Sacrocolpopexy post-op shoulder pain

[wampam]

I am 71 and had a Robotic Sacrocolpopexy and Cystoscopy 5 weeks ago.  The first two weeks were a breeze, with only a few abdominal pains controlled with ibuprofen.  However, I developed intermittent left shoulder and neck area tingling, numbness and spasms after 2.5 weeks, which is ongoing.  It seems to occur most often when I move in a certain position but not always.  I had back surgery about 15 years ago when a rupture was repaired between L4/L5.  Some of the pain/discomfort is similar and I think I may have developed a bulge that is impinging on nerves in my neck area.  I wondered if anyone else has experienced neck/shoulder pains following this surgery.  As others have mentioned, I have now developed some urge incontinence when my bladder is full.  I will speak to my doctor next week at my six week check-up.  I did have the surgery performed by a Uro-gynecologist and her team.  It was performed at an highly recognized medical center known for excellence and I was confident in their performance.  I was told that this particular surgery for POP is the gold standard.

After reviewing the information about post-op activity, I believe I have been overdoing it.  I am not doing heavy lifting nor have I returned to my routine fitness and athletic routines, I feel I might have overdone some lifting and walking.  I had hoped to return to golfing after my 6 week check-up but after reviewing everyone's comments, I'm not sure I will be able to do so.  I will ask the doctor how long I will be restricted.  Has anyone else returned to golfing or aerobic work on an elliptical machine?

[UKlady1001]

Pilates can be good as long as you avoid any stomach crunch, planking or other position that creates pressure abdominally as this puts pressure on prolapses and prolapse ops.  A specific prolapse DVD is Pflates which was devised by a Dr specifically for POP etc.,  and the Hab-it system is also on DVD and this is specifically to strengthen the PF.
What type of pessary did you use?  Look at specific incontinence pessaries like the Incostress etc.,  I use a T pessary type R which does lift up my urethrocystocele etc so maybe a different type of pessary to the one you have already used could help and not cause issues.  
Urogyens and GP rarely know the wide range of pessaries on the market so it is worth doing your homework before your appt and taking a brochure with you.  
PT can be really helpful.  It does take time to take affect so try to be patient with it.  It has really helped me to strengthen my PF etc.,  
Good luck

[wampam]

Thanks again for your feedback.  I will stay in touch.

I used a pessary for over a year (days when I was active) and would not look forward to going back to using one.  It did help a great deal with the prolapse discomfort but the Urogynecologist indicated that the pessary can also irritate the uretha and bladder causing leakage in some cases.  I'll wait a while and continue to see my UG, whenever necessary.  I know PT will help my neck/back issues.

Are you aware of whether Pilates on a Reformer is a good approach to strengthening the pelvic floor.  I did Pilates twice a week a month before my surgery and I think it helped but don't know if it would be wise to go back to it now.

[UKlady1001]

From my understanding your Robotic Sacrocolpopexy will not have directly involved supporting your bladder, however, the resulting inflammation and recovery could be at least part of why you are experiencing some urge incontinence when your bladder is full.  I also note you had a cystoscopy done when you had your operation.  A cystoscopy is a procedure to look into your bladder, but sometimes you can get an infection due to the possible introduction of bugs during the procedure.  This can happen with catheters as well during prolapse operations.. so you could consider urine testing to make sure you are clear of any infection.  
I am glad you are going to be able to see a Urogynecologist and also that you will ask to see a womens PT as this is important for the best recovery and maintenance of your PF etc.,  
Great to hear you are planning to organise the lifting and carrying of your clubs and lengthening your recovery time as well.  
If you still have problems with bladder leakage after your recovery, a good womens PT will be able to help you to strengthen your pelvic floor muscles and if you are still having bladder leakage issues you could also consider whether a pessary could help with this and of course see a Urogynecologist about a possible operation if you feel this is what you want to do.  I would try.. healing first, then PT, then a possible pessary and then a possible operation, in that order, and you have lots more time to recovery to go yet.
You are clearly very fit as well as motivated to sort this out, so take this in stages.  An operation can be seen to be your last option right now.
Dont ignore you neck pain either.  I think the 'dorsal lithotomy' position is with your arms straight out to the side with your back and neck flat.  It could be possible this has irritated something but you will need an appropriate Dr to look at this for you if you continue to get problems with this.  My guess is more PT, but I could be wrong.

Good luck with this and let us know how you get on

[wampam]

Thank you for your feedback.  I intend to ask my surgeon all of these questions.  Unfortunately I only live in the area where she practices about 6 months of the year.  I will be returning to another state and changing my health insurance which provides coverage through a closed panel HMO.  I do have excellent Urogyn's there and a wonderful Internist, so I will be seeing them soon after I return in June.  I will be back where my surgeon practices next November.

My surgery was about 2-1/2 hours and it was reported to have gone extremely well.  I was in a "dorsal lithotomy" position, which I understand to be on my back with my head facing downward.  

I will ask my Internist or Urogyn to refer me for PT specific to my condition as I am counting on being able to golf this summer.  I use a riding cart but will have to have the bag boy or husband carry my clubs to/from my car.  I appreciate all of the information about the need to be careful regarding lifting and lengthening my recovery period.  

It appears from some of the comments that another surgery to resolve the bladder leakage is possible.  Is that true and generally does it resolve the problem?  Is it usually a bladder sling or some other type of procedure?

[UKlady1001]

I am sorry you are having some pain and issues.
It is very disappointing that so many Urogynecologists etc tell patients that they will only need 6 weeks to fully recover.  It can take months to be fully healed but normally ladies say 12 weeks is an average amount of time to feel pretty good.  Walking is OK and are you seeing a womens physio therapist?  If not, ask your Urogyne to refer you to one to help you to safely exercise your PF and strengthen which is is important whether you have  POP op or not.
How long did your operation take?  What position were you in exactly?  Maybe ask your Urogyne to see if they think there was any particular pressure on the area of you back that is troubling you.  
You may need a different referral for your neck etc.,  
As far as going back to your 'normal' exercise routine including golf and the gym etc and of course lifting.. you will need to consider life long changes in your life style if you want your repairs to last.  Lifting is contraindicated for POP, as is running etc.  Speak to a womans physio therapist about what is and isnt safe for you to do.  
You could try specific strengthening exercises when you are given the all clear to do so by your Urogyne like... Hab-it DVD, or Pflates etc.,  
Aerobic work with swimming ( maybe not breaststroke ) could be useful.  
I really dont know if golfing is OK, but a heavy caddy is out unless it is easy to pull.  The walking would be good though.  
Considering you are only 5 weeks post op, all talk of going back to exercise apart from walking is really too early though.  
Take it easy and consider seeing a womens PT plus speak to your Urogyne about your post op pain and back and neck plus bladder issues.
Take it one step at a time.
Let us know how you get on