt at all I'd like it removed as can't face having to yet another op.

Tink65 - what a day! Good luck with your decision.

Tink - I'm so sorry to hear of your troubles . I've been thinking about you since I read your post. I hope you won't be offended but has anyone ever said whether an electrical stimulator might help? I have a neurotrac pelvitone and know you can get an anal probe for it. To save asking around, you might like to PM Nankypeevy as she is a physio on here with a special interest in prolapse. (You may have seen her thread.) Worth asking the question surely - even if the answer is no, at least you will know. As for the op, I think the only thing you can do is trust your gut feeling on this - we all know our bodies best!
Wouldrather - I had a hysterectomy at the same time as my anterior repair (I had a uterine prolapse as well as the others) and really don't regret it for a minute. My recovery was very slow and painful but looking back I believe now that was mostly down to the infections I had and not the op itself. Again, go with your heart as it's usually right.
I've had a pretty good day today and have even managed to feel bored which I take as a good sign! If the bruises weren't in such a private area I would be keeping a photo log of them... I'm waiting for the moment when they all join up.

Hi - may I join?

I used to be a regular on the Ragged Bits thread but after several procedures, my bits are no longer ragged in fact when viewed from the outside they are rather pretty, but they are falling down. The insides at least.

Just saw GP for pelvic exam yesterday and told her that my Grade 2 vertical prolapse (as diagnosed by pelvic floor physio) wasn't getting any better, and would she please take a look. She agreed with me that it was definitely not fabulous, and also found a polyp. Whether it's a cervical polyp or actually on the vaginal wall she couldn't tell, so has initiated a referral to a gynae. Hopefully the one who did my first operation (wedge resection and posterior repair), and if I can't get in to see her, another, more local one to me, who has a lovely reputation.

(Should add I'm not in the UK, I live on the West Coast of Canada. 8 hours behind GMT, and so post at odd hours.)

She had a good old rummage-around to try to see the entire polyp so my insides are feeling a little unsettled today (ouch).

She asked me very bluntly if I would like to discuss a pelvic floor lift only when I see the surgeon, or if I was open to a lift and sub-total hysterectomy (leaving cervix and ovaries) given that I'm done having children (thanks to DS's shitstorm birth) and my very irregular periods. My cycles have been steadily shortening, despite progesterone supplementation. Last month was 22 days. Pretty soon I'm going to menstruate, ovulate, and have PMT all in the same day .

I would be fine with a lift and sub-total hysterectomy. But would really like to hear people's experience of either/both.

Thanks in advance, and apologies for crashing the thread!

If I bring and and cake? Or Canadian Thanksgiving turkey?

oh dear did I break the thread?

Aw shoot, that would have been , not .

Welcome to the thread jack not crashing at all everyone is welcome to the fallen fanjo club

So sorry to hear that you are having such a dreadful time. I am not sure what a lift or a Wedge resection are?

I have no experience of polyps but did discuss a sub total hysterectomy with my cons before deciding against it due to me be hormonally very stable with no monthly problems.

It sounds like you have alot to think about and I would do as much research as you can.

Sorry that I can't be of more help there are lots of lovely ladies on this thread all with different experiences so keep posting x

Hello Jacks, sorry, I haven't experienced either of those procedures, maybe someone else will be along who has.

I'm feeling a bit fed up today, I want to get a bit more active but am paranoid about overdoing things (10 days post-op now). I sneezed a couple of times yesterday and it hurt, then I had some fresher (redder) bleeding today. I have cut back my painkillers a bit but it feels all tight down below, I guess it's the stitches pulling, I'm finding it hard to get the balance between lying in bed all day and sitting downstairs (I am sitting back in a squidgy armchair, not upright). Every time I sit in the chair I worry I might be putting too much pressure on.