Pelvic Organ Prolapse, Support Thread - Page 66

[cagirlintexas]

4 weeks from due date and dreading the return of POP

Anyone have any tips for me. My POP has been gone most of my pregnancy but with only 4 weeks left in my pregnancy I am starting to be hit with the realization it will be returning. Anything you can recommend I do now or following birth of baby?

[pwit]

I just saw a urogynocologist and am back to share with you all. Hopefully some of this will be helpful to others.

I have grade 2 cystocele, rectocele, and uterine prolapse. Because of stress incontinence and a CHANCE he thinks things could heal better with wearing one he wants me to come back for a pessary fitting and try wearing one during the day time for a year. I really can't stand the thought of walking around with something stuck up in me holding things in place- it seems really unnatural to me. But it also seems unnatural to be falling apart and not be able to run without peeing my pants. I'm gonna try out the pessary because worse case I don't like it and quit using it. Best case I stop retaining urine all the time which drives me nuts and peeing my pants if I don't stop and clench before coughing or sneezing. I really dread that fitting appointment though. I don't think I'm gonna be able to get it in and out right.

He talked a bit about how my ligaments are stretched out which causes the sagging and it got me thinking that I have done no reading up on nutrition for ligament health. I have started googling that this morning but so far haven't come up with any plan.

He also said I am horrible at doing Kegals and doing them all wrong. I knew I wasn't able to squeeze and hold for several seconds, I try but I just can't. I didn't think I was doing them wrong though. I asked if he could send me to physical therapy for that and he said yes. So I'm looking forward to some humiliating physical therapy for kegal training

[GiantGi]

subbing...

[kltroy]

Originally Posted by pwit

He also said I am horrible at doing Kegals and doing them all wrong. I knew I wasn't able to squeeze and hold for several seconds, I try but I just can't. I didn't think I was doing them wrong though. I asked if he could send me to physical therapy for that and he said yes. So I'm looking forward to some humiliating physical therapy for kegal training

oh my I hope this is your paraphrasing, and not an exact quote from your doctor! Ok this is me, the biomechanics professor, speaking now: The thing about the kegels and all muscle dysfunction issues is that it's not that "you are horrible" at it. It's that your brain is sending the right message -- a message that *used* to work -- but because some of the nerves that activate those muscles have been damaged, or the muscles themselves have been damaged, they are unable to carry out their mission. As humans, when things aren't working quite correctly we naturally try to recruit larger muscle groups to help accomplish the task that the small ones used to do by themselves. So in the case of kegels, your brain says squeeze and your muscles don't squeeze. Your brain says "squeeze HARDER!", so it turns on some other muscles like your abdominals and maybe glutes to help with the job. This is "wrong" because esp. with POP you need to actually isolate the pelvic floor and *not* use these larger muscle groups.

So my two points are that (1) it's not your fault that you can't do these. It's a problem with the connection between your brain and the muscle. It's not that you're stupid, it's that your body needs to be reminded how to use that muscle again, and it may need to rebuild some of the neural connections that were damaged. (2) Doing kegels "wrong" usually means that you're using muscles other than your pelvic floor. A PT can be very helpful for this, because she can help you learn to identify when you've got it right. My PT used ultrasound so that I could actually *see* my bladder lift up when I was doing the kegels right. I could see, on the screen, how the muscles moved when I activated them. This made a huge difference and, with some practice, I no longer needed to have that visual feedback to know that I had it right.

Also, it helps that my PT treated this very much as "business as usual" -- she specialized in pelvic floor and urinary dysfunction, and was very professional. Although it wasn't something I initially looked forward to, I did look forward to the visits because I felt a sense of accomplishment at how much better things got for me. It's worth it.

[kltroy]

Originally Posted by MabMama

My question... I joined a gym a month ago complete with a personal trainer. Besides crunches, is there anything I shouldnt do to further complicate things? I know that tonight, we did a very little bit of spin class and I wont be doing that again. That hurt my entire pelvic area regardless.

No - you can actually do crunches if you are careful about your form even. Know that rule "squeeze before you sneeze"? Same business with anything that causes you to valsalva. So with crunches or any sort of weight training, any time that you are flexing your abdominal muscles, remember to lift UP first, THEN flex the rest. Pay attention to your posture and you can do anything.

I will say that with the spin class it's probably the bike seat that is the culprit -- they may have a few with women's seats - they make a huge difference. Biking is actually one of the activities that I've been able to do all the time, even when my POP was at its worst.

In any case, I would just pay attention to your body as you are exercising. If you feel like what you're doing is putting a lot of downward pressure on your pelvic floor you need to stop and reconsider your form and try lifting up before you do it. If you can't do the exercise without feeling that pressure, check it off your list as a no-no. I basically do everything that I ever did at this point, but I do pay attention to make sure it doesn't feel like it might aggrivate things or cause me to have symptoms again.

[AlaaJ]

Oh wow I think the birth of Baby 2 has caused me some type of prolapse which I haven't realized till now. After Baby 2, I started practicing Fertility Awareness Method as birth control. Sometimes, when poking my finger inside to gauge the height and 'feel' of my cervix, I'd feel a bulge against the back wall. When pushing against it I'd feel the urge to .. umm.. move my bowels. What would be the cause of that? Also, I noticed the usual urinary incontinence brought about by sudden sneezing/coughing/jumping jacks and other exercises.

In a nutshell (because I'm sure the bazillion pages here already cover this), what can you do to try to avoid any type of POP in the future?

*Sigh* .. mamahood sure is bittersweet..

[ngaburon]

Maya abdominal massage can help with this. You can find a practitioner in your area, just google it. Mothering magazine did an article on this a few years ago and when I had it done for other reasons the practitioner said she had helped some women who had prolapses and fixed it.

[AlaaJ]

This maya massage sounds interesting. I come from a culture where the woman has to almost completely bed rest for 40 days postpartum and receives special abdominal and lower back massages from Indonesian women during this time period. Unlucky me, I grew up in the good old US and scoffed at such practices!

[xelakann]

A quick update on me... I am meeting with my doctor to schedule POP repair surgery. I have had a second and third opinion and the consensus is that the uterus needs to come out too. I am done having kids so I don't have to deal with those feelings, but I am really freaking out about the recovery process.

My baby is 13 months old. She will be 15 months when I have the surgery. My doctor is SUPER supportive of breastfeeding and says there is no need to wean, but I am thinking of weaning. Well really I'm not sure. I'm on the fence.

I am doing PT to help strengthen my muscles. pwit I wasn't doing them right before either. After seeing the PT several times now I am a champ at them. Still not super strong, but I am doing them right. I highly recommend seeing a PT for this. I also had A LOT of pain associated with my prolapses and the PT has helped with my pain, even though my actual POP have gotten worse.

I was a case where the PT isn't really to help now-- damage done. But to prep for post surgery.

[Kellyh_01]

I just had my repair surgery a week ago Friday. I had a laparoscopic tubal ligation, anterior and posterior vaginal repair with mesh, and suburethral sling. The first 5 days were the hardest. By a week, though, I was feeling much better. And today, 10 days post-op, I feel really good. I have no pain now and a decent amount of energy, and I'm taking care of my family again (driving, cooking, etc.). Initially I felt like it was a much bigger deal than I had anticipated going into it. I had more post op pain than I was expecting, but it was well managed. I spent one night in the hospital. I wasn't able to pee after they took the catheter out, so it had to be replaced and I had to go home with it for the first week. Once that came out then I bounced back very quickly. Peeing was quite uncomfortable at first, and all the sensations in my pelvis are still different - a full bladder feels different than it used to, and peeing itself feels different. I feel a sort of pressure when I cough or laugh, but I think that's just because surgery was still very recent, but I don't leak! I know that things look better down there - no more visible prolapse or cystocele. I still have sutures in my perineum, but the swelling is way down. I'm still doing light activity and no lifting. At this point I'm glad I had it done. I feel much better knowing that my insides are no longer on the outside! I am hopeful that when we are able to have sex again that it will be successful. I just want to be careful during my recovery and afterwards so that it doesn't happen again.

[kltroy]

Wow Kellyh_01 that's great that you're feeling so good after your surgery.  I hope it all "sticks" and that you continue to heal and improve over the next several months!  I think the press on the reconstruction surgeries has been generally negative, so it is nice to have a different perspective.

[pwit]

kltroy- he didn't explain it nearly as politely and as encouraging as you did, but he had more tact that what I gave him credit for.  I do appreciate your explaining it better though!

Kelly keep us updated on your recovery.  That is very encouraging.  I'm pretty sure surgery will be in my future, its just a matter of time.  I'm hoping physical therapy will make things a little better or slow down the rate at which things seem to be falling.  But if/when things get to that point I don't want to be scared of something that is needed to make living easier.

[Kellyh_01]

Originally Posted by kltroy 

Wow Kellyh_01 that's great that you're feeling so good after your surgery.  I hope it all "sticks" and that you continue to heal and improve over the next several months!  I think the press on the reconstruction surgeries has been generally negative, so it is nice to have a different perspective.

Yes, you're right - there is a ton of negative stuff out there.  It makes me a little nervous, but there's really nothing I can do now other than wait and see what happens.  So far I haven't had any problems, and I feel like I'm recovering fairly quickly. The pressure sensation with coughing and laughing is gone now.  And I came down with a head cold yesterday, complete with lots of sneezing, but no peeing!  I am thrilled with that!  I am only 37, which I think is on the younger side of women having these types of surgeries.  I think that a lot of the unsuccessful outcomes and complications happen in older women who are already post-menopausal.  I hopefully have many years left and will have long-lasting results.  

[pwit]

Kelly I hadn't even thought about that the surgery success rate would probably be smaller for women who are in their 60's or 70's.  I'm coming up on 30 so I'm sure I'm one of my urogynocologist youngest patients.  I haven't asked him about his surgery success rates or how he measures his success rate.  I'm still hop9ing for a physical therapy miracle.  In the evenings when my pop is usually at its worst I often ask how much longer I can deal with this.

[SpuglyRoo]

Unfortunately I belong here.  I'm in the process of reading the archives of this thread, I'm about halfway through.  I'm 26 years old, four months postpartum with my second.  I realized something was wrong at around 3 weeks.  I think I actually helped cause the prolapse due to a lifelong habit of sucking my belly in, breathing improperly and chronic constipation.  I also may have helped it along because my postpartum bleeding stopped really soon with my first, so when it stopped soon this time around, then started again I was wondering if I had a clot.  I kept trying to push to see if one would come out because I was certain that I had a clot that needed to be passed.  Shortly after was when I realized that there was no clot, but that things weren't where they should have been. 

I am curious how many women here also had pelvic girdle pain, or sciatica, or sacroiliac joint pain during their pregnancies because my sacroiliac going out of place was my first symptom of pregnancy this time.  My SIL mentioned that a friend of hers had one of the above problems and then went on to prolapse which made her concerned because she is currently pregnant and has severe pelvic girdle pain.  Her PT said the two problems aren't connected but take that with a grain of salt because the PT also said that I should just plan on having surgery, she seems way more mainstream/medical than I would like (she isn't my PT, she is my SIL's).  So, I was curious to see if anyone else had two cents to put in on that front (perhaps I just haven't read about it in the archives yet).

I must say that I really appreciate what I have read on this thread.  When I first discovered my new problem I was devastated and an emotional wreck.  I was angry with myself, with my newborn, with my midwife (who had never mentioned anything like this was even possible).  I am beginning to come to terms with it and accept that while it may not go away (so far no real improvement) I don't have to let it take over my life.  I am a much more happy and stable person right now (thank God the hormones of pregnancy are going away!)  I am encouraged by some of you who were on this thread when it began and have now had more children, especially since I thought that this was going to mean we were done at 2 when we had hoped to have 4.  I now plan on having at least one more and then reevaluating after that. 

I was curious how some of you are handling bowel movements without doing any sort of straining.  Any specific tips for combating constipation?  So far for me it has been a lifelong struggle and I haven't really learned much that helps other than fiber, water and exercise, and even that only helps a little bit.  Anyone have any experience with using the breathing the baby out technique applied in this area?  Recently that seems to be helping.  Thanks for being here, though I'm very sorry the thread is needed by any of us.

[Mamasweetpotato]

I'm still having trouble with constipation and have been taking stool softener nightly for 4 months now...I am now panicking that I have taken it for too long and have damaged myself even further...seriously freaking out.  Left message with gyno on how to wean off.

It just never ends!

Anyone else get themselves regular again?  (Meaning b/ms?)  Please respond with some hope...I'm kind of upset here.

[eclipse]

I'm still taking stool softeners every day. I was told they can be taken long term - laxatives can't, stool softeners can. I also take a fiber supplement (one of the powdered ones you can add to food or water) in addition to trying to get adequate dietary fiber. I have not gotten myself regular, even with those added. I usually only go twice a week or so, but it doesn't feel as impacted as it does when I miss a couple of days of the stool softeners.

[Mamasweetpotato]

Thank you, eclipse.  That's what I get for googling.  I had heard about laxative abuse, but was reading it applied to stool softeners like colasce as well (??) and that really upset me.

That sounds like my schedule as well (2x a week - 3x is bliss).

[eclipse]

Originally Posted by pwit 

Kelly I hadn't even thought about that the surgery success rate would probably be smaller for women who are in their 60's or 70's.  I'm coming up on 30 so I'm sure I'm one of my urogynocologist youngest patients.  I haven't asked him about his surgery success rates or how he measures his success rate.  I'm still hop9ing for a physical therapy miracle.  In the evenings when my pop is usually at its worst I often ask how much longer I can deal with this.

I'll say - the urologist I saw said the opposite. He said that the repairs tend to fail over time, so he prefers women to wait as long as possible to get any repairs done to prevent the need for even further intervention later on. It didn't sound like it was so much the age of the patient as the length of time that the repair can last.

[xelakann]

Originally Posted by Kellyh_01 

I just had my repair surgery a week ago Friday. I had a laparoscopic tubal ligation, anterior and posterior vaginal repair with mesh, and suburethral sling. The first 5 days were the hardest. By a week, though, I was feeling much better. And today, 10 days post-op, I feel really good. I have no pain now and a decent amount of energy, and I'm taking care of my family again (driving, cooking, etc.). Initially I felt like it was a much bigger deal than I had anticipated going into it. I had more post op pain than I was expecting, but it was well managed. I spent one night in the hospital. I wasn't able to pee after they took the catheter out, so it had to be replaced and I had to go home with it for the first week. Once that came out then I bounced back very quickly. Peeing was quite uncomfortable at first, and all the sensations in my pelvis are still different - a full bladder feels different than it used to, and peeing itself feels different. I feel a sort of pressure when I cough or laugh, but I think that's just because surgery was still very recent, but I don't leak! I know that things look better down there - no more visible prolapse or cystocele. I still have sutures in my perineum, but the swelling is way down. I'm still doing light activity and no lifting. At this point I'm glad I had it done. I feel much better knowing that my insides are no longer on the outside! I am hopeful that when we are able to have sex again that it will be successful. I just want to be careful during my recovery and afterwards so that it doesn't happen again.

Thank you so much for sharing this. I have my pre-op appt tomorrow. We will discuss what option we are going with. I will most likely have my uterus removed too as well as anterior and posterior vagnial repair. Not sure about the mesh or the exact procedure yet. I will update tomorrow.

See I am totally freaking out about the pain and recovery. I am glad to hear that for you, 10 days out you are feeling a lot better. I am overly anticipating the pain and still fear that I am underestimating.

How old are your kids? I have a 13 month old. I just can't fathom not picking her up. :-( But I can't go on with these prolapses.