Prolapsed Bladder after Hysterectomy for Prolapse

[Joan288]

I am a 65-year old teacher with a bladder prolapse that gets worse as the day goes on.   I will go into the washroom at work to urinate and can't and by the time evening comes, I have to lie down doing Kegel exercises so I can empty my bladder at bedtime.  I gather it's Stage 3 because it feels like it's falling out and protrudes so that I can fell it when I'm walking.

The surgeon just said that nothing could be done about it when it happened after I'd had hysterectomy with anterior and posterior repair.  He said that he will not do surgery with the methods they have now so I'm left with this problem that is driving me crazy.  I ordered a "truss" that is ridiculous and just cost a lot of wasted money.  I ordered a book on exercises that say it takes six months of doing them four times a day when I'm teaching all day, marking and prepping at night.  I don't have the time and retiring right now is not an option.

I am getting osteoporosis and am supposed to be doing lots of exercise.  I had been doing it, but have had to stop altogether with this problem.  I have told some of my friends at work but nobody talks about it or knows anything about it.  

Any help you could suggest would be appreciated.  

Joan (Canada)

[sherrieP]

Please see if you can find a urogynecologist for a consult, I have to assume by the comments your dr made that he/she is either a primary care or gynecologist rather than a specialist. There is no doubt that something can be done to correct your cystocele; you just have to find the right dr. Your symptoms do indicate you are probably grade 3 and it is very difficult to balance advanced POP with exercise (although I always recommend women continue exercise programs for maintenance whether they have surgery or not). I'll send you a PM of someplace you can check for a urogyn in Canada-some provinces have them, some don't.
Sher

[Joan288]

Thank you very much, Sherrie.  I feel some hope after being very frustrated and depressed about this.  The doctor was my surgeon whose speciality is Urology and he didn't offer any advice or help for this.  My family doctor is a man, too, but I will make an appointment to see him when I'm off this Thursday to get a referral to a doctor I found on the site you sent me.  The problem might be that you wait months to see specialists around here.  My surgeon is in a small town as is my family doc. so I get in quickly.  The Urogynecologist is at the huge medical centre here.  

I've always been pretty slim and fit and sitting or lying around is really difficult.  I love to walk, but I'll have to wait, I guess.

I have just found this weekend, that if I sort of stand on my head I can urinate--I put my hands on the floor.  Crazy but it beats going to bed at night with a full bladder.

I am so glad I found this site.  Again, thank you very very much, Sherrie.  I don't feel alone with this now.

Joan

[sherrieP]

At first I thought you meant stand all the way on your head-once I read the whole post I had to laugh a bit-thought holy cow hadn't heard that one yet. :)
It makes sense that "headstand" forward helps release urine, when women lay their tummy on their legs it puts the bladder in a different position. It also sometimes helps to massage the bladder (urethra gets crimped, massage shifts it to a different position).

If you want to try to keep walking, see if your dr would fit you for a pessary or try getting support type undergarment-sometimes that helps.

I know it's frustrating to wait to see a specialist but you want anyone going in to truly know what they are doing.

Sher

[czlc89]

You should definitely get a second or even third opinion. You can never be too cautious before deciding to get surgery, especially such an invasive one. If you do decide to operate, I would recommend that you do thorough research into the procedure, brand and device that they are using. Don't be afraid to ask questions, esp considering all the stuff about transvaginal mesh now:
  http://www.newsinferno.com/defective-medical-devices/consumer-reports-slams-fda-approval-system-that-allowed-sales-of-transvaginal-mesh-metal-on-metal-hip-implants/36433

[Joan288]

Hi Czic,  

I appreciate your advice.  Thank you.  I did read about the problems with the mesh and don't plan on having surgery for this yet, unless they can offer something else.  I had a hysterectomy last July for a prolapsed uterus and they did both an anterior and posterior repair, but then the bladder prolapsed after that.  I'm not ready to rush into surgery again unless it's been proven to be problem free.  I just want some relief from this bladder thing, especially when I have to stand most of the day.

Take care,

Joan  

[sherrieP]

The mesh complications are another reason to see a urogyn rather than a gyn for these procedures-it truly takes an expert to get it right. Problem with no mesh is failure rate of surgery is very high in 2-5 years. Very personal decision, important to have all the facts both pro and con mesh and surgery prior to making decision.

Sher

[Joan288]

I have an appointment to see my surgeon who is a Urologist tomorrow.  My regular doctor was away so I couldn't get a referral to the urogynecologist.  My surgeons nurse got me in quickly,  I just want to ask him about some kind of relief like a pessary or something, not surgery.  

We just started a new term and I have big classes so I had to stand all day today and then was having a terrible time urinating when I got home.  Fortunately, I've been able to sit and later lie down on the couch tonight after I finished preparing lessons for tomorrow, but I just can't go on like this.  I'm so used to being very active.  

Joan

[Joan288]

I am booked for more surgery on May 29.  I was quite surprised, since thi sis the surgeon who did my hysterectomy and he indicated he couldn't do anything for the bladder when it prolapsed again.  This time he said I have a hernia higher up and he wants to repair that before it gets worse and will do the bladder at the same time.  He mentioned the mesh and said that there are a lot of lawsuits in the States over that but the only other alternative at this point is my own tissue which isn't working too well, so I guess it might happen again, but I have to have the hernia repaired anyway.  

[sherrieP]

POP will get worse as the day goes on, especially for women on their feet-also difficulty urinating usually indicates a more advanced level of POP. It is true, tissues stitched for support won't hold up long term thus the need for mesh procedures. Important to check into how many of the procedure type he wants to do he has already done and what his success rate is. I'm hopeful you were fitted with a pessary to give you some comfort while you wait for surgery.
Sher

[czlc89]

best of luck! hope it goes well

[Joan288]

Thank you for the support, czic.  

Sherrie, thank you as well.  No, he didn't even mention a pessary and I was so happy he could do something that I forgot to ask.  Afterward, I was left with questions, like what kind of surgery does he intend to do and what are the long term chances of success.  I think I will call and leave some questions for him.

I hate to think of going through this surgery and having the bladder prolapse again.  This has been such a nightmare.  The school was unbearably hot today with a sudden heat wave and I could hardly walk out of there.  Also, I have had to stop exercising altogether, and have to lie down in the evenings, just so I can empty my bladder at night.

[sherrieP]

You can also try wearing  a support undergarment, some women with POP find them too uncomfortable, others can tolerate it ok-depends on organ position. If you think you can tolerate it, wash your hands and gently push tissues back into vaginal canal in AM (when first rising they are usually not bulging as much) and then put on the support garment. When you have a bowel movement, "bridge" your fingers over the labia (again clean hands) and push up while you bear down to have the bm. A quick fix in place of a pessary is a tampon but this should only be done once in a while if you are on estrogen therapy, not a good idea at all if  you are not. Delicate estrogen deprived vaginal tissues are very sensitive.


Sher

[Joan288]

Thank you, once again, for the good advice, Sherrie.  I am soooo happy I found this forum and am not alone with this miserable problem.  I have just put in a super plus tampon and had no trouble because it was a plastic inserter.  I am on hormones because of research on Alzheimer's since both my parents had dementia in old age.  I had been on the minimum but have gone back on .625 mg. when the bladder prolapsed after I'd already had surgery.  I've been hoping it will help the vaginal walls thicken up again a bit.  I'm surprised this happened, since I went directly onto HRt when I went through menopause at 55.

Anyway, I'm now wearing a super pad, a super plus tampon and am optimistic that the bladder will stay up at least a little better as the day goes on.  I've had a migraine on top of this (probably because I'm on hormones) but you can't win.

I'm going to look up a book I have on exercise with prolapse since I'm feeling like a couch potato which is not me.

Thanks, again, for being there.  You have no idea how much it means to me.

Joan

[sherrieP]

Google Tasha Mulligan, her exercise regimen for POP is great and she has multiple videos online.

Best for general exercise is swimming (organs float and it's aerobic and works all muscle groups but few have access to a pool), most pilates is good, Pfilates is targeted as pilates + pelvic floor. Anything that jars the guts down is a bad idea without internal support.

It's a good idea to build up the vaginal walls prior to surgery-will help the heal curve!

Sher

[Joan288]

Thank you for all the help and suggestions, Sher.  I will definitely google Tasha Mulligan and start her exercises.

I have to tell you, the tampon idea is working wonders.  I have had no problems at all and was able to be out in the yard today working on the pond and went for a nice walk with my husband tonight, rather than lying on the bed all evening so I could urinate at bedtime.  I can go to the bathroom anytime and drink all the water I want.  It has eliminated the problems altogether and I am looking forward to teaching tomorrow and standing all day will be no problem.

I agree with you, though that exercise before surgery is a very good idea.  I have a health club membership and can take Pilates classes and use the pool.

Thanks again for being there.

Joan

[sherrieP]

That's great news Joan! I'm so glad it helped and you are able to be more active comfortably. It always makes me happy when women are proactive!

Sher

[Joan288]

I am going in for surgery at 6:30 a.m. tomorrow.  I'm really nervous though I went through this a year ago.  Any last minute advice?  He is going to repair the bladder again and also another hernia further up.  I am planning on doing Kegel exercises all summer since I'm off work now and but am really worried about a recurrence.  

The tampon has worked to a point, but some of them were soaked in urine when I took them out so it has been anything but ideal.  I had to change them quite often because of this.  I sure hope this surgery can give me some relief.

The funny thing is that the substitute teacher who is replacing me has the same problem but not as bad yet.

Joan

[sherrieP]

Tampons should not be urine soaked when they come out,the uretha hole is an entirely separate hole from the vagina. I'd tell the dr that info. It is important that you take the appropriate time to heal post surgery, no lifting/driving/vacuuming until released. Icing is of great benefit post surgery for  both swelling and pain. Have your post op area at home set up prior to leaving for hospital so you don't have to worry about it when you get home. Have a pillow handy in case you need to cough or sneeze so you can hold it against the abs. Take a garbage bag with you to hospital to put on seat, makes it easy to swivel into position.

Good luck, hope things go smoothly. Let me know how things turn out once you are up to writing. I'll keep you in my thoughts!

Sher

[Joan288]

I'm home and the surgery seemed to go well.  I haven't any pain today and am just not moving around very much.  I'm still bleeding but hoping that will stop soon since it's just from incisions.

I chose to have the freezing instead of general anaesthetic and it worked  well.  Just a shot in the spine and something to make you not anxious and so that you can't remember what went on in surgery.  I have trouble remembering much of anything.  The freezing took about 5 or 6 hours to come out which kept me immobile in bed but guess that's not such a bad thing.  It was Day Surgery but I was there about 9 hours in all.  

I spent the night on the couch in the livingroom since we have a two storey house.  This is the first time I've come upstairs where my computer is.

I want to be sure I never have to go through this again and plan to do everything I can to strengthen my pelvic muscles after this ordeal.

Thank you for all the support and suggestions, Sherrie.  I really appreciate it and am so glad I found this forum.

Joan

[sherrieP]

Glad this is behind you Joan. Please try to avoid using the stairs this first week, give your tissues a chance to heal. (Boy do I know how hard it is to give up the computer for a few days.......)

You're one brave soul, I'd be terrified to have procedure w/o being knocked out (and a big needle weenie to boot!).

Please do very little this first week, absolutely no lifting! No vacuuming! Be a good girl and lay low!

Sher

[audro]

i had hysterectomy last august and operation for prolapse bladder two weeks ago.if anyone has this problem,i would say go for the surgury.well worth it..two  weeks later i feel little tired but thats all,no pain what so ever

[sherrieP]

Thanks for sharing audro!
Sher

[Joan288]

I had the same surgery at the end of May as you can see here.  My advice would be to be very very careful about lifting anything heavier than you can do with one hand easily.  I am also very careful not to get constipated (lots of fruit and vegetables) and also ordered the book that Michelle Kenway puts out regarding which exercises to do and not do.  You can order it online by doing a search for her name.

Good luck to you.  Sherrie is a wonderful help and knows this field very well, by the way.

Joan

[sherrieP]

Great suggestions on the lifting and fruit Joan. :)

There is also a great dvd by Tasha Mulligan on how exercises for pelvic floor.

Sher