Advice needed please r.e. treatment options for uterine prolapse

[AdvicePleaseOnThis]

Hello, just looking for some advice please from women who have experienced any of these three treatment options.

I am 68, with high BP and a previous major heart bypass. I have been diagnosed with a uterine prolapse and have been given three options:

(1) Do nothing.

(2) Get a pessary.

(3) Have an anterior vaginal wall repair, which possibly may also involve a hysterectomy at the same time. Of course this is major surgery!

I would really appreciate hearing from anyone who has experienced any of these three options. What did you find were the pros and cons? Do you wish you had chosen another option?

Thank you in advance for any advice you can offer.

Were physio and vaginal oestrogen not on the list?

They should be.

At this point, it’s probably worth saying yes to everything to get on the waiting lists and find out more.

Pessaries can be a bit of trial and error.

Wider health wise you dont sound like an ideal candidate for surgery so that may not turn out to be an option without resolving some of the other matters first.

Thank you for replying. No, neither of those options were on any of the leaflets, or discussed with me. Do you think they would be worth trying? Do they work for many women?

The best practice guidelines say physio should always be tried prior to surgery.

If you’re in a position to do it, a private specialist physio appointment would be a good investment. Physios have the benefit of working with patients who take all the different approaches (pessary, surgery, lifestyle adjustments) whereas the pessary clinic only tend to see pessary patients, surgeons surgical patients etc. The appointments are also much longer than consultant or GP ones so you get the wider context discussion.

The anterior repair is not going to address a uterine.prolapse. A hysterectomy would but then you risk further prolapses.

I had a sacrohysteropexy for uterine prolapse and it worked wonders… but look carefully into procedures where mesh is used. Mine did involve hernia mesh and I’ve had zero problems..

I would highly suggest seeing a private women’s health physio whose specialises in pelvic health. It’s usually about £80 for the session and they’ll have a wealth of information for you. It’s the best £80 I’ve ever spent and well worth it.

And yes physio and cream can really benefit and help the symptoms be much better. The physio can also make sure you’re doing the exercises correctly

Thank you for getting back to me again. Yes, I would be very interested in physio. Is there a website of registered women's health physios for the UK, do you know? What should I look for when I'm choosing one?

Thank you again in advance.

Thank you for sharing your experience, I am really glad to hear that everything went so well for you. Of course surgery is the last resort for me, but I will remember your advice about the mesh, thank you.

Hi OP.

Is the prolapse bothering you? I saw gynae after GP diagnosed rectocele, Gynae told me it would improve my quality of life if I had it repaired.

So I had the op, prolapse recurred within 3 months. And honestly? I feel that things are easier with the prolapse than without it.

I should add I also have slight uterine descent and stage 2 anterior.

I did have a year with a pessary which was fairly easy to manage, but I got tired of taking it in and out every time I wanted to poo or have sex! Because mine was for rectocele, whenever I needed a poo the ring would slip down and have to come out.

I saw private physio and private uro-gynae and so had a lot of choice and flexibility.

Gynae has offered to do the repair again but I've said no. I am 47.

I think if you can afford it, your options are better privately. And my GP sourced and fitted the pessary. I didn't have to go to any NHS clinics.

Thank you so much for this information, if physio could help that would be ideal! May I ask how you discovered your specialist physio in the first place, which website/register did you use? Is there any website which offers reviews of physios as well, that you know of?

Also, what was the name of the cream you used?

Thanks very much in advance for any more advice you might have.

OP, just Google women's physio in your area. There are loads of them.

And you need Estriol cream. It's oestrogen cream and really firms up vaginal tissues.

Hello and thanks for replying. Yes, to be honest my prolapse does bother me unfortunately, I feel a "pulling" sensation, can't bend down to pick things up and sometimes struggle to urinate.

Thank you also for sharing your experiences about the pessary, and for telling me the name of the cream, I will definitely look into it.

@AdvicePleaseOnThis good luck. It made me very emotional and it was a very stressful few years. I'm much happier now, but the surgery is massive and I found myself being incredibly anxious afterwards.

I would say that if I was older I might have it done again as less likely to need a second repair (they generally last about 10yrs).

The specialist physio I saw said I should use estriol. It took speaking to the right GP at my practice, and needing something from the physio in writing, but they eventually prescribed it to me. The physio gave me a plan to use the cream - every day for 2 weeks, then twice a week from then on. So it’s useful to see them as a they can help with prescribing needs.

1. you could use - https://www.csp.org.uk/public-patient/find-physiotherapist and use “women’s health” as the search function.
2. you may find a google search “pelvic health physio your location” will yield your best results
3. I highly recommend the Squeezy app too and they have a search function also https://squeezyapp.com/directory/

It was so important I saw the physio because I was actually doing the pelvic floor exercises wrong and could have made things worse.
she taught me exactly how to do them.

I hope you’re ok. I’ve felt incredibly lonely and sad at times in this journey. To do, I’ve just done physio and cream and seeing how long it lasts before I might need to do something else.

Don't suppose you're in the South? I'm looking for a recommendation...

If you watch reels, I follow female physio, shes Australian and makes kegels a damn sight more fun than the bloody squeezy app which I have come to hate 🤣

I recommend seeing a women's health physio who can also fit pessarys or is linked with another practitioner who can. I found The White Hart clinic in Barnes really good and travelled quite a way to see them on the recommendation of a more local physio. I was also prescribed vaginal estrogen as a little tablet. My local physio taught me to do hypopressives, it a type of breathing. Hypopressives with Alice is great on YouTube to get an idea. I'm back to running, lifting weights, etc with little concern. The prolapse is still there but currently no symptoms.

POGP is the specialist physio group. You can look up ones in your area on there. Squeeze app also has a list I believe.

Thank you for your kind wishes, sorry I didn't get back sooner due to family issues. Sorry you had such a tough time. I am going to hopefully try a combination of cream and specialist physio. I don't know what to do about a pessary ... I might put my name down for the op as apparently the waiting list is 1.5 years, but that would be a last resort if the situation only gets worse. Thanks again for all your advice.

Thank you so much for those links and for getting back to me yet again, sorry I wasn't online due to other issues. I have luckily managed to book in with a very well-regarded women's pelvic physio therapist in early December, not too far from where we live. I have also requested an Estriol prescription from my GP, not sure if I will get it without physio's help.

Sorry to hear it's been tough, it's a horrible experience. Hopefully the cream and exercises will keep it in check for both of us 🙏

Thank you so much for this encouragement, I am really glad you have had so much benefit from your physio. Unfortunately I live too far from Barnes, but have booked in to see a specialist female physio near-ish to me. I will check out that YouTube channel, thank you!

Really hope you continue to have no problems, thanks again!

Thank you for this resource, I have managed to get an appointment with someone registered on there for early December. I am also going to try the cream if I can be prescribed it.

Do nothing if you can. As long as you're prolapse isn't painful or interfering with your daily life, it's best just to leave it.

You're probably far too young for a pessary. I've heard a consultant gynaecologist.Say that you might want a ringpassery if you are 85 but at your age, it's unlikely to be a long term solution.

Physio won't work. You can't contract or train the muscles that are holding your uterus in place.It's too high. Pelvic floor physiotherapy won't have any effect on it

If you have a hysterectomy surely your vaginal vault will just prolaps next? It's usually how it works.

Have you asked about a sacrohysteropexy? But then you might not want mesh, even though it's safe in those circumstances.

Honestly I'd do nothing if you can for as long as possible.

I agree with @TheLivelyRose do nothing as long as possible.

I don't know about being too young for a pessary though. Mine was fitted at 43 on the advice of a Professor in Uro-gynae.

They don't stay in. You take them out for sex or I needed to remove mine for the loo. Mine was silicone, not one of the rigid NHS beige plastic ones.

You could try a shelf pessary though, they do stay in I think.

Because doing absolutely nothing is a well known way to improve a situation, or preventing it deteriorating.