33, one surgery down - now what?

[SDURKEE]

Hi Sherrie,
I had the pleasure of running into you on Monday when I was getting ready for my physical therapy appt.  What a wonderful blessing that I was so early for my first appt.  Otherwise I would have missed you!

I'm 33 and have 3 children - 5, 2, and 7 months.  I had my youngest in January and he was over 10 lbs.  About 2 weeks out I felt a definite bulge and got in to see a dr. My Midwife was out of town.  I was dismissed and told it couldn't be prolapse because I was too young.  I later saw my midwife who diagnosed the prolapse but wasn't comfortable being more specific - she recommended an obgyn.  I saw 3 different ones.  Two told me to to kegels but did not recommnd PT or show me how to do them effectively.

I finally found a dr. I felt was listening.  He recommended surgery for the prolapse.  In June I had a TVH wtih anterior repair for the cystocele.  Then the fun really started.  I felt a bulge again about 1 week post op.  I called in and was told it was swelling and not to worry.  At my 2 week check the Dr. didn't do an exam, but told me it was probably still swelling.  Finally at 6 weeks I made another appt. even though he didn't want to see me again and was told the prolapse was not back but the entie pelvic floor was so weak that was what I was feeling.....?  I was referred to PT.  I had my first appt. on Monday and was given exercises to do bu was told that the cystocele was back and I'd probably have to do electrical stim and or vaginal weights to make any progress.  

I'm also feeling like a possible rectocele now......I have since found a urogyn - didn't know there was such a thing before - and have an appt. set for Sept.  What are my options?  It is hard to recover with three kids at home.   My husband took all his sick time after the last surgery to help me and my mom came to stay.  

The dr. didn't want to use mesh because of my age, but is that the only option now?  How do I know if I'm a good candidate or not?  

I'll be getting your book asap.

Thanks again and I'm so glad I bumped into you!

[sherrieP]

I'm going to send you a PM (private message) with a link on how to narrow down urogyns in your area, s/b a few in Madison.

[SDURKEE]

I checked out my Dr. but didn't really find any reviews/etc.  Do you recommend anyone in the Madison area?  I just want to make sure I get the right person this time.  

[sherrieP]

I can't begin to tell you how often I hear of women being "dismissed" when they tell their physicians of POP symptoms; it is frustrating beyond words and one of the paths I hope will shift is getting the medical community to recognize the need for screening in ALL women 6-12 months post-partum and ALL women in menopause. These are the 2 leading causes of POP and there is not screening in place. That needs to change. When we recognize symptoms like bulging tissues, chronic constipation, pain with intercourse, vaginal/rectal pressure and tell our drs, they need to listen to us. There is a huge shift in motion now and I'm so hopeful in a year the protocol will be an entirely different page.

I'm so glad you continued to pursue an answer, so often women start to question themselves after they are dismissed a couple of times.

To have gone through surgery and not have a resolution to POP is extremely frustrating and many women experience this because the physicians who do their surgeries are not properly trained. When I say it truly takes an expert, see a urogyn, I mean it from the bottom of my heart. These specialists go through an additional 2-3 years of fellowship training and are the best  bet for repair. Additionally I recommend women check the  physician "watchdog" websites to look up their physicians records like ratemd, vitals, and healthgrades to find out how well their dr is rated. All women should go to their urogyns with a list of all their questions written down and demand answers-we need to remember our drs work for us not vise-versa.

The additional benefit of seeing a urogyn is this physician will address all the POP issues not just one during the same surgery. I had 3 types of POP fixed, we knew about the rectocele/cystocele going into surgery but not the enterocele which was large, but it wasn't a problem once she got in there and found it-she just fixed it.

Since you are so fresh from surgery, I have no doubt your urogyn will address the repair you've already had done. Often drs don't want to use mesh on younger women, some urogyns worry about complications, the top shelf urogyns look at it as the best long term fix is the most viable option. When mesh is not used, once you reach perimenopause and muscle tissue starts to get weak (all women have this issue with menopause, estrogen impacts muscle tissue strength and integrity), often non-mesh surgery will fail and you'll need additional repair. In my case I was already menopausal but I was also concerned about the fix being permanent because I am an aggressive exercise nut. I didn't want to repeat surgery in a few years.

Write down all of your questions and make sure the urogyn addresses them all. Talk about mesh with your surgeon, there is currently a debate on the good/bad of transvaginal mesh procedures (through the vagina rather than with abdominal incision-I feel it is a good procedure and is what I had done) but complications from this procedure are typically related to improperly trained physicians who are not urogyns doing the procedure. I not only discussed mesh but also what kind of mesh-I wanted to know the mesh my dr would use had passed the tests of time.

Step one is finding out what all is going on POP wise. The good news of no mesh being used in your June surgery is there won't be any "undo" factor mesh wise. Once women have progressed to grade 3 and 4 POP, physical therapy is not as effective for treatment, but it is always a woman's choice whether or not to have surgery or treatments. If you are seeing a PT, it is vital that you see one that specializes in women's health-this is a separate division of APTA and there is a list on the APOPS website to access their listing.

There is a chapter in my book that has "questions to ask your dr" but adding any and all questions you have is important. There is no silly question. The more info you have, the more comfortable you'll be making your treatment choices.

There is a POP Risk Factor Questionnaire on the APOPS website, print it off and see how many risk factors fit your situation, you can take it to your urogyn.

Here's links to 2 posts of mine that may be of help for some basics.

http://www.medhelp.org/posts/Pelvic-Organ-Prolapse-POP/LETS-TAKE-PELVIC-ORGAN-PROLAPSE-OUT-OF-THE-CLOSET/show/1531725

http://www.medhelp.org/health_pages/Womens-Health/KEGELS-AND-KEGEL-BREATHING/show/1133?cid=994

The Kegel piece can be of benefit post surgery as well for maintenance but first step is finding out exactly what is going on. Trust your gut, no one knows your body like you do-you've been doing a great job of  continuing to look for answers!

It's hard to say what your urogyn will recommend, it will depend on your specific POP issues. Once you've made a connection and gone for your office visit or after you read more POP info, send in your specific questions and I'll do my best to address them.

You know where to find me!
Sher

[sherrieP]

It always amazes me when I happen onto women navigating the POP pathway; I always feel it was a connection "meant to be". I do have a meeting to head off to but will get back to you shortly hon!

I'm so glad you found a urogyn, that is step one! As far as your age, as I believe I mentioned when we connected I know women in their early 20s with POP-it is pretty frustrating that this is still viewed as a mature woman's health issue only. I'll get back to you on all of your questions as soon as I get back to the office, have to run so hang in there a little bit longer.

Sher
ps-your children are BEAUTIFUL!!!!