I am falling apart...what is this thing protruding from my vagina (oh yes, way to much TMI thread!)

[DeChRi]

Lemme tell ya, this pregnancy is a beating!! My last two were seamless and this one is about to take me down.

I need some advice. A few days ago I noticed some odd "bump" protruding (almost like swollen) form the perineum side of my vagina. It was right at/just inside the opening to my vagina, and right there at the back (does a vagina have a "back"??). I noticed it when I sat down to pee. I pushed on it and it felt like swollen tissue vs a firm lump of any kind. When I pushed on it, is seemed to disappear/spread out upwards and almost into the rectum area. It is about nickle size and round, but again, just squishes out (like swollen tissue would) when pressed on. ALSO, when I feel for it standing, is just isn't there. It is just when I sit on the toilet, of in that position. I feel a good amount of pressure there too. It does not hurt at all. I have been horribly constipated this pregnancy but have had Zero hemarroid problems of anything.

What could this be??? It feels like my vagina is turning inside out, lol. Besides that I have either a yeast infection or BV, and awful SPD this time, causing wicker pressure and pain in the vaginal area as well. I feel like that whole area is going to he!! in a handbag.

I have a Dr appt Friday, but does anyone have an idea of
what that would be???? (Sorry for the TMI )

[mediumcrunch]

my money is on a rectocele or a varicosity

[sostinkinhappy]

I hate to be the bearer of bad news, but it sounds like you are having a prolapse of some kind (mine was a vaginal vault prolapse).

I strongly urge you with the most emphatic voice possible to get thee to a urogynecologist ASAP. Most ObGyns will not know how to deal with this in the most effective way, nor will a urologist. Urogyns have gobs and gobs of training specifically about how to deal with these issues comprehensively (and trust me, it makes a difference!!!!)

You can find a urogyn by searching at http://www.mypelvichealth.org. That website also has a lot of good information as well so be sure to check it out.

There isn't much that can be done until after baby comes, but your provider needs to be aware of it because prolonged, extended, and "purple pushing" can make this far worse than it is right now.

Just as an aside, research has shown that women who suffer from SPD/DSP in pregnancy are much more likely to develop prolapse issues either in pregnancy or later in life. The SPD is an early indicator of laxity in tendons and other supportive fibers. Sometimes Kegels can help, but depending on the cause of the prolapse and where it is located, they may not help at all. This was the situation in my case - my prolapse was caused by precipitous labor and tears to the supportive fascia underlying the vaginal muscle. I could have Kegel-ed until I was blue in the face and it wouldn't have "fixed" what was ailing me, which sounds exactly like what you are dealing with.

Best of luck - I do know that the earlier you seek treatment, the less problematic prolapse are and the more easily they are treated!

[aloneinid]

If it is at the "back" (posterior) wall of your vagina it is most likely a rectocele (your intestines pushing through a weak spot in your vagina) and the pressure of sitting on the toilet is making it protrude. I would see an OB-GYN (one that specializes in this) for an opinion and tips on how to manage it. I don't know that a urologist is going to be helpful with a rectocele (vs. cystocele- bladder pushing through weak spot in vagina).

[sostinkinhappy]

Originally Posted by aloneinid

If it is at the "back" (posterior) wall of your vagina it is most likely a rectocele (your intestines pushing through a weak spot in your vagina) and the pressure of sitting on the toilet is making it protrude. I would see an OB-GYN (one that specializes in this) for an opinion and tips on how to manage it. I don't know that a urologist is going to be helpful with a rectocele (vs. cystocele- bladder pushing through weak spot in vagina).

That's why seeking a consult with a urogynecologist is so important for either a rectocele or a cystocele! (Do I sound like a broken record yet? )

Not only are they usually a board certified ObGyn, but a board certified urologist as well. They *really* understand how the girlie bits down there fit together with all the other parts and how weakness in one area can lead to weakness in another area. These are the kinds of doctors who wend to med school, then spent another 10+ years studying how rectocele/cytocele/uterine prolapse can affect a woman years down the road - not just in the 6 weeks after a delivery.

Even if you have to drive a bit of a distance DeChiRi after your baby comes next month, it will be worth it in the long run. I wish I had sought more specialized care as soon as I had noticed something was amiss. If I had, I wouldn't be in the precarious predicament I am in at this very moment!

[DeChRi]

Thanks you all for your responses. I checked the website and there are a couple listed within about an hour from here, including our area's major university affiliated med center. They have a dept of urogyn/ob there. So I know the care is around.

I called my OB, got the nurse, did the best to describe it to her. She talked to Dr, called me back, said Dr told her that "bulging there is normal this late in the game and that they would check me at my next appt"...which is in 2 weeks. I felt better for about 10 min until I grabbed a mirror, sat on the toilet, and beared down a but and it looks bad. Now I am in a bit of a panic again.

So should I call directly to the uro-gyn/ob, or call me Dr back and ask to be seen asap first, then move on right to the urogyn? I guess I feel a bit like I should see my OB here first, even if I plan on seeing the uro-gyn regardless, just because if they have recommendations, I would like to feel good about her working with them, if that makes sense. I like my OB a lot but I do feel like I need to be seen on this one. She is very non-alarmist with me, and commented when I got pregnant that I have an exceptionally strong pelvic floor. (We are also kind of gym buddies...I am an avid weight lifter/power lifter, so she usually assumes that most everything in strong.)

Of all things, this just has me in a panic. I hear horror stories of various prolapsed things and pelvic floor disorders. Plus, I am wondering if I am doing things at the gym I should not be, that may make it worse. If indeed it is something.

[IAMommy]

I just went to a meeting on pelvic floor rehab last night. You should definitely look into physical therapy for that as soon as your baby is born. One thing the therapist mentioned is that she sees women who carry heavy weights often experience pelvic floor problems. This is mostly in other countries where women do a lot of manual labor, but it might apply to you too. She mentioned that PT should always be the first course of action for pelvic floor problems - the mesh they use to surgically repair things can cause more problems than it solves.
You might have to find a therapist that does internal work (yes, internal) - I had no idea that existed until last night.

Here are some websites you will find helpful
http://www.clearpassage.com/
http://hab-it.com/
http://www.healthcentral.com/incontinence/

Good luck!

[CherryBomb]

I wouldn't want to mess around with a possble rectocyele or cystocele, so personally I'd just bypass the OB and go right to the specialist.

[DeChRi]

I am seeing my OB at noon tomorrow. If she dismisses it I will move right on to the specialist. I may still do that anyway. I will press her on it. I have a good amount of respect for her and she has sent me other places for other things when she felt like there was a better person to handle. I am just glad to be seeing someone fast, and may go ahead and start the process with the referal tomorrow as well.

[sostinkinhappy]

Originally Posted by DeChRi

I guess I feel a bit like I should see my OB here first, even if I plan on seeing the uro-gyn regardless, just because if they have recommendations, I would like to feel good about her working with them, if that makes sense. I like my OB a lot but I do feel like I need to be seen on this one.

This is exactly what I would do, especially since you are so close to delivery. A urogyn can come up with a treatment plan and then your regular OB can help execute it (hopefully!).

Best of luck to you - soon we will have these babies in our arms and be on the road to recovery!

[sostinkinhappy]

Originally Posted by IAMommy

...She mentioned that PT should always be the first course of action for pelvic floor problems...
You might have to find a therapist that does internal work (yes, internal) - I had no idea that existed until last night.

16 weeks of twice weekly internal physical therapy later, I can attest that these kinds of PT DO exist. Who knew??? Most urogynecologists work closely with a PT who specializes in pelvic floor rehab so make sure you find one that does. My PT was a wonderful woman named Claire Kalina who made an otherwise unbearable experience slightly more tolerable.

[DeChRi]

Thank you again for all of the advice. I am feeling pretty confident it is a rectocele. After looking at pictures it is identical. I mean, exact.

I have done my best to inspect everything in there while straining. My cervix and bladder and everything seem pretty sturdy and in place. No incontinence problems. And I don't feel anything at all bulging further up that posterior wall either, when I strain.

Granted, I am far from an expert and have no idea how to diagnose, but short of the bulge at the opening, everything else feels pretty good.

I have decided that although hitting my OB at noon today, I am going to do ahead and try to get in with the uro-gyn near here before birth, for a second opinion.

[mrsfru]

Originally Posted by sostinkinhappy

16 weeks of twice weekly internal physical therapy later, I can attest that these kinds of PT DO exist. Who knew??? Most urogynecologists work closely with a PT who specializes in pelvic floor rehab so make sure you find one that does. My PT was a wonderful woman named Claire Kalina who made an otherwise unbearable experience slightly more tolerable.

I can also attest that this kind of PT exists--went to it years ago for problems from chronic pain related to endo and IC. When it's necessary, it's SOOO worth while, even if it's a bit embarrassing at first. I learned SOOO much!

mrsfru

[DeChRi]

Thank you all for the advice. I did see my OB today. Turns out she started the specialized schooling for uro-gyn after regular OB school (I am sure there is a technical name, lol) but decided that she would rather catch babies. So while she is not a uro-gyn, she does have some extra knowledge there AND has a great respect for them in general.

So she did a full questioning and lots of examination and such. Her 2 cents were that yes, I was right, it is a type of prolaspe (rectocele). She said that everything else...uterus, bladder, etc, seemed very well in place. She said that from what she could tell, it was not severe. However, hard to tell this late in the pregnancy game, since there is so much pressure there. She said that generally, for that type of prolapse, the end of pregnancy will make one that was previously there but asymptomatic, suddenly very symptomatic/bulging.

She said that my baby was extremely low (yeah!) and that contributed. Also, she noted that she was not saying it was nothing, but, that the prolapse could appear worse than it is at this moment and until delivery it will be hard to tell. She said there is a uro-gyn nearby (the one I found) that she thinks very highly of, and two PTs in town that specialize in this. Her suggestions was to have her watch and reasses through these last weeks, as well as some modifications to my activity, have my birth, then see what my body does in the 6 weeks after delivery.

At that point she would like to refer me to the uro-gyn, to have things assessed, even if they seem better. She noted that even if it no longer protrudes after birth, that knowing the prolapse is there is still a good reason to hit some PT after baby to strengthed everything. She gave the disclaimer that it could get worse, but that's why there are specialists and PT folks and that we would cross that bridge quickly when we got there.

I feel good that I know what is going on, there is a plan, she didn't pretend to know it all, that is could not be as bad as I think, but if it does get worse, there is swift help on my side and my OB here locally ready to roll with it. She even told me that at 34 weeks in her last pregnancy she had a uterus prolapse and had to see the uro-gyn and do PT for a long time. Her words "nothing like having your colleague do and exam and tell you the pressure you feel is your cervix an inch above your vaginal opening" lol.

[To-Fu]

I just wanted to say that somewhere out there in MDC Land there is a support thread for people living with Pelvic Organ Prolapse. You might check it out!

So glad you're feeling better about your situation and that you have a plan. That can make all the difference in how you feel going into labor. Hooray!