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POPQ II, the gyn suggest to repaire it
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POPQ II, the gyn suggest to repaire it

Hi, Sherrie

I went to see a known gyn in Beijing three days ago. She is known for the repairment of POP, especially for elder women.  I was told my  rectocele and cystocele are on POPQ degree 2. You know, I had my baby with forceps a year ago (I am 33). The doctor said there is old vaginal laceration, also degree II. My vulval slit is large (5.5 cm). She suggested to have a simple repairement.

She rarely recommend young women have surgery. But, she said I can have the repairement because it is damage from delivery of baby. I am afraid of relapse. But the gyn said it is not so high risk of relapse for me. The problem may occure when at menopause. She suggest me to go back home and decide.

I have never met a lady (around me) with this kind of issue. I don't know if it is right to go repairement.

I have concerns
1) how long it can sustain after repairment. generally if it is only 1-5 years, that would be frustrating
2) the scar after repairment:  when I get older, I may need the second surgery which may be operated on the scar tissue. Will it impact a lot on later surgery?
3) vagina repairement, Will it result in intercourse ache
4) How helpful it can reduce  constipation, ( at current satge, my constipation is not sever)
5) risk of urinary leakage?

If I willnot go for repairement, I am afraid the rectocele and cystocele would develop very fast ( because of large vulval slit )

I know there is risk for any surgery. I accept that, but I need to think cautiously.
Sherrie, can you give some advice?  Many thanks.

Tags: POPQ, rectocele, cystocele, old vaginal laceration
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The current school of thought is POP is a condition most often occurring in women 50+ but I so disagree-I speak with women every week who are in their 30s and 40s and sometimes in their 20s who have POP. Since vaginal childbirth is the leading cause, it is very common in young women; it simply is not being detected because little screening is in place. There is much women can do to help it from progressing if they are aware they have it. Women who lift heavy weight (and who doesn't when you have children?) increase risk of POP progressing. By the time we get to menopause, the damage is typically significant.

The youngest woman I guided was in her very early 20s, she had never even been pregnant. Multiple risk factors and causescome into play with POP. Please don't feel there aren't many women in your situation, it is a matter of they are not talking about symptoms that are occurring and they don't recognize they truly have a health condition that needs to be addressed.

In situations like yours it truly is a good idea to consider surgery, extensive damage from forceps delivery can not heal itself by doing Kegel exercises. Whether you choose surgery or not, you should be utilizing treatments to prevent POP from progressing. Wearing a support garment or a pessary (pessary probably not going to be effective in your situation because of tissue damage from forceps) will help support pelvic tissues/organs; that helps contain POP. It is vital that you are extra careful when lifting children or heavy things because when we lift heavy weight it pushes our tissues/organs down.

The reason surgeons have started using mesh for POP repair is to avoid more surgery down the road. It would be a good idea to questions the physician(s) you talk to about repair if they do utilize mesh or are stitching tissues together. Tissues stitched will translate to more surgery later.

It is important that you think preventative maintenance post surgery (all women who have POP surgery should, I do and highly recommend it) to maintain your repair for life. This isn't like an appendix operation where they remove the organ and the problem goes away, it is repair of tissues that need continual maintenance similar to how we keep brushing our teeth daily even though we see a dentist to fix cavities. Doing a few exercises, wearing proper support when necessary, paying attention to how and what we lift, recognition of things we do that may make things worse like running/jogging are all important to maintain repair.

I don't think reoperation on scar will be a problem-take proper steps to heal post surgeries and you should be fine.

Question your physician on vaginal repair regarding impact to intimacy, if the repair is done properly it should not hamper sexual relations. It is vital that you abstain from sex during heal curve however and when you first re-initiate intimacy approach it slowly.

Surgery for rectocele typically helps constipation, if you don't have severe constipation now there should be no problem with it post surgery-eat tons of fruit and use a stool softener after surgery until your body is balanced. Narcotics given for pain post surgery do cause constipation so you will really need to bump up the fruit fiber and water during that period.

If surgery is done properly, there should be no problem with urinary incontinence.

POP will likely continue to advance in your situation, it is imperative that you do whatever you can to prevent it from getting worse whether you choose treatments (like support) or surgery. I'm so glad you are getting a 2nd opinion, that will make the decision easier for you. It would be a good idea to ask your questions of the drs you are seeing so you can compare their answers. Good luck and  let me know how things turn out.

Sher
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