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Bladder prolapse
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Bladder prolapse

I am a 65 year old female with a prolapsed bladder. My OB/GYN offered to refer me to a bladder specialist, which I declined. Recently it has dropped to the vaginal opening. My only problem is that I must sit on the toilet or urine sprays all over, We do a bit of traveling. No leaking, pain, urgency or problems with intimacy. Should I be doing anything hygiene wise? For years I have been walking 5X a week about 2 1/2 mile, usually and exercise for seniors with weights, a band, ball and aerobics at a gym 2X a week and yoga for seniors 1X a week. Exercise includes  a bit of tucking the pelvis and squeezing which I think may have helped me. I really don't want mesh or a pessary. Is there any other help for me?
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Good idea to find out as much as you can and see a specialist.  When you go for an appt remember to ask about womens physio ( they deal with the pro active exercises mainly ) and have all your questions written down.  You could see a Urologist and a Urogynecologist ( Fellowship trained if possible in the US ).  It is good to get an all round opinion as to where you are now, what you can do, and what to expect in terms of long terms prognosis whether you have intervention or not.  Good luck with your specialist appt.

I hope you get your questions answered and come back and let us know how you got on.
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Welcome to the Pelvic Organ Prolapse forum.  Sorry to hear you have discovered you have bladder prolapse.

I realise you dont want mesh or a pessary, however, there are none mesh operations for cystoceles.  Is there any particular reason why you turned down the opportunity of seeing a bladder specialist?  It looks like your Ob/Gyne isnt a Urogynecologist.  Urogynes are able to look at the whole prolapse picture in the US so this could also be an option for you at some point.  I am not suggesting you have an operation.  What may be suggested is some womens physio as well as other options for you and you would also be more informed about your specific prolapse and what can be done and not be done.  

I do feel that womens physio would be a good idea for you to try and you can also discuss other options as well in this type of appt.

Are you put off by a pessary because you have heard they are uncomfortable or have to be put in by a Dr and left in?  There are a lot of different pessaries to choose from.  I have a silicone pessary I put in during the day and take out at night.  They can be very helpful to lift up the prolapse as well as support it so it isnt under so much strain.  

You say you do weight baring exercise.  This is not recommended with prolapse.  Walking is fine.  Correct kegel exercise is a must whether you have an operation or not.  Aerobics may not be a good idea.  Anything that puts a strain on the abdomen whether its lifting weight, stomach crunches, running etc is not recommended.  However, yoga ( without downwards abdominal pressure ), ball work ( which can be used to strengthen pelvic muscles if done correctly ), walking etc are seen as positive ways to exercise with prolapse.  All exercise has to be done correctly in order to be beneficial.  There are DVDs and books to help you but I would recommend you see a trained womens physio to check out your kegel strength and technique as well as get advise that is based on what is best for you and your bladder prolapse condition.

If your prolapse is at you vaginal entrance this may be a grade 3.  There is a tendency for prolapses to get worse and you could also be prone to getting more than one prolapse as time goes on, especially with no support like an operation, pessary or correct exercising.  I dont mean to frighten you in any way, but rather to inform you that it is a good idea to grab all the information and help you can now in order to be able to do what is best for you now as well as be prepared to review your condition as the years go by.  

I hope this helps.  Let us know how you get on
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Thank you UKlady for your input. I chose not to see the specialist because I don't have any major problems. I guess I will though, since I do exercise and I don't want to do exercises that could do more harm than good.
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Avatar_f_tn
Good idea to find out as much as you can and see a specialist.  When you go for an appt remember to ask about womens physio ( they deal with the pro active exercises mainly ) and have all your questions written down.  You could see a Urologist and a Urogynecologist ( Fellowship trained if possible in the US ).  It is good to get an all round opinion as to where you are now, what you can do, and what to expect in terms of long terms prognosis whether you have intervention or not.  Good luck with your specialist appt.

I hope you get your questions answered and come back and let us know how you got on.
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Thanks again for all your suggestions. I have my list of questions ready for the urogynecologist on Friday. He started his training in Egypt., again in England and is now in the USA in the Buffalo NY area. It seem like he is quite an expert. I sure hope so.
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Glad you have an appt with a Urogyne.  I hope you get answers to your questions.  Good luck with your appt and let us know how you get on
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Hi UKlady. I went to the urogynecologist today. He did an exam and scheduled me for a Urodynamic Test and a cystoscopy, 10 days later.He has me taking an antibiotic pill just before I go for the appointments. After the tests he'll discuss options. Most of the questions I had for him can't be answered until after the tests. He seems to know his business and said that if a procedure is required, what  he does is minimally invasive.
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When you next see your Urogye, if the recommend you to have a prolapse operation you could ask them how many of these operations they do a week and their success rates.  

Good luck with your tests.  It is important to have them done.  This is normal procedure.
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I hope this isn't a repeat. I posted yesterday but don't see it here. The URO/GYN tells me I need a hysterectomy. That seems rather drastic to me. I have no pain or symptoms, I have stage 3 prolapsed bladder, uterus and vagina and. He says he'll repair the bladder, along with using sling tape and the rectum.. His success rate is 100% except for the sling which is 93%. He says this should avoid further surgery in a couple years. Am considering a second opinion. I have a call in to my OB/GYN to talk about it.
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Hi Beek48.   I am glad you have had a Urogyne opinion and understand you may be hesitant to have an operation.  I do feel a second opinion is a good idea in order to cross match and consider your options before you go ahead especially as you are so hesitant anyway.  Personally I think a second opinion is a must for prolapse.  Your Urogyne success rates look good though.  Some ladies have 3 to 4 opinions by the way.

What I think is worth remembering though is that you have already noticed that your bladder has fallen to your vaginal opening and you dont want to use a pessary.  Prolapse doesnt go away and it does continue to get worse unless supported or operated on.  I too am not keen on having an operation and use a pessary but I am also aware that as we get older it can be more difficult to operate due to advancing age and or other complications such as other illnesses that can occur with age as well.  
I do not wish to frighten you and of course this is always our choice as women and our body.  It is important for you to feel completely happy with your decision so you may want to take your time in deciding.

I am sure you will make the right choice for yourself.  Let us know how you get on, and good luck.
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I'm fine with an operation if necessary. I just wonder if a having the uterus removed is usually necessary. Is it necessary to be able to do the other repairs ? I'm going for the second opinion on Dec.5. The URO/GYN has me doing Kegals and I'm down to 2X a week with Estrace. I no longer have night sweats, which is great !
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I use vaginal estrogen daily and am happy to do so as it has helped in more ways than one including the quality of the skin which is important to POPs.  
Have you asked your Urogyne why they feel they need to take out your Uterus and discussed with them the support of your vaginal vault?  Is your Uterus prolapsing?  

Hope all goes well with your second opinion and great to hear your night sweats have gone.
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I now have exact results of the original URO/GYN clinical exam.
Vaginal atrophy
urethrocele grade III
cystocele grade III
uterine descent grade II-III
enterocele grade II
rectocele grade I-II
vulvo vaginal atrophy
vaginal and uterine prolapse
Final surgery would  be Transvaginal hysterectomy, anterior and posterior repair, trans-obturator sling, cystoscopy and sacrospinous fixation. This is from the dr's notes. I have a lot of things to look up the meaning of. It will be interesting to see if the 2nd opinion agrees. The first one says he discussed everything with me in detail, but I don'r agree. Many of the risks were not mentioned.  He did ask me if I had any questions, but I was so blown away when he said hysterectomy that I couldn't think what to ask. Thanks for "listening".
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Great work so far Beek48.  I realise you have quite a list here and a second opinion will help you to cross match the above and take it all in.  Hopefully you will be prepared to ask the questions you need to clarify as well.  Essentially your decision will be whether to have an operation or not and if so, what type.

I see the recommendation is to have  a sacrospinios fixation along with the other procedures.  This should hold up the top of your vagina so it doesnt prolapse down after a hysterectomy.  

Maybe the Dr didnt understand you needed more information.  You could go back to this Dr and put some questions to them about the recommendations they have made and if you decide to have an op I am sure you will want to clarify what is being done.   Did you ask them how many of these operations they have done?  

It is great to hear you are getting the information you need.  Take your time to get all the information you need in order to be happy with any decision you make.  

How are you feeling?  I hope you are Ok and not too shocked by your first Drs comprehensive diagnosis.  It looks like they are being thorough though which is a big plus.

Let us know how you get on with your 2nd opinion.
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I got the second opinion. He found it odd that the 2 previous doctors did not communicate with each other and me, as to what would be necessary or if immediate attention to the problems was necessary. The 2nd opinion Dr. didn't feel I had to rush into surgery since I have no major problems and do not have stress incontinence as the first referred to doctor seems to think I do. 2nd opinion Dr. did agree that I have the other problems.  I talked to my original OB/GYN  and he said that it sounds like I don't need the surgery immediately, that I can wait until symptoms appear or I'm  uncomfortable with the prolapsed bladder. I've decided to wait, as I don't want to take a chance of side effects giving me problems when I only have the minor "spraying" problem now. Oh. I found it interesting that the 2nd pinion Dr. said estrace (2X week) usually doesn't stop night sweats! It does give me vaginal irritation and itching though. Trying witch hazel and a OTC vaginal cream suggested by my pharmacist, to sooth it Thank you for all your input. I'll be sure to save it for future reference.
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I am so glad you decided to get a second opinion.  It is important for you to not only have a full diagnosis but also a comprehensive explanation of your options and it looks like you have found out a great deal in a pretty short amount of time.  Take your time to consider the options.  As you say you dont have to do anything right now.  However, gravity and other factors are likely to mean that your POPs are going to progress and this is the same for all of us as time goes by after menopause.   Maybe you could consider a pessary again to keep things in place for now until/if you decide to have an operation.  I hope you can tolerate the Estrogen cream though as this should help to maintain your vaginal skin etc which is a good idea for POPs as well.

Estrogen cream did nothing at all for my sweats but it isnt prescribed for that anyway.  I am surprised you are getting vaginal irritation with Estrace and wonder if it could be worth ruling out any other reason for the irritation and itching as this sounds more like candida which could be sorted out with treatment.  I have vaginal dermatitis as well as vestibulitis ( which gives me vaginal soreness etc, ) and have had a lot of candida in my life time plus itching etc., and found that the Ovestin cream I use helped with this as well as Bacterial Vaginitis.  

I dont know what OTC vaginal cream but am glad to hear this is helping you.    Great to hear from you and a very well done for getting so much information from your Drs in a relatively short period of time.  I can tell you are very well organised and feel you will make the right decision for you at whatever time and stage you wish to do this.  Great to hear you are not having any pain or interuptive symptoms right now and long may this continue.
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UKlady1001
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