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Stage Two - What should I do?
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Stage Two - What should I do?

I am 59-yr old with newly diagnosed POP at Stage 2 (rectocele, cystocele, and what they called uterine "apex" prolapse).
I have had constipation issues for many years and could never get it under control.  Two months ago, while straining to pass a hard stool, I felt an extreme pressure and realized something was not right.  At that point, a hard bulge was evident at the mouth of the vagina (freaked me out!!) so I just stopped trying to pass the stool and frantically starting browsing the internet to find answers (thank the good Lord for Google).  It was then I realized that I had a rectocele.  Thankfully I found out about "digital splinting" to help straighten things out and, with a two-day double dose of Miralax and finally Milk of Mag I managed to clean out the pipes.  I have been using Miralax and stool softeners daily since, which stopped the constipation but certainly creates other problems if you know what I mean.  I still need to use the digital splinting to fully pass even a soft stool and I hate that!
To make a long story short, I found out that my personal physician had just left her practice and that I was on my own without a trusted physician to confirm my own diagnosis.  After doing as much due diligence as I could (and ordering Sherri's book, bless you!) I located a Urogynecologist to make an appointment with.  Unfortunately, the wait time was MONTHS, so I got an appointment with the Nurse Practitioner who I met with this week for the first time.  She seemed to do a thorough examination, both lying down and standing up, and then surprised me by saying that I had a Stage 2 rectocele, Stage 2 apex prolapse, and Stage 1 cystocele.  I had only been aware of the rectocele, and honestly expected it to be a Stage 3 based on my discomfort and the pressure.
Because I had educated myself online and with Sherri's book, I at least knew what all these things meant, but I felt really up in the air since my problem was "only" a stage two...what to do?  The NP didn't have a firm answer as to whether my problems would get worse with time. She did not suggest any further testing, which sort of surprised me.  She said that I could definitely have surgery now to fix all three problems, but I opted to try a pessary first to put off surgery as long as possible.  
ANYWAY, my question really is....does anyone suggest having surgery early versus waiting until it just can't be put off any more?   And, as a second question, does a pessary really help with the rectocele or only with the uterine prolapse?  The NP indicated that I may still have to "splint" to pass a bowel movement, which seems to make the pessary kind of useless in my case.
Insights from others would be much appreciated.  I realize everyone is different, but...hoping for some clarification for the best course(s) of action.
J in Colorado
Tags: Stage Two
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I think every woman should be referred to a physical therapist prior to surgery (unless she is absolutely sure surgery is the path she wants to take); there are multiple treatment options that can be explored. The stage of POP presenting (no matter which type you have except enterocele) will vary depending on time of day exam is done and what you've done that day. If you spent the day picking up children or grandchildren or heavy objects or appt was late in the day, POP will be more prominent. Trust your gut with this, no one knows our bodies as well as we do.

No matter what you do, the constipation is nearly impossible to eliminate with rectocele because of the nature of the bulge the poop is stuck in. Constipation makes us push more which compounds the situation.

POP nearly always progresses unless you do all the right stuff (so many causal factors), in general women will find they are able to prevent progression by utilizing treatments or they opt for surgery. Very personal choice. No one ever absolutely has to have surgery-it is always a woman's choice no matter what. Any dr who pushes surgery is a red flag.

A pessary can  help with all kinds of prolapse, there are multiple types of pessaries, which type is needed depends on individual situation. Pessary will not take care of constipation, it is to contain prolapse, eliminate symptoms, and prevent POP from gettting worse.

Hope this helps a bit!
Sher
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