Stress Incontinence, possible prolapse?

[maryalice40]

Is it normal if something pushes into the mid area of your upper vaginal wall when bearing down, would that likely be a mild cystocele? Nothing should bulge into the area of your vaginal wall, upper or lower, should it? I know this question is crazy, sorry, but I am desperate to know what is wrong. I have had a past cervical, uterine prolapse, 2 cystocele's, & a rectrocele. Had a partial hysterectomy, perineoplasty w/ rectal repair, & bladder slings. Am having constant pressure, constant urge to pea when laying down, and stress incontinence. I had the pressure prior to my retrocele repair back in July. Then I also developed incontinence right after the surgery.

[sherrieP]

I do know someone who knows a ton about and has a network for IC so if you need any advice in that direction Mary I can give you her info. I kind of thought that would be the case with the MFR but always like to give the info out.
Sher

[maryalice40]

I had a little incontinece to show up on the test (I did get the results) but it was nothing bad I guess. My x-ray was printed on paper and from what I could tell, I am not positive of this, but it looked like the abnormal shape of my bladder was down toward the bottom and it was going downward, so I'm thinking maybe there is a tumor in my bladder. I do have IC so it's possible. Also have gotten some relief cleaning out my colon, I have not once suffered as bad as I was since that first colon cleanse, at least I am not peaing myself to death for most of the time now. Still feels like something is pushing into my urethra.. It's not so bad to deal with when I don't have a constant urge to pea. I am waiting for my PCP to let me know if he can do a test to see what's up with my bladder. I also have an in office cysto scheduled for next month if he can't do anything. I'll get it figured out one way or the other. And thank you so much for helping. I would love the physical therapy but I have no way back & forth that far off, but thank you for the emails.

[sherrieP]

If you were leaking during the test and you were aware of it and they told you there was no leaking, I have to question the quality of the health care professionals and facility doing your testing. I absolutely think you should request copies of all of your test results (I always do no matter what is being done, I want to see for myself rather than be given some blanket dx that has a huge range of "what is normal". I still feel MFR is worth a shot for you for treatment and pain and pressure relief, I did get a reply from MFR on someone in your area, I'll send a PM shortly. I could see where if you have classic POP displacement of organs that the pic might display the "indent". Since all the organs are tightly packed in the pelvic cavity, when one is displaced the shift impacts more than one organ or area of tissues. And yes it is possible that when your bladder is full it is out of position and the pressure will be different than when it is empty, same with bowels. Any other organ displaced can be making that pressure sensation too.

I'll get that listing off to you for MFR now.
Sher

[maryalice40]

Is it at all possible that something is pressing on my bladder when it fills with urine, and when it's empty, nothing is pressing on it?

[maryalice40]

I was told that the urodynamics showed my bladder was shaped funny during filling but the IVP I had done was normal. I had the IVP done to see if anything was indenting my bladder. The GYN isn't going to do anything else, she talked like I didn't have incontinence bad enough to do anything but I asked for therapy or a pain clinic and she said she'd refer me over to a pain clinic. Weird thing about the incontinence, she talked like the test did not show it, I know for a fact that everytime I coughed on that test, I leaked urine. I might have to go get the results so I can see for myself what it says. I don't want anymore surgeries, I think I still need to heal from the last one. The thing I'd like to try is B&O or valium suppositories. I hear they work great for pelvic/rectal pressure but my urologist would not prescribe them. Maybe a pain clinic will. Any idea why my bladder would be shaped funny during filling? I'd get that if something was indenting it but the IVP would show that. This is so frustrating.  

[sherrieP]

Some physical therapists do MFR, some massage therapists do it. I did check the listing for the MFR center I recommend (I'll send you a private message on this info) and I don't see anything for your state but will contact the MFR therapist I know to see if she knows of anyone in your area that is good with women's pelvic floor issues. (Not all MFR providers are schooled in pelvic floor.)

Personally I still have both pressure and constipation issues from IBS even though I've had rectocele repair. My urogyn told me she doubted the IBS would go away, that is an entirely separate issue. Good days when I have no stress and my guts feel good I have no pressure and I poop just fine. Other days when I am even a little stressed the pressure/constipation are back. It is so obvious to me that my issues are tied to stress gut.

Having more surgery is not the solution unless it is done by someone you are convinced is going to solve the problem, otherwise all you are doing is padding the pockets of drs who  push to do surgery. Ask tons of questions about the outcome and potential complications prior to agreeing to have another surgery. I can't begin to imagine having another procedure done in your situation by a resident; she might be an awesome dr but since the pelvic cavity is extremely intricate, it truly takes an experienced specialist to get it right. More money out the window, pain from surgery,  and no resolution to the problem would not be do-able for me but it is a personal choice. Ask her what kind of procedure she wants to do, find out if she will do an MRI prior to surgery to see exactly what she is dealing with, find out how many of these procedures she has done and what her training has been to do them. (Remember, she works for you-you are paying her salary whether it comes out of your pocket or the pocket of the insurance  you pay for.)

I'll send a message over with the link to the Myofascial Release Therapy website that I refer people to, you can e them directly to see if they have anyone in your area. Using pain management seems iffy to me if you still have adhesions or scar tissue causing your pain but it is a path to investigate.

Good luck, hope you find some answers soon!
Sher

[maryalice40]

What type of facility deals in pelvic myofascial release therapy? I'm just not aware of anything like that around here though there could be. I am thinking pain management clinic if all else fails. My gyn is a resident, I don't know if I'd want to switch to someone else, and if my bladder is reprolapsed, it really isn't going to matter, she seems to think I have sling failure and will very likely want to do another surgery anyways. And I am going to be dumb enough to say okay because I'd take the chance of it stopping this pressure. Could it make it worse? It does seem that laxatives calm the pelvic pressure down extremely but I still had the rectal pressure all night. I definetly do not have a retrocele any longer. The constipation might be caused by where I have IBS, gastroparesis, or diverculitis, I'm just not sure why my bowels never want to work. It isn't that I have an urge to go and can't. I just don't need to go.

[sherrieP]

So many procedures to suffer through; many thoughts come to mind. First up I've got to say that I feel it would be in your best interest to seek advice from a urogyneocologist rather than the other physicians you have been treated by; a urogyn is THE specialist for pelvic region, they are familiar with all of the organs, structural aspects, and soft tissues in the pelvic cavity-uterus, bladder, colon, vagina, intestines. Although the need for ob/gyns, urologists, and gastros is vital, when it comes to the pelvic floor area the urogyns are able to treat everything within the pelvic cavity, a one stop shop if you will.

I truly believe you have POP issues as well as other issues that need to be addressed, and it sounds like there may be complications from other procedures you've had. An enterocele frequently occurs in women who have rectocele. Scar tissue and adhesions can create many problems as well. Every time a procedure is done, there is potential for scar tissue and adhesions to restrict proper position and function of organs and tissues. In many cases, myofascial release therapy can release restrictions but I feel your situation may be much more advanced than what therapy can address.

The incontinence, constipation, and bulge you feel vaginally certainly suggest that a POP eval needs to be done. If that is the case, it could be the cause of your pain rather than the IC dx you've received.

I've dealt with IBS for more years than I care to say and the interplay between IBS and POP can be pronounced. On days when my digestive system does not work properly, the constipation is still there despite my rectocele repair. The traditional treatments for constipation are of little help; I try to keep regular by eating crushed pineapple every morning, eating an oatmeal fiber bar daily, drinking lots of water, and exercising regularly but if you still have a rectocele that probably won't help.. With a colon cleanse you do empty the entire bowel, not sure that you get that from Miralax to the same degree. When the bowel is empty, that pressure is gone. Surely indicates a check for rectocele issues should be done....pressure from organ/tissue displacement  can roll from one organ to another since everything is so bunched up together in the pelvic cavity.

Whether or not another cleanse relieves your symptoms, I highly recommend you try to connect with a urogyn for eval. If you have diffuculty finding one in your area, send me a PM and I can tell you how to search. Repeat use of colon cleanse or laxative is not a good idea, creates lazy colon, so  you'll want to get dx as soon as possible.

Please let me know how things turn out for you.

Sher

[maryalice40]

I developed a cystocele, uterine & cervical prolapse in 2002 after a cystoscopy/hydrodistention procedure. Urinating over 100 times a day, pressure, pain, urgency, incontinence, etc. The symptoms were blamed on IC. Hysterectomy w/ bladder repair in 2006, fixed my problems. In 2008 I developed a renal stone blockage and pressure/pain again, while not knowing what was wrong, went to an RN who said my bladder was not prolapsed, went to my urologist who dx'd the stones and says I had a mild prolapse, and re-did my surgery & did laser surgery. I was fine afterwards. Went to another urologist questioning if I had IC (with good cause) in 2009, he demanded doing the cystoscopy/hydrodistention and I get pressure/urgency after this procedure and end up finding out I have a retrocele later on. He took back my dx of IC saying if I ever had a UTI, I could not have IC, I had the retrocele repair in 2010. This is when I developed the incontinence. The procedure did not correct the pressure issue. My gyn did a perineoplasty. It does look like there is some scarring there. Sometimes I get sore there in the surgical area. I have been told I have no cystocele but I can see something bulging down into my vaginal wall when bearing down. Even if it's a mild prolapse, it could cause me problems, but I'm told I don't have one. It is seriously hard for me to believe considering I have the symptoms. I have recently went back to a urologist (2nd one I went to) and I am re-dx'd with IC, I really don't even believe the dx at all, but I do know I have mild chronic inflammation of my bladder regardless of whether it's IC or whatever be the cause. She thought my symptoms were from OAB, now IC. One of the doctors that works with my gyn thinks I have OAB also & is recommending I get an interstim implant (don't want). My PCP sent me last week for an IVP to see if anything is indenting into my bladder. I had to do a colon cleanse which made me sick (vomitting green stuff, blood, became dehydrated - dry sticky mouth, lightheaded when standing, pressure in ears when standing), I'm better now but the thing is, when I went to bed the night of the test, no pressure whatsover. And it was better for a couple of days after that. Now I have had rectal pressure on top of the pelvic pressure since. I have slow digestion, IBS, go to the bathroom twice a week, been on Cleocin 3 times in a row, it caused constipation so bad, I just stopped going to the bathroom and had to start using Miralax. Miralax does not stop the pressure, but the colon cleanse did. Why is that? Is there any way intestinal pressure can cause pressure on your bladder? I am going to cleanse my colon out today and see if my symptoms improve again or not before calling my doctor.  

[sherrieP]

There should not be tissues bulging from your vagina and although you may feel some kind of pressure against your upper vaginal wall, it may not be cyctocele. I am curious how many procedures you have had done, did one of your cystocele procedures fail so you had to have a second one? Can you give more detail on the surgical procedures themselves? The bladder slings/cystocele procedures are the same thing and if things are repaired properly the first time, you should't need a second one. Sometimes women do have uterine prolapse or rectocele repairs done separately from cystoceles because the physicians they see only know how to repair one type of POP (there are 5 types); I always recommend women see a urogynecologist, the specialist who can repair all types of POP.

It is possible you have either vaginal vault or enterocele issues, sometimes women who have a hysterectomy will end up with this type of POP. (It is also possible you have adhesions or scar tissue from past procedures that is creating the pushing sensation in which case a myofascial release therapist would be of great benefit.)

You should not have incontinence or pressure if procedures are performed properly. Please seek the advice of a urogynecologist for an evaluation. If you need assistance finding one in your area, send me a PM and I'll tell you how to find one.

Sher