Rectocele, Cystocele and Prolapsed Uterus advice

[BikiniFi8]

I'm 43 years old and have just been diagnosed by four different physicians (yes, I was in denial) that I have rectocele, cystocele and prolapsed uterus. They have all recommended a vaginal hysterectomy, said my cervix must come out and I need a bladder hammock.

I am very scared. I'm afraid sex won't be as good for my husband because they expressed a little concern about vaginal shortening. I'm worried I will not pick the right physician. I'm worried that I will end up feeling worse and/or in more pain than that which I'm currently enduring.

I would love any advice I could get. The one urogynecologist I saw was completely rude, and I did not like him at all.

[J. Kyle Mathews, MD, DVM]

The use of mesh with the uterus in place will make the removal of the uterus more difficulty because of the tissue ingrowth into the mesh.  The uterus will be less mobile which is the intent of the repair thus making hysterectomy more difficult.  

Pelvic floor muscles exercises, and weight loss do help POP.  

Regarding anything else causing these symptoms, your doctor would need to take a detailed history to rule in or out the possible other causes.  

[BikiniFi8]

Can you explain your comment that it will "be more difficult" to remove the uterus in the future?

Have you heard whether physical therapy, weight loss and diet have helped reverse POP?

Also, is it possible there is something else, like a hernia or inflammation, that may be pushing down on everything else, causing these symptoms? I do have an umblicial hernia and a hiatal hernia. Could those hernias be causing inflammation and pressure that's pushing down on everything else? What type of physician could look at these other possibilities?

Thank you!

[J. Kyle Mathews, MD, DVM]

Traditionally vaginal hysterectomy has been done when treating prolapse.  However, more recently, we are leaving the uterus in those patients that wish to keep their uterus providing it is not a source of pain, abnormal bleeding or other problems.  

I routinely offer patients the option to retain her uterus providing she is not experiencing problems associated with her uterus.  In addition, the patient must be made aware of the fact that should the uterus need to be removed at a future date, it will be more difficult.  

I am sorry to read of your experience with the urogynecologist you saw.  It is important that you have a good relationship with your surgeon.  Repair of Pelvic Organ Prolapse is more complicated than it appears and your choice of surgeon is important.