Urogynecology Archive Expert Forum
Exercise & Weight Limitations After Cystocele/Rectocele Repair
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Questions in the Urogynecology forum are answered by medical professionals . Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.

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Exercise & Weight Limitations After Cystocele/Rectocele Repair

I am a fit and very active 37 yr. old.  My urogyn says I have between a grade 1 and 2 rectocele and cystocele.  I have experienced stress incontinence, however, ONLY during intense exercise sessions with my personal trainer. And, it is not on a consistent basis.  I can go months with no problems.   My urogyn has recommend a Transobturator sling procedure with a/p repairs along with a perineoplasty revision.  I will NOT be getting the sling procedure. I am not confident the sling is the best approach to my issues.  Coupled with that, there seems to be overwhelming incidences of negative effects from the sling (mesh erosion, mesh migration, too tight, too loose, urge incontinence, infection, recurrent UTI's).  To me, the risks outweigh the benefits.  However, I am still interested in an obtaining a/p repair.  My only concern is that I exercise daily, I do weight training 3x's a week and cardio everyday.  I understand my exercise will be severely limited while I'm healing from the a/p repair.  After I am finished healing, can I resume normal weight lifting activities?  Does healing generally take 12 weeks or the requisite 4-6 weeks?  Can I still perform squats, lunges and abdominal exercises?  Also, am I forever limited on the amount of weight I can lift?  I've read some sites stating women are never to lift anything above 20 lbs.. Is this accurate?  My doctor says my repairs are small.  Would I be better off
avoiding surgery and simply getting pelvic muscle training instead?  
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I also wanted to add that my urodynamics study only noted slow urine flow. I did not demonstrate any stress incontinence during the session.  Granted, sitting on a modified toilet is a world of difference than running on incline 15 level 7.5 on the treadmill or jump roping rigorously for a minute.
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My urogynecologist also told me two and a half years ago that I need to have surgery with a sling for my cystocele and rectocele. I have been avoiding it because I also read that it is not natural and could create more problems, check out www.wholewoman.com, a website devoted to prolapse issues and exercises and proper posture which can be done to eliminate the prolapses. I could not remain committed to the exercises so I have not been successful with them.  However, I have had success in the past with wearing a pessary, but currently the pessary is causing inflammation of my cervix so I no longer use it. I know that I will need the surgery soon, could you please explain to us what your Dr. recommended to have done, "a Transobturator sling procedure with a/p repairs along with perineoplasty revision", and what you say you are only interested in having done "a/p repair without the sling". Even though our cases may be different I would like to understand the differences in what your Dr. recommended and what you want to do. Also what does "a/p" stand for.
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I have been to ****.com.  While the exercise, diet and posture information was helpful to me, the demonizing of surgical solutions was not helpful.  I am all about being an educated consumer.  However, you have to keep into consideration the woman who originated the site is interested in selling books and products related to her method.  This is really NO different from physicians offering medical intervention.  I think it is pertinent to weigh all of your options before making a decision to live with prolapse or seek surgical intervention.  I know personally I would not feel comfortable living with a grade 3, 4 or worse prolapse protruding from my vagina.  Call me vain, but that is not the quality of life I would be interested in accepting.  However, I respect another woman's choice to live that way.  It is just not the right path for me.      

As far as what my doctor has suggested..
TOT sling- is a bladder sling placed under the bladder to support it.  They use a polypropylene mesh material which your fascia eventually grows into in order to support your bladder.  The risks associated with this are mesh migration (meaning the mesh doesn't take and migrates to another part in that area), mesh rejection, mesh erosion into the vaginal wall, urge incontinence, infection, placed too tightly, not tight enough, and recurring leg pain. I have been recommended for this treatment because I sometimes leak urine when I exercise.  I will NOT be getting this portion of his recommended surgeries. Personally, I feel the risks outweigh the benefits.  

a/p repairs- anterior vaginal wall repair/posterior vaginal wall repair.
These surgeries pull together the stretched or torn tissue (essentially a hernia) in the area of prolapse. Surgery will also strengthen the wall of the vagina to prevent prolapse from recurring.
A rectocele (rectal prolapse) occurs when the end of the large intestine (rectum) pushes through the back wall of the vagina. A posterior repair corrects this.  A cystocele occurs when the wall of the bladder presses against and moves the wall of the vagina. An anterior repair corrects this.

Perineoplasty-  perineoplasty surgery is to restore the normal structure of the external aspect of the vaginal opening. Due to the unplanned vacuum extraction of my son, my perineal muscle tore and retracted.

As far as PME (pelvic muscle exercise), I plan on requesting this from my urogyn.  It is advocated you do these to manage/prevent further prolapses.  I plan on having my urogyn fill out a medical necessity request for the Athena Pelvic muscle trainer, which is a device you can use at home to train your pelvic muscles (similar to biofeedback).  

I did find the answer to my question above on another site from a urogyn at UCLA.  She stated I should NOT engage in high impact types of exercises like jump roping, jumping jacks, etc. now and even after my surgery.  She said high impact exercises are never suitable for womens joints, breasts and most importantly pelvic floors.  She said barring any issues after my surgery, I can resume my regular exercise routine in 6-8 weeks.  

Hopefully, I have answered your questions and you are able to make an informed decision that is right for you.    
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Thank you so very much. I am very impressed as to how you have educated yourself regarding the prolapses. I agree with you, the woman with the natural alternative for repairing the prolapses has her own agenda, and I also was turned off by the tyrade against having surgery to repair the prolapses.
I have what they call a "Universal Prolapse", and will like you, need a/p repairs, I feel the same way you do about not getting the mesh. I was shying away from the operation altogether, and that is why I used a pessary for two and a half years, but that has irritated and inflamed my cervix, that is why I don't want a foreign material permanently placed inside my body. Would you be able to share the website you know of that address the issues involved with prolapses.  Your post has been one of the most helpful, clear and informative that I have read regarding the surgery for prolapses.  Thank you so much for sharing the research you have done and educating us all.
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A related discussion, Rectocele - foreign mesh was started.
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