Urogynecology Community
Considering surgery
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WELCOME TO THE UROGYNECOLOGY COMMUNITY for WOMEN: This Patient-To-Patient Community is for discussions relating to Female Incontinence and Pelvic Floor disorders such as, Cystocele, Drooping Bladder, Intercourse Pain, Pelvic Organ Prolapse, Vaginal Relaxation and Vulvodynia.

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Considering surgery

I am trying the forum for the first time.  I have been to a urogynecologist several times.  Pessery didn't work out. I know that the mesh surgery is my next step, I'm reluctant to take it.  I need to feel that the chances of developing core strength again and being active without worrying that I will "pop again" are good.  I realize no one makes promises because each of us is unique.  I  had a vagina hysterectomy in 2003, hoping for some repair.  Needed a urogyno then, I guess.  I am 60, in good general health and want to be active.  How do you find the best doctor for the repair?
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I'm so sorry to hear you haven't had any luck using a pessary, were you fitted by the urogynecologist? Sometimes pessaries are not fitted properly and women are not aware that they come in different sizes and shapes. There is no problem with your age as far as improving the POP situation, since you have been to a urogynecologist and the treatments you tried did not help, it might be a good idea to ask for a referral to a physical therapist if you don't want to have surgery. PTs often can go into more detail and spend more time showing the different types of therapies for POP. Kegels do help but they have to be done properly and consistently as do the other types of treatment options, Pilates/Pfilates core strenthening, estrogen therapy to increase muscle tissue integrity, support garments, biofeedback and electrical stimulation to help recognize pc contractions.

If you do decide to go ahead with surgery, I truly feel you should  have it done by a urogynecologist; this is THE specialist for POP. If you are not happy with the urogyn you went to I suggest you try another. I can assist you if you can't locate another one, if that is the case please send me a PM (private message) and I can help you with that.

Yes we are all as unique on the inside as we are on the outside; the path is different for each of us when it comes to POP repair or maintenance. Good luck, I hope you find the help you need!

Sher
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Hi, I really can't give you any help with finding a urogyn for the surgery. Sherrie is the authority on this and is extremely helpful. I wanted to let you know that there are many of us out there with similar situations.  I too had a vaginal hysterectomy by a GYN. I should have gone to a urogyn to have the prolapse addressed. I'm thinking this happens more than we know. I have been using the pessary for a couple of weeks. After everything I read, I guess it wasn't exactly what I expected. I went back twice to get a different one. It fits ok at times, but not so well at others. I wanted to not feel it at all and that just isn't the case. I causes me some discomfort at times. Do keep up with the post and let everyone know how you are doing.
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Wanted to let both of you know that sometimes women have to be fitted several times b/4 they get the correct pessary (both type and size). When you have the right one, you truly shouldn't feel it in there at all and it should stay in position fine. There are over 20 different styles of pessaries but only a few that women can insert and remove themselves daily. For women who don't mind going to the dr monthly to have it removed and cleaned and reinserted, there's more options pessary wise. The one I used was one I could insert and remove myself and although it fit great (if you feel it or it causes discomfort or you can't pee, it is not a correct fit), I just didn't want to deal with the hassle of "one more thing to do everyday" so I opted for surgery. (Plus I had 3 kinds of POP and was grade 3 so I felt it needed to be dealth with.)

If you need help finding a urogyn fedup49r, I can assist you with that, give me a shout.
Sher
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Thank you for the feedback.  Tried many pessaries with the urogyn, they too were dismayed by not finding something that worked.  I do need to work on Kegels regularly. The PT route is a good option.  Thanks again.
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I need help in finding a urogyn.  A year ago I had a bladder prolapse.  Went to local gyn and she put in a pessary.  It just about killed me, the pain is so bad inserting it.  (I've never read anyone else addressing this.)  I only see her every 6 mos.  Yesterday I disloged it straining to have a bm. I now feel it (very uncomfortable), my back hurts, and emptying my bladder is in a slow stream.  Guess I will see her Mon. and put up with this over the weekend.  This is just not gonna work - I am miserable.  The reason I am reluctant for surgery is that I hear it doesn't correct the situation permanently - with patients usually having to have it done again.  Any input you can give me is greatly appreciated.  Thank You.
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Some women have pain and difficulty urinating with pessaries which means they are not fitted properly so don't think you are alone with this problem-most women just don't disclose POP concerns to others so we never hear about these kinds of things. Dislodging a pessary during a bm is common too; you need to "bridge" the labia when bearing down for a bm (make your fingers into a V shape and place them on the outside of the large labia lips and apply gentle pressure while bearing down-this should prevent the pessary from coming out if it is fitted properly). I do think it would be a good idea to see a urogyn to get the proper type/size pessary.

On the repeat surgery subject, part of the reason there are so many repeat surgeries is because women are having surgery done by physicians other than urogyns. The pelvic cavity is extremely intricate, it truly takes a specialist familiar with the surgical choices as well as the correct attachment points and if mesh is used, how tight to attach mesh. A urogyn can address any of the 5 POP types, most other physicians will only repair one or two types-what happens if your dr goes in and finds a type of POP he/she is not familiar with? That repair won't get done and you end up needing an additional procedure. This does not mean the other surgeons are not good drs, it is simply a scenario where you want the best for this procedure. Another reason women end up needing additional procedures is they don't listen to drs orders post surgery, you truly need to "behave yourself" after a surgery this intricate in order for tissues to heal up properly.

A urogyn should answer all  of your questions and guide you in either surgical or non-surgical treatment options; the choice should be up to you which type of treatment you want. If you are not sure how to find a urogyn in your area, you can send me a PM with your city/state and I can check or I can send you a link to a site where you can find one on your own.

Sher
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17 years ago I had a hysterectomy due to prolapsed uterus, followed by a 2nd bladder surgery (marshall-marchetti). The urologist said subsequent operation would result in cathing. In the years since, a watershed of symptoms ended in being told in blunt terms I had POP. An OB GYN proposes surgery using mesh because "there is not enough native material left" to repair the bladder and rectum. After much research online it has become apparent that problems with pregnancy were early indications of trouble. I had four complicated pregnancies and births where I experienced contractions but never the urge to push. I don't push for bm's and couldn't even if I wanted to. There is a congenital birth defect in my spine and also the labia. Was diagnosed with an incompetent cervix after losing twin sons and a subesquent son. Spent three months in bed trying to save a fourth one. At 61 am at my wits end with the pain and problems. Research online indicates the importance of  underlying causes, repair work addressing them, and the Dr. doing the surgery. I feel like there is one last shot at getting this right and need the doctor and the hospital too. Anasthesia is critical as I get violently ill. Can't stand long, can't sit...only lying down brings any comfort. Please help me find a doctor and get this over with.
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Heading home but still  having laptop problems, will get back to you as quick as possible!
Sher
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