Prolapse. 1st Gynae appointment.

[Winniethepooer]

In November my GP refered my to a Urogynaecologist as i have a prolapsed bladder.

The appointment is next Monday.
I am terrified. Terribly anxious. I've waited so long, its made the anxiety worse!

What can i expect at the appointment?

My GP gave me no information. The hospital didn't send any information & Google is frightening the life out of me!

Thankyou.

Do not be terrified. I had a rectal prolapse after baby 3. GP referred me to gynae. It was a very intimate and thorough exam but it did not hurt at all. She made me do all sorts of squeezing to see what my pelvic floor was doing whilst she had her hand inside me. It felt like it took a very long time but it probably wasn't. She gave me a set of exercises to do 5 times a day for 6 weeks and when I went back said it had improved dramatically and wanted to see me again in a year. Mine pops out again if I get constipated so I've made some changes to my diet and don't have much in the way of a problem now.

Well done for dealing with it. I know women too embarrassed to go to the gp about their prolapse and I was mortified but needed to get it resolved.

Oh and she also gave me the option to rebook for the internal exam as she said she didn't like to do it when women hadn't been warned it was going to happen (I had not been warned but sort of assumed she would need to examine me!). So I had the choice to do it there and then or come back another time. It was not as bad as she implied it might be!!

Thanks for responding.

I have had this issue for 9 years.

I've had a rectal prolapse for years as i tore severely when my oldest dc was born 27 years ago but didn't realise it wasn't 'normal' as my GP told me it was part & parcel of having a baby young!

I just feel I'm going to end up poked & prodded, the anxiety & stress really isn't worth it!

Bump...

Please go! Yes you will feel anxious and stressed but only until Monday. If you don't go you will end up anxious and stressed for years When I went I was treated with great courtesy, yes there was an internal examination but everyone was so kind. I was referred for a couple of tests and signed up for a medical trial but knew I could withdraw at any time I liked. (I am not a brave person and the way I manage it is to tell myself before an appointment "In three days it will be over and done" "In 6 hours it will be over and done" etc etc. )

Thanks.
Yes very good way of looking at it. I have daid to myself, just go on Monday so you know exactly how things are.

Chances are they will say its not too bad
Do more pelvic floors & off i go!

I'm exhausted as i can't stop thinking about it or relax so constantly on the go & have been for about 2 weeks now.

It's ridiculous - I'm ridiculous!

Not ridiculous at all, I hope it goes OK for you on Monday. Treat yourself to something nice, chocolate, new book or whatever so you have something to look forward to

Thanks but the anxiety is so bad i can't sit long enough to read!

Yes, I know that feeling!!

What is it that's making you panic quite so much?

I've tried to work it out & there isn't one thing.

I dislike all things medical. Even whilst pregnant, i struggled with scans or medical appointments. I refused monitoring (hospital policy from 37 weeks due to my age) as i couldn't cope with going in 3 times a week.

I'm scared i need surgery. I have no family/support, just split with dp.

I'm scared of the embarrassing medical tests/exaiminations/scans.

I'm a raging control freak.

I wish I'd never gone to the GP now. Horrendous evening. I'm so irritated by the dc.

I can't go on like this...

When I get like that more information makes me feel better rather than less. The unknown can feel very scary.

If it makes you feel any better there is NO WAY you need surgery for a prolapse. If you want surgery, great. But if you're happy to live with your symptom the doctors are really happy to let you carry on as you are. A prolapse does not need a surgical fix.

You can also have a pessary which is a small device (most commonly a ring) that can help pull everything up. You could leave it up there for 6 months at a time. As you say, physio is great and can really help resolve some minor prolapse and a lot of complications around them.

The negatives of a consultation are - being examined isn't pleasant. But wine when you get home does help . It's a really common problem they reckon 50% of women will suffer with a prolapse in their lifetime so no need to feel too embarrassed, the doctors have seen it all.

Thanks Faux

I know doctors have seen it all but it doesn't help.

My GP told me most prolapses eventually need surgery. My age etc are all relevant. Neither the bowel or bladder are minor prolapses. I said to the GP i felt it was OTT to refer me. She replied that she couldn't work out how I'm not doubly incontinent.

It was meamt to be an urgent referal! 18 weeks later...

Honestly, I have very severe prolapses and there is no rush or urgency to operate - it is up to you. I'm sure my doctors would be happy to leave it if I was. Your urogynaecologist will be able to advise you a lot better, I'm glad you're going straight to a specialist department not just a gynaecologist. Where in the UK are you?

At my urogynae the first consultation involved filling out a questionnaire on one of their computers so I could answer lots of questions privately and honestly - for example

Can you wear a tampon?

If not - how much does this upset you 1-5?

That helps because you don't need to sit and talk through the minutae of toileting etc. I will advise you to give how much something upsets you on the worst day you have it, not when you're being all brave and "I know I'm ok really".

Don't go into the appointment with any pre-conceived ideas of what will happen, that way you can be free to discuss alternative ways such as conservative management like pessaries or physio. Even if you want an operation to repair your prolapse I recommend you at least talk about getting a pessary on Monday so you can have an idea how you will look/function once every thing is lifted. The waiting lists can be horribly long so worth having a management plan in the meantime if they do any more investigations etc whilst deciding surgery.

Best of luck

Thanks Fauxgina.

I was thinking about exactly what you said in your post.

How much do the symptoms trouble me?
Can i just carry on as i am?
Why am i reacting so strongly to this appointment?

So i am goig to go. Have a chat, get some information & very hopefully that will be it.
I really couldn't cope with physio or pessaries. I don't have smears for tbe same reason.
My symptons really aren't bad enough.
My GP didn't listen to me & pushed tbe referal on me. I only went to see her as i had a kidney infection.

Thankyou for your kind words.

I'm in London

Hi Winnie,

I had a double prolapse after a traumatic birth with DD. If you think of a prolapse as a type of hernia it can be a helpful way of thinking. A severe bladder prolapse is often held in check by the rectal one. My rectal one wasn't too bad on examination and the bladder one pretty bad, yet I had no symptoms for the bladder one and tonnes of symptoms for the rectal one.

I had to digitally manipulate (splint with a finger) to poo. The poo never left my body straight so it was like pooing round a u-bend so needed more muscular effort and it was a mess to clear up. Even breaking wind was an effort. Its like pooing through a kinked hosepipe. Women often come up with coping strategies that become normal and doctors telling us this is a side effect of childbirth shouldn't. It does not have to be that way. Pelvic floor exercises are not the 100% answer, they don't solve it, just like sit ups don't solve a gut hernia.

The bladder prolapse can be symptomless as you have said because it can cause a urethra kink thus giving the impression of good bladder control. Some women when they have a bladder prolapse repair find continence becomes an issue and they get a procedure (TVP) where a bit of tape is inserted to re-kink the urethra.

The surgery is not as scary as it sounds. They basically repair the muscle fascia layers. There are different ways of doing it but for me, the layers were sewn back together and a the vaginal tissue was sewn with a reinforcing overlap (which my husband informs me is fine) and provides vaginal wall strength. In some people they insert a gauze like layer as a fascia replacement but that's becoming less common now. Surgery is fairly short and they pack your vagina afterwards to provide support and you have a catheter initially. You can go home when you are a. feeling ok and b. can fully evacuate your bladder (they scan to check). They also ask if you can break wind and I was delighted to say I could with no effort! (simple things ). I was in hospital for 2 days then had 7 weeks off work, following the advice given on lifting etc. Cystoceles (bladder prolapse) have a 30% chance of reoccurrence, but rectocele reoccurrence is very rare. My surgery was in the April and by the August I was working in a very hostile environment and was absolutely fine.

Although you may feel that surgery is not for you, don't turn away from the idea. Find out about it and see what is available for you. Good luck.

I could be wrong but I do think they'd listen to your wishes and not operate. I've read quite a bit and spoken to a lot of doctors about it and no one was in a hurry to repair mine. Everyone I asked said there's no reason it should get worse if I chose to leave it.

At your initial appointment explain how uncomfortable it makes you feel to be examined and they'll go slowly. They've always been very thorough in explaining exactly what they were going to do in the examination and always sought my permission first.

Reconsider the physio - you don't actually need to let them examine you! I've heard of a few women who go and don't have a physical examination the first time. The physio will talk through all the risk factors more so than the consultant will. So physio will talk about weight, coughing, how to improve length between trips to toilet, can advise you on pelvic floor exercises, what drinks irritate bladder etc. Just explain you're not happy to be examined I'm sure they can still help. They are good at improving pelvic floor technique via a physical exam but that's not all they do.

I'm not in London, wondered if you were going to my local hospital so I could talk you through what to expect a little more but never mind.

It'll be Monday evening before you know it

Did you have a double repair Violet? I'm due my repairs next week they're not deciding whether to fix bladder till they've fixed my uterine prolapse and posterior repair. I'm curious what it will be like if it's all stitched?

How did you feel after 2 weeks?

Thankyou both.
I understand the 'mechanics' of surgery, physio etc through reading as much as possible. For example i only drink water. No juices/caffine. I'm not over weight. I rarely cough. Stopped all impact exercise. Yoga & Piliates too. Only walk. No lifting etc.

I understand how I've managed so well for so long.

My phobia isn't rational, i totally get that.

I did explain to my GP that i have no care or outside help/support for the dc. So wven sttending appointments is difficult, let alone an operation.

At home, the youngest is just 3. 2 with SN. Oldest is 15. Older 2 live otherside of UK now.

Oh dear Winnie it does sound rough, sounds like you're doing a great job if looking after yourself. I went to pelvic pilates and it was brilliant, learnt even more than at physio as another gentle option, give all the muscles chance of supporting the ligaments .

I had a double repair Fauxgina and it was fine. After 2 weeks I was walking far more than the received advice although I did have a daily nap. I did get a post op infection so I bled for longer than I should have done (you do get some post-op bleeding btw) but ABs cleared that up. I also had a dissolvable stitch take ages to come out but that was it. I am pleased I had it all done at once. Got it all out of the way. DD (18 months) couldn't sit on my lap for the first week but it was fine after that.

Winnie if surgery doesn't currently suit your lifestyle then absolutely avoid it. Ask for other strategies. They will advice you on pessaries etc.