Anterior & Posterior Prolapse

Hi everyone,
I had a hysterectomy 7 years ago, which included bladder and bowel prolapse. I now have been diagnosed with A & P prolapse. I saw my Uro in March, he recommended Physio, which I have had for the past two months.  This appeared to fix my constipation, for awhile.  I return to the Uro 10/05/10 for further options.  My symptoms are, feeling of pressure, painfull sex, tired all the time, feel like I am carrying around a brick, also after a bm I feel that I have not emptied properly.  These symptoms have become worse over the past month.  Is there any suggestions from anyone, as to weather I should have a pessary or surgery.  Has any else been through this, I am truly at my wits end.

[sherrieP]

Hi maurz, welcome to the Urogynecology community!

I assume that you had a hysterectomy 7 years ago and they diagnosed you with the bladder/bowel prolapse at that time, is that correct? If that is the case I also assume that you were in a lower grade of prolapse such as 1 or 2 at that time and now you have advanced to grade 3. Your symptoms are classic POP symptoms, pressure sensation (either in vagina or rectum or both), painful intercourse, I assume the “carrying around a brick” sensation you refer to is the lump you feel at the end of your vagina, and incomplete stool emptying. (The fatigue can come with any chronic health issue, it’s exhausting to not feel well for an extended period of time; with some health issues it’s a direct symptom, with some it is indirect.) Do you also have difficulty urinating?

Both of the choices you have can improve how you feel; it’s a matter of personal choice whether you are ok with having to insert and remove a pessary daily or if you prefer to have your POP issues fixed. Many women opt to use a pessary prior to deciding to have surgery just to see if it will be user friendly enough for their lifestyle. Many women (like me, I had grade 3 rectocele, enterocele, and cystocele surgery-colon/rectum, intestine, bladder) decide almost immediately that they want a permanent fix and choose surgery. There is no right or wrong here, it is simply whichever path fits your lifestyle best.

A pessary will give you the necessary support to improve how you feel daily. Most pessaries are inserted and removed and cleaned daily, a few are put in by physicians and removed on a monthly to tri-monthly basis for cleaning. If you have urinary leakage (indicative of grades 1 or 2 prolapse, once you get to grade 3 you typically have difficulty getting the pee to come out), it will prevent the leakage from happening. It will hold your organs/tissues up in the pelvic cavity where they belong so you won’t have that bulge sticking out of your vagina giving you discomfort. (If you haven’t done this yet, I recommend women take a hand held mirror and look between your legs to see how much tissue is sticking out beyond the outer edge of the vagina; it makes women realize the reason why they feel like they have guts sticking out-they usually do.) For constipation, some women find that if they wash their hands and insert them into their vagina or push up on the perineum, it helps the poop to come out. No amount of fiber or water drinking or exercise is going to fix the constipation if you have a rectocele; poop gets caught up in the bulge in the colon and it’s a matter of when enough builds up, it sometimes will push out.

The surgery to repair these types of POP issues is not an easy surgery, the first week is a bit rough and the heal curve is 6-12 weeks, depending on what all you have to have fixed. But once it is fixed and you’ve gotten past the heal curve, you no longer have to deal with the symptoms. I always recommend that women who have surgery do maintenance to keep the pelvic floor in top condition so it continues to support the area that was repaired. I have never regretted for a second my surgery; if I had the choice to make over, I’d do it again in a heartbeat-beats the pants off of dealing with symptoms.

I recommend that you write down all of your questions so when you go to your urogyn you don’t forget anything. It’s a bit confusing why you have to wait until October to see the urogyn again, if you are in advanced POP state, you should at least be utilizing a pessary for more comfort and to keep it from getting worse. There are also additional treatment options for women who opt to avoid surgery, typically a physical therapist can provide these treatments such as biofeedback, electrical stimulus, Kegel instruction to utilize along with pessary use.

Good luck maurz, I hope you find the answer that suits you. If you have additional questions, feel free to post them or send me a PM (private message) and I’ll address then as best I can.

Sher

[maurz]

Hi Sher, thank you so very much for your response, I really appreciate it, and you have so much information.  I do not have any trouble with my urine, and I really don't think I would be comfortable with a pessary, I see my Uro again on Monday 10th May, I seriously can't wait for that visit.  I shall let you know how I go, I have tried physio, it helped a little, but I really just want it fixed.  Thanks again for all your advice, it really was very very helpfull, and helped me understand a bit more.  How long was your hospital stay??
Maurz

[sherrieP]

I was the same way, I just wanted to get fixed and get on with my life. I was only in the hospital for 2 nights, in other countries they keep you in for 5-7 days. I went home with a catheter,that is pretty much standard procedure. They may remove it to see if you can pee but for most women there is too much swelling to pee on your own so the put it back in and you go back to dr several days later to have it removed. You don't really get off of the couch  much that first week. Icing area is extremely important to help control pain and swelling (you will be on narcotic pain meds to).

Good luck!

Sher

[maurz]

Thanksagain for your response I will let you know how I go on Monday, it is the first time in my life I am looking forward to seeing a doctor.

[sherrieP]

My pleasure kiddo, yes, please keep me in the loop! Remember to write all your questions down so you don't forget to ask them all, I always go with my question sheet in hand.
:)
Sher

[barbaramroberts]

Hi Sherri,

I am wondering if this is the right place to write a comment....I'll give it a try again.

I had a complete hysterectomy a long time ago but was on natural estrogen and progesterin for years....when I went off those hormones a couple of years ago,  I experienced pressure in my lower abdomen and upon examination was found to have a prolapsed bladder....the vaginal walls were very week.  I was given Vagifem to try and I have found I don't have the discomfort any more,  the pressure.  I was told to do the Kegal exercises also.....so,  just wanted to let people know that this is worth a try....it has not cured the prolapsed bladder,  but I don't feel discomfort.  bye for now, barbara

[sherrieP]

Hi Barbara, yes this is the spot! Thanks for hanging in there until you found the posting location, I do appreciate it!

Yes, once estrogen source is eliminated or depleted, POP often occurs (menopause is the second leading cause of POP). I'm glad the Vagifem has given you relief. Do continue the Kegel path, maintenance is very important whether you have surgery or not. If you have any questions about Kegel technique, you can click on the link to the health pages article I posted about it.

http://www.medhelp.org/health_pages/Womens-Health/KEGELS-AND-KEGEL-BREATHING/show/1133?cid=591

Thanks for sharing!
Sher

[maurz]

Hi Sher,
I need surgery but am unable to have it for three months due to the fact I am a smoker, my uro says that the operation will not succeed if I am still smoking, so now I have a medical reason to give up, I am on the patches and haven't had a cigarette for two days, I have been smoking for 35 years, 15 to 20 a day, so at the moment, using the patches, but feeling proud of myself.  The only down side is the waiting for the Op and the pain I am going through.

[sherrieP]

Hang in there, that is very cool that you are taking the steps you need to have surgery!  You have every reason to be proud! Yes, waiting for surgery will be tough but you'll handle the procedure so much better without the impact of smoking to your body. You can do it. What pain is the hardest for you to deal with?

[maurz]

The pressure in my pelvic area, I am taking nurofen plus, only when needed, it seems to be worse at the completion of a bm.  Surgery booked for 28th August

[sherrieP]

Since you don't think you can use a pessary, you might want to try using some kind of support garment, that might help with that pressure sensation. Having some structure hold things in place may take the pressure off of your own tissues doing it. The support garments they have now are so much nicer than the old girdles used to be. It makes sense that the pressure is worst after a bm, you push so hard to get the poop out and it makes the rectocele more pronounced. As weird as is sounds, if you can use your fingers to apply pressure to either side of the labia while you are bearing down for a bowel movement, it may help a little. Some women find that if they wash their hands and insert them up into the vagina during a bm, it makes bm come out easier. Other women find that pushing up on the perineum helps.

At least you have the comfort of knowing that you have a surgical date scheduled. Just need to find a way to hang in there until repair. You can do it!

[maurz]

I will check thing out, thanks again for all your help, I shall keep you up to date, thanks again for all your support as well.  It has been fantastic, and very much appreciated.

[sherrieP]

Your so welcome!

:)