TMI warning - Pelvic prolapse / posterior vaginal prolapse

[gullshelp]

Hello,

NC from usual username for this as embarrassing.

I'm waiting to see my Gp as I'm 8 months postpartum and despite Pelvic floor exercises I've had trouble emptying my bowels.

It didn't take long to search online and find an exact match to my symptoms. I have a rectocele or posterior vaginal prolapse.

Basically the wall between my vagina and rectum has prolapsed to create a pocket. Horrible but basically poo gets compacted in there and in order to empty my bowels I need to push it back up and into my rectum. It's not so severe that if has fully prolapsed and hangs outside my body (as I have read can happen) but going to the toilet is not pleasant.

Has anyone experienced this and how was it treated ? Did you need surgery and would you recommend this? The prospect terrifies my but I would rather like to be able to poo normally again.

Complicating factor is that I plan to try for a second baby fairly soon (DH and I are not getting any younger) and I wondered if:

A- vagjnal prolapse could cause issues in subsequent childbirth, eg better to get it sorted before txt

B- it would be better to get it sorted after having DC2.

I'd be grateful if people could share their experiences. I think this must be quite common!

Thank you.

Jeipping you have also said that you had a repair that failed. I wonder how common this is.

I had this. I had surgery - I think it was called a suspension - and it completely got me back to normal. The surgeon told me all the physio in the world wouldn't repair it. I did have physio after the op. All on the NHS but this was a few years ago.

I also didn't know that was called "Splinting" ! When I had to open bowels I could see a bulge so the only way I could "go" was to push it up and in.

The process for me was:

• 6 week check up after birth, told GP I didn't feel right. GP wasn't confident to diagnose, so referred me to gynaecologist.
• 71 days til I saw the gynaecologist. In the mean time I saw a private PT who told me I didn't have a prolapse! But I think I was unlucky there and would pay to fast track treatment again.
• saw the gynaecologist. She diagnosed grade 2 bladder and bowel prolapse and referred to woman's health physio
• 3 weeks later had my first PT session where I basically just cried and said "I miss my vagina" over and over 🙈
• saw PT weekly, then fortnightly, now down to once a month. She's awesome and has done wonders for me. I've progressed to a point where I don't need a pessary or surgery.

That being said. I am very aware from talking to others in the same position, that this is a life long injury. It will get better, but I will never be the same again. In my mind a C section would be the safest alternative, however I'm also aware that another pregnancy would put added pressure on my pelvic floor and undo some of the work I have down. Additionally aware that the NHS don't always count prolapse as a reasonable reason to have a c section, so would have to go private.

I'm getting back to a good place - vaginally speaking - and have taken the decision that I would rather us be a happy family of three, than every risk feeling how I felt for the first 6 months of my sons life ever again. I also believe it's a way to safeguard my health - I want to be active in the future etc.
( Which reminds me, absolutely no heavy lifting or high intensity exercise for you. No running, jumping etc. Stop. Cycling or swimming for now. Nothing that puts pressure on your pelvic floor.)

That being said, I don't have the primal urge that other women have for a second child. If I did, I don't know what my choice would look like x

Thanks so much Sar

I have read the grades and am confident I also have a grade 2 prolapse. Fortunately I've had no bladder issues.

It sounds like you've worked incredibly hard and have come a really long way doing the exercises. It's easy to underestimate the impact that something like this has on your everyday life.

I appear to have the primal urge for just one more bablet so will have to proceed with caution and make sure I'm properly assessed and advised.

I wonder what the relationship is between prolapse and difficult births. My baby was back to back and I had an extremely long active labour and a 3 hour pushing phase. Before birth I had very strong pelvic floor muscles so I think there must be a relationship.

Olly
Great post thanks really helpful, I'll certainly look up suspension. I'm so glad you got sorted. X

Definitely a relationship I think! Similar to you had very strong pelvic floor, physically very fit and active, normal weight. Back to back, 2 hours pushing, episiotomy, ventouse (3rd attempt). The consultant gynaecologist just nodded when I described my birth and sighed "yes now prolapse".

PP who have mentioned prolapse not case for cs I have had mine agreed and I'm not pregnant. This is a London hospital with aggressive policy to keep cs rates down. I got a letter in my maternity notes at the first appointment to say no cs without medical grounds. But have had no fight to get cs approved for future pregnancies. This is with a moderate prolapse. HTH

Mumu incredibly helpful thank you and good luck with any future pregnancies

Labour times vary. I had a rapid labour- 3 hrs from start to finish. I arrived at hospital 7-8cm dilated. I gave birth around 1hr after arriving.

I was fine I thought but the prolapse appeared after my 2nd birth which was 6hrs but very controlled and short 2nd stage.

If you have too much sagging afterwards, physio won't always help. I had electrical stimulation for the muscles from a physio and it made no difference.

Having said that, I think things have moved on since my DCs were born 30 yrs ago. Physio seems more sophisticated - I was never given core exercises, just PFE.

Physio is the first step anyway.

I had a repair privately 2 years after my 2nd DC.

11 day overdue, stuck baby, 52hr labour, waters manually broken, induction drip used, 2hrs of pushing, episiotomy (plus tear up the front) and forceps to get him out. He weighed 9.5lbs. He also required physio from four weeks old for his wonky neck, bless him. He was well and truly stuck.

I had v strong pelvic floor and sound intimate knowledge and health, which is why I knew something was wrong.

Definitely a link!

I have bladder, bowel and uterine prolapses - diagnosed not long after the birth of my first child in 2011. I saw a Women's Health physiotherapist and was given exercises. Stress incontinence was my main issue but the Urogynaecologist would not operate until my family was complete. My second and last child was born in 2016 via natural delivery and with no obvious worsening of my prolapses.

I had a TVT fitted this Spring which has completely changed my life in terms of the stress incontinence but now my rectocele has worsened significantly so I am having a repair scheduled for later this year. It's an unpleasant experience having prolapsed pelvic organs i am finding, especially as my consultant says that it's only a matter of time before I need additional surgery. The apops Facebook page can be quite a useful resource. Good luck.

Just to add to the comments above - I have a rectocele as a result of a tricky labour with my second - all the symptoms you describe. GP was really quite hopeless and I was fobbed off for a long, long time. Referred for NHS physio which was no help at all. Eventually went for private physio with someone who was highly recommended. Vast difference and it was very useful so would highly recommend doing the same. However, I also by this stage several years down the line pushed for a gynaecologist referral. When I was finally seen, was told that no amount of physio would resolve what was a large rectocele. Had surgery which was not pleasant or easy in terms of recovery. I could however eventually poo properly again - hoorah! Unfortunately I was left with a very notable ridge of internal scarring and over about a year the rectocele symptoms have returned again. Not quite as bad but not good either. I'm v wary of repeating the surgery but dietary changes have really helped reduce the need to splint. In your sit. I would def. consider a c-section as you really don't want to risk it getting worse. I had none of this after my firstborn so the link to a poorly managed, difficult labour is very clear to me. If I knew what I know now it would have c-sections all the way. Wouldn't wish this on anyone - v undignified and I worry about managing it in my old age! Good luck op!

Just to reiterate that, medically, it's a Urogynaecologist you need to be referred to as opposed to a gynaecologist. The former has specialist training in diagnosing, grading and more importantly, treating prolapse. You may also need to see a colorectal specialist if it's a rectocele/posterior prolapse.

There's an organisation called APOPS that has a wealth of info. They also have a FB page and there's loads of us from the UK navigating treatment through the NHS.

Thanks for the advice about what to push for in terms of who I see.

I'm happy to see a women's health physio and do exercises to minimise this. I will have to stress to the gp though that I've been doing PFE since DD was born, and crucially, I'm confident that I have a permanent rectocele pocket (almost herniated as a distinct pocket even if bowels are kit full) so like some have said PFE May not ultimately solve this.

I'm glad I know which specialists to ask for and the options re using private care albeit frugally eg to get letters written.

I have also been concerned about this rectocele affecting me in old age and I certainly don't want it getting any worse.

Distinct pocket even if bowels are not full ....

Op, until the dr diagnoses you with prolapse you can't know for sure you have one...

Googling symptoms doesn't mean you have it, as you can google any symptoms and come up with all kinds of stuff

It would be best to let the dr first of all see you, hear what your symptoms are, examine you, and then diagnose you with what he/she thinks..

Thanks anxious.

With respect there is a very clear and persistent area of herniation post childbirth, I'm very anatomically aware and it's very clear what the problem is. As I've said, I am going to the docs. It's glad I've had so much feedback as I'll now be able to describe the issues more clearly.

Prolapse is one of those things that are fairly easy to self diagnose. I went to the gp for a referral and didn’t get examined - she wrote he referral. Physio of course examined as part of treatment and I unquestionably have a prolapse. Even a couple of weeks post birth with nothing down there in a familiar state it’s pretty clear!

Hi yes I had posterior repair and re stitching of episiotomy. Probably from difficult births. It was only a few months before it came back sadly.

Not to detail the thread but v curious - seems lots of us have had repairs but symptoms returned. Has anyone had successful surgery for rectocele that has resolved the issues on a more long term basis?

Derail not detail!

Sadly, I don’t think there is any surgical intervention that can guarantee no recurrence in future. Even after a total hysterectomy, the vaginal vault can prolapse.
Gravity is a bugger...

And this is what puts me off having another vaginal delivery ... if it gets worse and can't be fixed.

Sadly you can also prolapse If having a Caesarian. And at menopause. Basically it’s a female thing. If life were fair there would be an equivalent issue where 50% of men’s penises just dropped off due to ageing or something.

Uncertain - I'm nearly 6 years post-rectocele repair and it has remained successful so far. Better still, I also have a low grade cystocele and was told that would almost certainly get worse without the recticele to support it but it hasn't. I was told that there was about a 30% risk of needing it done again so I am careful with my lifting, exercise etc.