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Could it still be POP
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Could it still be POP

I am new to this forum and am in need of some answers and support. I must first give my history. I have given birth to 3 large babies the biggest being 8lbs 11 oz. I am 47 years old. In 1978 I had a partial oopherectomy due to cysts and 2 surgeries for adhesions due to that surgery.  Three weeks ago after several days of vigorous exercise and shoveling a 1/8 mile long driveway twice in one day, I woke up to feel as if something was hanging out of my vagina.  I had increased urge to urinate and pelvic pain and pressure.  Also embarrassingly enough it seemed my labia minora had slipped below my labia majora(I had to look up those terms). I went to a gynecologist 2 weeks ago who did a pelvic exam and a urinalysis.  He said there was no evidence of prolapse and the urinalysis showed no bladder infection. I am scheduled to go for an ultrasound on Monday. I went out today after feeling a little better and mistakenly tried shoveling the snow and ice we got in a storm last night. When I came in I had to have a bm with some excess pushing. Right away afterwards I felt that extreme pressure like something was falling out and felt in the vaginal area and there was bulging in that area.  Right now I am feeling uncomfortable aching there. Also over the last few days I have been having back hip and leg pain to the point of needing ibuprofen to help me get comfortable enough to sleep.  I really thought before I went to the doctor that everything pointed to POP.  When he said he did not think he felt it I was shocked.   Could it be missed on physical exam and if so will my upcoming ultrasound show it? Please offer some input I am feeling pretty down with this latest flareup.
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1128665_tn?1269277071
You are having POP flags all over the place, there is NO doubt in my mind that you were right in feeling that was what your symptoms indicated. As much as I hate to say it, I hear all too often that women are misdiagnosed when they have POP. I urge you to consider finding a urogynecologist in your area who will most likely be able to diagnose as soon as a pelvic exam is done not only whether or not you have POP but also what kinds (there are 5 types) and degree. It sure sounds like rectocele (colon) and cystocele (bladder) judging by symptoms. As a woman in Milwaukee area who just got dumped on big time with snow I recognize the necessity of shoveling, but if it is at all possible, please refrain from doing it or if you absolutely must do it, please pick up a firm support garment to wear while you are doing it. The pain in your hip and leg are absolutely tied to the POP issues, often the organs/tissues put pressure on the sciatic nerve-thus the pain. Indicator flags you have are
*3 vaginal childbirths
*peri-menopause age when estrogen levels drop and muscle tissue strength with it=weak pc muscle which is the support structure for pelvic organs
*bulging tissues
*pelvic pain/pressure
*snow shoveling under physical conditions already existing
*aggressive exercise without internal support like a pessary
*hip/leg pain
Please follow up on this no matter what the ultra sound indicates, it is seldom that I say to a woman that I am sure she has POP because I am not a physician but in your case the indicators are truly there big time and I'd sure like to know that this will be addressed. Please keep me in the loop with what you find out.
Sher

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Thank you so much for your response. I will go for my ultrasound Monday and meet with my gynecologist directly afterwards if he continues to insist I don't have POP I will make an appointment with a urogynecologist. Do you happen to know of any in my area? I live in Medina, Ohio. I have one more question. After I shoveled yesterday I felt bulging and aching down there for the whole day and evening and had to take Ibuprofen for relief. Today I still have the aching but do not feel the bulging as much. Is that normal with POP or should it be unrelenting symtoms (symptoms)? Also you didn't really say, is it possible that my ultrasound would show the POP or does that not show up on that type of test? Again thank you this is a very isolating issue. I have been feeling very alone in my suffering.
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1128665_tn?1269277071
It is normal for POP signs/symptoms to come and go, tissues will bulge out and then recede, also when you are lying flat on the table for pelvic exam the organs can shift back into their normal positions making the POP flags less obvious. Many gyns do not catch it. When you are involved in activities that create pressure on pelvic cavity (even downward pressure from coughing/constipation), it makes POP worse. Below is a link to article on POP basics I posted to forum-

http://www.medhelp.org/posts/Urogynecology/Taking-Pelvic-Organ-Prolapse-Out-of-the-Closet/show/1271553

Ultrasound is not a typical test for POP, it may or may not show up depending on what they take pics of and what kind(s)  of POP you have. Urogyn will be able to tell w/o test whether or not you have POP but will probably have a couple of tests done to fine tune diagnosis/degree.

Please do not feel alone, there are millions of women in the US with this and millions more women around the world suffering with it as well. Truly time to create some awareness, it's been in the closet for way too long.

I'll send you a PM on urogyn in your area later today, have to hit the road right now so hang in there a bit longer!
Sher
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Avatar_n_tn
I went for my ultrasound today with my gynecologist and insisted that even though he did not see POP on exam before that I am definitely still  having  pressure and pain upon lifting and bowel movements and at other times also. My rectal and vaginal area are both achingly painful. He did another pelvic exam and found a rectocele and said my uterus is down some but not significantly.  He said that he was perplexed and went ahead and scheduled me for a hysterectomy(uterus only), rectocele repair, and urethral sling. Of course I freaked out about the hysterectomy and he said not to worry that since my ovaries would remain I would not be thrown into menopause. After all he advised he sort of sounded not convinced it is POP because nothing is hanging down. He also said that this surgery is not guaranteed to relieve my symptoms. To you I ask does this sound reasonable.  He seemed perplexed as to why I am having so much pain. Does having my uterus removed sound reasonable?
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1128665_tn?1269277071
PLEASE see a urogyn b/4 you procede with surgery, the fact that your dr is perplexed is a huge flag! Women often end up having unnecessary hysterectomies, and some gyns who do these procedures do not have the technique perfected and end result is you may still have pain or dysfunction. Do not let yourself be pushed to have surgery until you are comfortable the physician knows for sure what is going on, a urogyn will be able to give you a defitinitve diagnosis. Since there are 5 types of POP, it is important to have all POP issues addressed at the same time if possible, you don't want to have a 2nd surgery-you want this to be a one time thing whether you need a hysterectomy or not.

Please get back to me with whether or not you've been able to locate a urogyn in your area that you feel will work for you, if not I will try to help you narrow down choices.

Sher
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Avatar_n_tn
I have an appointment with a urogynecologist on Friday.  I will let you know what happens.
Thanks for everything!
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1128665_tn?1269277071
I'm so glad to hear that! Yes, please keep me in the loop!
Sher
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Avatar_n_tn
I went to the urogynecologist.  I really liked him. He spent an hour just talking to me. He said I have a cystocele and a rectocele. He said they are small though. When he examined me I almost jumped off the table when he touched my bladder.  He believes my pain is radiating from there. He put me on Prosed(?). He said I might have interstitial cystitis. He gave me a huge handout about the disease and needless to say it depressed me. It described the disease as incurable and said a large number of sufferers develop depression. My main pain is the severe aching pain in my vaginal area.  I have been taking large doses of Alleve for that.  Have you come across sufferers of this?  Are there any hopeful stories?  I guess after reading the handout from the doctor I have talked myself into being depressed over this.
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1128665_tn?1269277071
Women often have pain with POP, it is extremely variable-can be back, pelvic, vaginal, rectal, any combo of them. I'm a bit surprised that the dr jumped to the IC page; I would think it may be just related to the POP issues, especially since you describe the  pain in your vagina. Please do not let yourself get caught up in assuming it is IC and getting depressed; take one step at a time. What is he recommending for the POP issues? Are you going to be utilizing treatments or going in for surgery? I can't help but feel that once the POP issues are addressed, the pain will go away. Are you using a pessary to create some internal support? If you insert a tampon does it make the ache in vagina get better?
If you are on your feet a lot, it may be helpful to you (pain wise) if you wear a support garment (these can be bought at Walmart in underwear section).

There are many women who have successful positive outcomes with POP, typically the only time people take the time to post their info is when it is negative-human nature I guess. I speak with women on a regular basis who have great success stories. I for one had surgery for 3 types of POP, grade 3, I am extremely pleased with my outcome. I also know women who utilize treatments who are happy with that path but it doesn't happen overnight-we all need to search for answers that best suit our needs with this health issue. It will get better! Even if it did turn out you have IC (and again, I feel the pain is probably POP related), I know someone who is brilliant at that health issue and at that point can turn you on to her. Right now I think you should focus on finding answers to the POP issues that will help get that under control.

I am hopeful your dr has either turned you on to a PT who utilizes pelvic floor treatments or you have had a dialogue about surgical options or pessary use.

Chin up, there truly is hope!
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I must say you are an angel to so many people that are really struggling and I so appreciate it. I must further explain my appointment. I found this urogynecologist after asking my sister-in-law who is an ob-gyn for a referral. She raved about him saying he is the best in the field. I really liked how he took so much time with me. We spoke of surgery because my prior gynecologist had suggested it. After examining me and my bladder causing excruciating pain he said he thought I might be having IC and that could be what was causing all my pain since my rectocele and cystocele are small.  He put me on Prosed.  So I called his office Monday and said I am still having vaginal aching.  He said to take 3 alleve every 6 hours.  After hearing back from you I decided after I get back from my upcoming vacation I am going to go back to him and see if maybe he could fit me for a pessary and then I can tell if the pain is really from POP.  The problem is I am having increasing burning in the vaginal area as well.  I unfortunately researched my symptoms on the internet and am afraid I truly do have IC or possibly worse Vulvodynia.  Both sound like dreadful diseases that you are destined to suffer pain with for the rest of your lives. It is a very slippery slope when you look too much on the internet.  I have really gotten myself into feeling totally hopeless.  I guess I need a pep talk.
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1128665_tn?1269277071
Please don't lose hope, I know it is difficult to keep your chin up when you are giving a dx of potential IC or Vulvodynia but I do believe there is hope for nearly all conditions if you find the right resources. I'll be curious to hear whether or not the Prosed helps more with the pain, that will give some indication about the IC path. Were the symptoms of pain as pronouced b/4 the snow shoveling? Is the pressure sensation more pronouced after you have been drinking coffee or soda? Do you need to urinate very frequently? And of course the burning sensation is a bit of a flag. Since a urogyn has diagnosed you with a small cysto/recto, I can see where it creates flags about other concerns, but I wouldn't jump to any conclusions yet.

I have to wonder if you'll even be able to get a pessary in if the pain is that pronouced, it may be difficult but it is certainly a good test to try. I'm going to send you a PM with a site you can check out for IC, the hostess of this site is wonderful and it has a ton of great info including product to utilize to help with pain. In the meantime please try to stay calm and know that no matter what condition this is, there will be some answers to help you get some control over it. It is always the most scary and unsettling when we are first trying to get a definitive diagnosis; once the dx is in hand we can move forward.

Hang in there, I'll get that PM off to you next!
Sher
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