Urogynecology Expert Forum
Need a 3rd Opinion
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Questions in the Urogynecology forum are answered by Bruce Crawford, MD, J. Kyle Mathews, MD, and other medical professionals and experts. 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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Need a 3rd Opinion

Hello,

To refresh your memory - this was my first question:

I am 7 weeks after childbirth (second child). I am nursing, and was told my bladder is a stage 2 cystocele.  My question is, once I stop nursing and my estrogen returns, what type of healing should I expect? My Doctor said not much will change since I am nursing, but at my 6 week it had gotten better from 4 weeks ago.  What is average healing for a grade 2 cystocele?

You told me to see a trained urogynecologist at U of M, in Michigan, which I did.  This is what I was told.  Could you help me in understanding how I could get two very different opinions?  

  I saw a urogynecolgist  at the U of M hospital.  I was told there is no prolpase and that it is normal to see the walls of your vigina (vagina) after having a baby, especially one as large as my son. I can see mine when on the toliet right at the opening, and while standing it is higher.  She put me on a kegel workout and said things should keep improving even while nursing.  After I'm done nursing things should greatly improve.  She also said this happens more than they would like, when other doctors diagnosis wrong and that prolapse is a easy thing to say when there is a little sagging or looseness has occurred in  that area.  She said I was at a negative 1 1/2, I forgot to ask her what that meant, since I was overcome with tears of joy!!!  Can you shed some light on what she meant?  All my other organs were completely fine also.  Does this happen often?  Or should I seek a 3rd opinion since I got two very different verdicts?  Overall very happy, but still a little nervous and confused!  She also said I was a 3 out of 5 after doing a couple kegels, and then a 2 out of 5 after I had done a couple more.  Can you shed some light please.  Thank you!

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Hi,
I apologize for my delay in responding. I have been away for several weeks because of a family matter.

Regarding your question, minus 1.5 means that the bladder neck (where the urine tube meets the bladder) is well inside the vaginal when you strain down. This means that the vagina is staying inside when you strain down. If there is prolapse, then the vaginal bulges out side, and the bladder neck moves outside the vagina. We use minus when the vagina stays inside, and plus when it falls outside with straining. We usually think of prolapse when this number is greater than plus 1. According to that exam, you do not have bulging of the vagina. Your urogynecologist is correct. THe vast majority of women who deliver vaginally will have some drooping of the vagina, therefore we consider it to be normal. It becomes a priblem when the vagina bulges out so mush that it becomes uncomfortable because of rubbing and chafing, or if it causes your bladder to retain urine (which your urogyne should have detected), or if it intereferes with bowel movements. If you do not have measurable prolapse, but are having pelvic pressure symptoms, then you may have some pelvic muscle trigger points, and these may be helped with a visit to a qualified pelvic floor physical therapist, who can help break up these trigger points, and provide you with some relief.

Dr. Hoyte
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Hi - sorry to repost but somehow my post got missed and I really want some help.  Here is my questions again.  I am now 14 weeks PP.  I made an appt with an urogynecoligist at the U of M hospital in Michigan.  I went to my appt at 8 weeks PP.  The doctor there did a very complete exam - the whole process took about 15-20 minutes.  She had me lie down, and then stand up and push.  Then she proceeds to tell me that there is nothing wrong with me that all I am seeing is vaginal wall, and that it is normal to see the front, back or both walls after childbirth - to a certain extent of course.  She also tells me that my bladder is right where it is suppose to be.  I am so overjoyed at this point and crying too - that I didn't even think of questions to ask.  She said it would get better, to just keep kegeling, not to stop nursing, and that everything will repair itself.  It has gotten much improved, but I can still see a "bulge or tissue" when on the potty and tilt my bottom forward while looking in a hand mirror.  It is not at the opening of my vigina (vagina), it is much higher. I can tighten it all up with a kegel and then when I stop it is loose again.  When my bladder is very full is when everything is at its best and nothing feels loose at all.  Then I pee and the muscles decided to take a "break" again, and become a little droopy.  The doc from U of M didn't discredit my doctor, but said if I had prolapsed then just about every woman who has had more than one child would have prolapsed then. She said I had no restrictions on what I could do or lift and etc.  She said I was just brave enough to take a look and see what is going on down there, when most women don't.  My question is  what is quote "normal" for seeing your vaginal walls after childbirth.  I never investigated my area before all this, so I don't even know what is normal and not normal.  I never kegeled a day in my life before now.  Now I might be considered a Kegel Master!!! Can you help me with this?  I have 2 docs saying 2 very different things. Of course want to think number 2 doc is right, but still don't feel all the way normal in that area either!  Is it normal to see some vaginal wall after child birth and if so how much.  How do you tell the difference between a cystocele and just being a little “stretched out”.  Thank you so much for your help!
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We are sorry, but our doctors can only accommodate one question and one answer.    If you have multiple questions or follow-up quesitons, we will be happy to help you schedule an appointment to see Dr. Hoyte, or if you do not plan to travel to Florida, then we suggest you schedule an appointment with a Urogynecologist in your area so that all of your questions and concerns can be addressed.

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J. Kyle Mathews, MD, DVMBlank
Plano Urogynecology Associates
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