Cystocele AND rectocele prolapse

[Whatelsecouldibecalled]

9 months pp after difficult vaginal deliver which resulted in a 3c tear needing big repair in theatre as torn front to back and into uterus. Horrendous recovery. Thought things were going ok. Recently not been feeling right in my vagina. Pain and dragging sensation back. GP today has confirmed a cystocele and rectocele prolapse. Basically both my bladder and rectum are falling to my vagina. I’m so so upset. I’m only 32. Just had my first baby. I’m being referred to gynae but just wondered if anyone else has had this and what the outcome was?

It is unfortunately more common than we are led to believe. I had similar issues after a complicated forceps delivery. First baby, aged 33.

My route was GP to Gynae, then on to a woman's health physio, who I saw for around 8 months. She was fantastic.
My mental health took a massive knock too, but improved as my symptoms improved with treatment.

I always recommend a Facebook (private) support group called Association for Pelvic Organ Prolapse Support (APOPS). Many many women who will unfortunately understand your experience.

It does get better.

I have this - diagnosed at similar age. I am 6 years post my last baby and I've just learned to live with it. I was referred to a specialist nurse who trained me how to properly do pelvic floor work which I guess must have worked to some extent because it's not as bad as when it was first diagnosed. I was told that the only other thing they could do was the operation where they put in mesh to support the vaginal walls but I read about the high failure rate and complications from that and didn't think it was worth it.

It's shit, but it hasn't affected me like I thought it would. It's mildly inconvenient now.

Thank you for your reply. Did you both prolapses. Have you recovered with physio and not needed surgery?

@BernardTheRobot thank you for your reply. Is it manageable to live with? The doctor told me without treatment it would get worse. I have visions of it all just falling out!

What do you find is inconvenient the most? I am constipated lots so trying to do something about that

Also have you both go on to have a sex life still? Least of my worried right now but I do want to be able to in the future!!

Apologies that this will be TMI, but re constipation: I usually have to insert my thumb and press backwards to push the rectocele back into place to allow bowel movement to take place. That is the main inconvenience, but it's fine once you get used to it. I try to avoid jumping exercises (no star jumps for me), but I've found that it I land and immediately bend my knees that cushions things so I can still to aerobic stuff.
I can't advise about sex because I was in an abusive relationship when I was diagnosed, then split a couple of years later and haven't had a relationship since. I did have sex with my ex but it was always horrible because he was violent and abusive so not very helpful.
I have not found it got worse, but I have also found that GPS don't really know much where the specialist nurse (obviously) did. She didn't say it would get worse unless I did loads of heavy lifting regularly or jumping exercise all the time. There is hope!

@BernardTheRobot I’m so sorry you went through that but thank you for giving me hope. Do you have to do the thumb think each time you have a bowel movement?

I have both, bladder mild-moderate, but rectocele only mild. I would not currently be a candidate for surgery for either.

Additional issues for me were nerve damage and failed stitching of the perineum (which basically barely exists now, it's just a couple of cm of scar tissue.)

My prolapses don't really cause any issues with sex. (My scarring does, but that's a whole other issue!) But it took time and really working at the pelvic floor therapy to get all the sensations back and for everything to be enjoyable again. My husband swears he can't tell the difference, so 🤷‍♀️

Like PP I avoid high impact activities (where both feet come off the floor at once) and any work that increases intra-abdominal pressure such as crunches. Although over the last three years, I have built up strength in that area that I definitely didn't have post-partum.

@sar302 thank you for your reply. So
It has improved over time with physio?

Hugely so. I did 8 months with an nhs physio, then engaged a private physio who was also a Pilates instructor, to carry on.

I'm 3 yrs on now and day to day life is fine. I leak if if consume too much caffeine or alcohol, if I have a prolonged cough for whatever reason (hello COVID 😒) or if I vomit. But that's it.

It was quite a lot to overcome mentally, and I was very angry for a long time. Still do get angry about it sometimes. But only sporadically now.

But the two physios who I worked with, honestly saved my life.

Oh and the heavy dragging feeling doesn't happen anymore either - apart from if I've had the bad cough, and then it goes away again after a while

That’s great to hear. Thank you for giving me hope. I have contacted a private physio today whilst I wait to see what is happening with referral. I think covid could put a stop to it though so anything I can do in the meantime

I have the same issue - it started with my first baby who I had at home (v straightforward labour) aged 32. Then the symptoms came back after my second baby; and again, worse I think, after third baby (who I had in August). Third time round I’ve got a proper diagnosis - I went to GP who referred me to urogynae at hospital, and to hospital physio. and I’m doing a pelvic floor rehabilitation programme with them. I have also found a great local Pilates instructor who is doing online postnatal Pilates classes and this has also really helped. I totally get what you and other posters are saying about feeling angry / depressed at having this - I really freaked out when the hospital told me I would need a hysterectomy aged 38 to resolve the prolapse. But my Pilates teacher had prolapse herself and is now symptom free because she really focussed on pelvic floor strengthening- there is hope. My plan is to use mat leave to make sure I do everything I can to strengthen my pelvic floor with support from hospital physio, and then work with private physio further if needed. I am also hoping that when I stop breastfeeding that will help like it did last time. Baby is now 5 months and the dragging sensation / feeling of weakness has definitely lessened already.

There are some useful online resources - the hab-it series is particularly good, and I credit this along with an excellent physio at reversing my prolapse.

Though managed and with no issues any more, I recognise that my pelvic floor will always be a muscle group prone to weakness, so do weekly Pilates and am v careful about anything high impact etc. I also know that a cough, or in later life the menopause, could cause my pelvic floors to weaken to the point that the prolapse returns.

Talking about it and learning not to be ashamed was also critical to my recovery.

Oh and sex is great - no issues when the prolapse was playing up, or now.

Oh and at the moment I have a ring pessary which supports the prolapse and can be a short term fix to allow you to strengthen pelvic floor and reduce that low level aching sensation of prolapse day to day - the hospital physio said that quite a few women have it for 6 months or so and then don’t need it after that. Though it is not a replacement for pelvic floor exercises!

@Whatelsecouldibecalled not every time - just when needed
The nurse specialist told me about it, and also to avoid straining to go. Basically anything which involves bearing down on the pelvic floor is not good for you.
I used to use a mooncup, but in the last few months have stopped since reading that they can make things worse, and I do feel better not using one (or any internal sanpro) now.

Have a look at the Hab-It website and Fem Fusion Fitness on YouTube for safe exercises that will help (actual exercise - not just kegels). If i remember correctly, both are physios. Anyway, they know their stuff.

You could look at the kegel8 machine too. Reviews are really mixed but some people swear by it.

You’ll be ok, OP.

@BirdsDoIt Do you have to get the pessary taken out or can you do it yourself?

@BirdsDoIt who fits the Pessary? How long can it stay in for? Can you have sex with it? (Sorry I sound sex mad! I’m just so upset of the thought of not being able to!!) I would be glad if I can relieve the dragging feeling a bit!

I’ve got an appointment with private women’s physio on Friday (via zoom - cheers covid) so hoping I might be able to do some
Exercises to help it a little.

Thank you everyone for your replies. Has anyone used the mutu method? I’ve been looking into that? Or kegal8 etc machines??

But most importantly thank you for reassuring me I am not alone

I had both cystocele and rectocele after my second baby. Was distraught at first. I saw a specialist physio and a gynae who was prepared to operate. If I'm honest I didn't get any benefit from the physio and exercises.
I had two children under three and made the decision not to risk surgery.
All that was 21 years ago. I would say long term I have had very little problems apart from mild stress incontinence which tbh many women have without prolapse.

@Phlicker do you have no side affects? No pain? Or dragging etc? Doctor told
Me would get worse if untreated. I had visions of my insides hanging out in 6 months??!

@Whatelsecouldibecalled @PerfidiousAlbion you can put it in and take it out yourself- I was a bit wary at first because I was worried I wouldn’t be able to put it back in properly but I’d say if you can insert a mooncup yourself then you can insert a ring pessary. It’s a plastic ring that you sort of pinch as it goes in and it sits just behind/above pelvic bone. I can’t feel it at all when walking around.
The urogynae doctor fitted it for me first time - because they have to make sure you get the right size.

I have never used a moon cup and struggle to get tampons in the right place!

I've got 2 things you can start straight away that'll help:

1. Cut out all caffeine.
2. When doing a poo you need to have your knees higher than your pelvis from now on. Best way is to put your feet on something like a step stool, lean forward resting your arms over your thighs and don't whatever you do strain, instead push your tummy out to go iyswim. Lots of water to avoid getting constipated too.

These, with targeted pelvic floor strengthening, will help.

Sex can actually help push everything back up too .

I had a mild cystocele and rectocele after the birth of my first child (very easy labour at home, no tears). I had two babies back to back though and as expected it got worse in my second pregnancy.

I was told that I wasn't a good candidate for surgery (I was 29 and was told I was too young) and got referred for physio. To be honest it didn't make much difference and I was depressed about it for a while as I was a keen runner before my children, but 4 years on the rectocele has disappeared and the cystocele is so mild I barely notice.