Pelvic Organ Prolapse, Support Thread - Page 25

[Ceinwen]

Joining you all.

I have two children - dd age five, dd age three months.

First delivery resulted in a fourth degree tear, and my second delivery was a scheduled c-section.

Around six weeks post partum I noticed the beginnings of a rectal prolapse. I knew what it was right away...

Anyway, I'm booked to see my GP on the 28th, and I'm sure I'll be referred from there.

Ugh. This is so not what I was expecting to deal with in my twenties! However, this thread is a wealth of information, and I'm going back to finish reading!

As a question, does anyone here have only a rectal prolapse? I don't feel any discomfort or issues with other pelvic organs, but I do have the rectal bulge following a bowel movement.

God, it's very uncomfortable and embarassing!

[IrishMa]

Originally Posted by veryerin

You know I totally have the aching thing going on. I also get pretty sharp pains in my pelvic region. I can't stand on one foot after working out (like to tie my shoe or take off clothes) without having serious pain around my hips and pubic bone. I had spd while pregnant and I feel like my pain might be more related to that, but who knows. I just returned home after almost 4 months of travelling around New Zealand (with a babe no less!) and am soooo ready to figure out some sort of exercise routine that works with this.

Well, best wishes to you and if you do find something that doesn't aggravate the ache or makes it better, PLEASE let me know! I intuitively feel like my stomach muscles need sharpening up but quite frankly, I've been too scared to do anything in case I make myself worse! The recommended pp exercises I can find just really don't do much for me, I must admit. If you have any travel tips, I would love to hear those too! We are going to be afloat for about 7-8 months just in time for this little fella to turn six months old...

[CKM5513]

Hi ladies,

Trying to wrap my brain around this one. Goodness how I wish I would of paid attention to my body more back in the "normal" days. Ok so I have this tissue issue in the back of vagina. Didn't worry much about it cause the front wall was closing in on it in the beginning, now that is much better. Any ways, trying to figure out what it is. Now every picture I look at online shows that rectocele is normally a little higher up, and then bulges droops down. Mine is right at my pelvic floor, almost like dear old doc didn't sew me up right? Which he said while sewing me up..."I have to stick my finger in your anus so I don't sew it shut". Not to get graphic but if I stick a finger in my anus and then one in my vagina I can touch them together right at the floor, there is still skin there keeping them apart. Now it has been like this since giving birth. I could not go #2 for a very long time afterwards due to the trauma, and had to ummm, well help get it out with a finger (and I wasn't splinting if you catch my drift). Is this suppose to be like this? Do any of you other woman out there have this? It does not do anything while I strain down or have a BM or anything...just kind of flops there. If you look at the picture of this website there is a little part of "pouch" if you will, that goes from the anus to the vagina at the base of the pelvic floor (not the rectocele that is higher). http://www.obgyn.net/displayarticle....amb_procedures This is what I am talking about...is that suppose to be there, and is it normal? I apologize in advance for my ignorance but, I am so dumb about where things are suppose to be and so scared that everything is failing. I have been looked at by a urogyn and nothing was said about it, but I was much more concerned about the front bulge and didn't even notice the back one until recently...if it even is a "bulge"? I hate dwelling on this, but I was not one to go poking around in there to see what was going on in that area!!! So if any of you know anything about this or can offer any advice, I would appreciate it!
Thank you in advance!

[veryerin]

Irishma -
I'll let you know if I find an exercise routine that doesn't interfere. I am going to go back to my yoga studio, I think that will probably be more helpful than anything.

As for travelling, your babe will be older than mine (which = more challenge, but more fun too!). The best advice I can give is to not worry about schedules or bedtimes or anything and just go with the flow. And my babyhawk was my best friend! Best money I ever spent! I hope you are BFing because that also made my life exponentially easier while travelling around! Have fun!!!!

[IrishMa]

Originally Posted by veryerin

Irishma -
I'll let you know if I find an exercise routine that doesn't interfere. I am going to go back to my yoga studio, I think that will probably be more helpful than anything.

As for travelling, your babe will be older than mine (which = more challenge, but more fun too!). The best advice I can give is to not worry about schedules or bedtimes or anything and just go with the flow. And my babyhawk was my best friend! Best money I ever spent! I hope you are BFing because that also made my life exponentially easier while travelling around! Have fun!!!!

I'm glad to hear your experience was so positive, I am looking forward to getting out there myself and I think bringing little fella along will be grand. Yes, I am BF and I'll bet you are right, it WILL make things easier in certain respects!

I purchased the Namaste Yoga series (they have it on Exercise TV) and I really like that so far because they don't hold things for too long, go at a decent pace for me (so far) and I just don't go in any direction my body isn't ready to go. So if anyone doesn't have a good studio by them, I recommend it!

CKM, your post saddens me because it's such an awful ,icky discovery. It's like, will this situation never end or resolve? I myself am thinking, okay, I can't cure it but at least let me be able to stabilize it! It makes me wonder what I will find if/when this bulge I have decides to firm up...

[wombatclay]

CKM- Hmmmm. I'm not certain I know exactly what it is you're feeling but maybe this info will help? I asked A LOT of questions after my tear/repair...

Basically, before the tear, the perineal area looks like this:

*O----O (*clitorus Ovagina---skin/muscle---Oanus)

After a tear it looks like kind of like this:

-^-----^--
* (vaginal opening extends into anus and "out the other side")
-v------v--

The depth of the tear can vary, extending "up" the rectum, or "up" to the cervix. (some mamas also tear forward through the clitorus). It's true that a finger or other tool needs to be placed in the space that was the anus in order to bring the pieces of muscle and tissue together properly, but it's not exactly that the dr would "sew it shut"... more like the pieces wouldn't be aligned and the sphincter muscle wouldn't function properly (leading to fecal incontinance or the inability to void at will). So while the anus was previously a single "O" before the tear, after the repair it's more of a "()" with sutures at "top" and "bottom". Sometimes the tissue heals a bit oddly and there can be "flaps" or scar ridges left behind.

Now, depending on how the tear was sutured you can have a raised scar running along the outside or the inside of the perineum. In my case, it's outside. From the vaginal opening to the anal opening is a ridge of tissue with a valley... like this:

___/V\___

The bottom of the valley is where the tissue was sutured and two little "flaps" remain on either side. Some dr's do this in such a way that the "raised bit" is inside and can be felt within the vaginal area. Some dr's suture "edge to edge" so your scar may be more like:

____ ____ (gap being where the scar runs)

In addition, if the tear extended "up" the rectum, the scar line (and possible raised scar or tissue flaps) would then be feel-able along the "back wall" of the vagina.

Is it possible you're feeling something like this? A tissue flap or scar line into the rectum that isn't directly related to the prolapse? During an exam your care provider may not have mentioned it since it's a "normal" part of the tear repair and not part of the prolapse. And as long as there is tissue there it isn't a fistula so maybe it wasn't something they were worried about? Normally there isn't a heck of a lot of tissue/muscle between the vaginal area and the rectum so it would be hard to say if your tissue was "thinner" than normal since most of us have no clue just how much tissue we've got there to begin with! (and I hear you... I wish I had exact photos of my inner bits before/after just so I could figure out what exactly had shifted and how much).

But I also agree with a mama who posted pages and pages ago... she said that a certain amount of vaginal/cervical/rectal change following birth really is normal. It's just the price we pay for walking upright against gravity and birthing kiddos with big brains/heads. Some change is to be expected and it's only when that change has a negative impact on your life that it becomes a "problem". So prolapse is really more of a quality of life question instead of a specific "if it moves X amount it is Y condition". I totally understand wanting to know exactly what is going on and what can be done about it... but if this thinner area isn't causing you a problem (and it sounds like it isn't?) then maybe just let it go as much as you can? I know it's a lot easier to say than to do, but maybe just try to focus on what is "right" (or at least, what is right now) instead of thinking about what might happen down the road?

But I know how hard that is to do... it's something I struggle with. And one reason I ONLY check once a day, while doing kegels in the shower. At first I was checking all the time and it was driving me crazy wondering if things were lower. I should check less frequently I think, but since it helps me to see if I'm kegel-ing properly I'll keep doing it for now. But I'm trying to just go with the flow and accept that things have changed...

[That Is Nice]

Has pelvic organ prolapse impacted your periods? How?

Thanks.

[IrishMa]

Originally Posted by wombatclay

But I also agree with a mama who posted pages and pages ago... she said that a certain amount of vaginal/cervical/rectal change following birth really is normal. It's just the price we pay for walking upright against gravity and birthing kiddos with big brains/heads. Some change is to be expected and it's only when that change has a negative impact on your life that it becomes a "problem". So prolapse is really more of a quality of life question instead of a specific "if it moves X amount it is Y condition". I totally understand wanting to know exactly what is going on and what can be done about it... but if this thinner area isn't causing you a problem (and it sounds like it isn't?) then maybe just let it go as much as you can? I know it's a lot easier to say than to do, but maybe just try to focus on what is "right" (or at least, what is right now) instead of thinking about what might happen down the road?

I thought this was a good response. I have also been trying (in a VERY fledgling way) to mirror this thinking. Otherwise, I've already driven myself nuts ruminating on what I could've/should've done differently. Since I recently started exercising again, I am checking the bits and pieces before and after to see what affects what but then I try not to think about it. I've depressed myself enough!

Incidentally, Wombatclay makes a great observation about a tissue flap. I actually have one (possibly two) of those. When I tore, my body dissolved the stitches faster than the edges were able to heal themselves so they didn't stay approximated. Hence, I had this weird thing that looked almost like a uvula (I know, SO attractive!) which my doc took off but there is still another one tucked up there that I can see. I am assuming it's the same thing because it looks identical to the one that was taken off closer to the vaginal entrance. So perhaps, hopefully, even though after such an experience, it's a very small step to assume the worst..maybe you actually have a nice, benign little situation like scar tissue. Now wouldn't that be nice!!

I myself have decided to think of it as those fabled saggy vaginal walls until proven otherwise. Mostly because I am still in the first year pp, so hope is hanging off my back like baby possum!

[Nicole R.]

Originally Posted by Spring Flower

Has pelvic organ prolapse impacted your periods? How?

Thanks.

This is a hard question to answer -- what changes are due to POP, and which are due to having had a baby, extended breast-feeding, being off chemical birth control, and getting older?

The main impact is due to the lowness of my cervix -- it's hard to use a tampon, especially toward the end of the cycle. (It's hard, but it's not impossible -- I found a new position to insert one, and it seems to be working well. And happily it doesn't involve lying on my back on the bathroom floor with my hips elevated, which my PT suggested.)

I feel like my flow is heavier, and also the flow cuts in and out during the four or so days of menstruation. It vanishes completely for many hours at a time. But this might have been happening before, and I never knew it because I wore tampons more regularly.

[mommak1]

I'm new here...I've read through the first 13 pages of the thread and will continue working on reading through the whole thing. I hate that I have to be here, but I'm pretty sure I belong.

I'm 4 weeks post-partum and pretty sure I have a uterine prolapse, and possibly other organs but I'm not really sure. I just got brave enough to check things out with a mirror and can see my cervix (at least that's what I assume it is) right at the opening of my vagina. It also looked like something else might be bulging right behind/below the cervix, but maybe that was just part of my uterus? The whole area scares me a bit at this point and I'm afraid to do any feeling around to try to figure out exactly what I'm seeing. I just put in a call to my OB to see if I can get in for an appointment sooner rather than later.

I've been very uncomfortable - more than I expected - since delivery but didn't really know what was going on or what to expect. I'm almost 36 and just had my second baby - my first was c-section and the 2nd (4 weeks ago) was VBAC with vacuum assistance and 10 lb 5 oz baby. I had a third degree tear and three other tears. Once I felt like the tears themselves were finally making good progress, I still felt just generally uncomfortable and kept thinking it was normal, but now I'm guessing it's the prolapse that's causing the discomfort. As others have described, I have that feeling like a tampon is in the wrong place and like I'm sitting on ball. I also tend to feel generally achey at the end of the day. I have not had any problems with urinary incontinence (other than the first few days post partum), but I have some rectal discomfort - I tend to feel a lot of pressure in the area and bowel movements are sometimes difficult - I really try to avoid straining, and generally what happens is that I tend to feel like I need to have a bowel movement most of the time, but it takes a long time to get to the point where I can actually get something out without straining. (Not that I sit on the toilet for a long time at on stretch - just that I have that feeling of needing to go for several hours before a trip to the toilet is actually productive, if that makes sense.)

So that's my very long background. If anyone has words of advice or encouragement as I'm just starting down this path, I would really appreciate it. I'm 99% sure my family is complete, so having more children isn't a concern for me - but I don't want to rush into surgery - if it's necessary at some point, I can live with that - but I don't want to do it while I have a breastfeeding baby and I hope to nurse her for about 2 years like I did with my son.

I guess my big question is how normal is this at 4 weeks post-partum? Is there any possibility that it's something that will resolve itself as just part of the general recovery process? The fact that my cervix is almost protruding makes me think I'm beyond what's within the normal range of what to expect post-partum, but I'm new to all of this.

[wombatclay]

Hugs mama... Congrats on the baby (and the vbac) though!

I guess my big question is how normal is this at 4 weeks post-partum? Is there any possibility that it's something that will resolve itself as just part of the general recovery process?

My wonderful OBs told me that they didn't consider anything "permanent" in terms of location/sensation until at least 6 months following the birth. And apparently in other cultures 6 months to a year is more common when discussing "normal recovery time" from a more or less normal birth (and a 3rd degree tear is far from a "normal" birth! The fact that you feel so good after a 3rd degree is awesome!).

Right now try to rest and enjoy your babe and littles, and try some of the "home remedies" mentioned in this thread. If and when you do see your care provider, make sure they check you while you're standing up and with an empty bladder. But really, you're so recently post-partum (and with tears) that it's really really likely that things will be moving up and in for a while. After all, your uterus isn't going to be "back" in it's normal resting spot for another few weeks anyway so you'll probably see A LOT of change in the next few weeks or month.

Hang in there, and congrats again on your birth!

[tayndrewsmama]

In case anyone is interested, my physical therapist said that they have seen many women heal complete prolapses with nothing more than kegels combined with abdominal exercises. This is not just for women have recently given birth either.

[CKM5513]

Wombatclay,

Thanks for the info girlfriend! You are a wealth of knowledge. Ok I'm heading back to the urogyn Thurdsay to have her take a look see. Recently I have been feeling a lot of pulling and just being a little uncomfortable in the anal area. I actually noticed more when having sex with hubby and I felt like I was going to pass gas or that something really low to my pelvic floor was pushing against my anus. Plus I have been gathering stool more in this little "pouch" area more than before. I am almost certain it is not a rectocele, I think more along the lines of a sphincter. I really don't think I was properly sew up...as one mamma said earlier - I too think my OB got his medical degree at Sears on sale! When I look at my anus, there is a half moon scar around the front of it and a little bulb of tissue to one side of it. On the other side there is a deep purple scar that when I push on it feels like it is attached to nothing, just like it is a hole with skin on it. No matter what it is, it was caused by the cutting of that area, I am almost certain of that (and of course just having the big guy come out of me). When my OB said he had to stick a finger in my butthole to make sure he didn't sew it shut, also leads me to think he didn't sew enough shut or tack down enough, if you will. Now if this was a rectocele, wouldn't I have this bulge while standing? I have nothing when standing but a tiny bit of floppy skin at the base of my pelvic floor. While sitting on the potty is when I can see it. And from what I can see the rectum doesn't start until a little higher up according to the medical pictures, and there is a part that is like a internal anus? From what I understand a true rectocele can not start until about 3- 3.5 inches (8-10 cent.) inside the anus. The lower part is still considered the sphincter. I am guessing that this is the problem, since I can just stick a finger in my anus (even before the first joint) and move tissue forward into my vagina with ease. This is the "pouch" that is trapping stool while going. I am also having some pain (kind of like a pulled muscle - a dull ache around the deep purple scar, which is where I'm guessing something should be attached and isn't). This whole thing is just driving me nuts! Just when the front is getting better the back goes to pot! I think the front bulge was infact helping keep this tissue in place, now that it is almost gone, nothing is holding it there. I'm not sure I can take another vaginal birth...mentally or physically. I'll let everyone know Thursday night what I found out. The doctor I see is really good, and takes the time to listen and really does a very good exam.

Wombatclay...you had a sphincter...right? What were your symptoms? Did you have issue going #2 and did you have to splint to make it all come out? Any trapping of stool for you? And what did you do about it? Another cut to fix it or did they do the dead correct the first time?

[CKM5513]

Originally Posted by tayndrewsmama

In case anyone is interested, my physical therapist said that they have seen many women heal complete prolapses with nothing more than kegels combined with abdominal exercises. This is not just for women have recently given birth either.

All of us around here LOVE hearing that! Thanks for giving us all HOPE!

[tayndrewsmama]

It should be noted that the PT's that I work with are trained in myofascial release techniques and cranialsacral therapy. I suspect there are very different thoughts in different types of PT.

[mommak1]

It sounds like PT might be a good place for me to start. I have an appointment with my OB/GYN on Thursday, so I'll be sure to ask for a referral.

[tayndrewsmama]

Originally Posted by mommak1

It sounds like PT might be a good place for me to start. I have an appointment with my OB/GYN on Thursday, so I'll be sure to ask for a referral.

May I suggest finding out who is near you that is knowledgeable in this area before going in? That way you can tell your doc who you want to see in case they aren't very familiar with good PT's for this.

[CKM5513]

Hi all,

Anyone with a rectocele out there? If so, couple questions if you don't mind. Where is it located? Can you touch/feel it right inside the anus, or at the base of the pelvic floor? I can stick my finger in my anus and go forward into my vagina at the first joint of my index finger, so maybe not even a half inch or so. Does it always bulge, or only with straining and or have bowel movement? No bulging while staining, just pushes this tissue down. I have been struggling with this "tissue issue" in the back of my vagina, that is very low at the pelvic floor and it is trapping stool. It has been there since I birthed my son. I just feel like things were not pulled together correctly after the cut was done (which went into my anus). Just trying to figure out what it is. I go to the urogyn tomorrow for a look see, but am trying to get all my duck in a row. After all I have learned that having knowledge of such things is a big help when dealing with doctors.

Thanks in advance to anyone that replys!

[mommak1]

Originally Posted by tayndrewsmama

May I suggest finding out who is near you that is knowledgeable in this area before going in? That way you can tell your doc who you want to see in case they aren't very familiar with good PT's for this.

Any ideas how I can find this out? I don't think I need an actual referral from my physician as far as insurance purposes go - by referral, I meant recommendations (hoping my OB/GYN can recommend some PTs with experience in this area).

[wombatclay]

Wombatclay...you had a sphincter...right? What were your symptoms? Did you have issue going #2 and did you have to splint to make it all come out? Any trapping of stool for you? And what did you do about it? Another cut to fix it or did they do the dead correct the first time?

Yes, I had a sphincter.

Sorry... I just love the way that sounds! Ok, back to reality. I had a 4th degree tear so the tear went right through the anal sphincter and out the other side. The OBs who attended my birth actually teach a class for midwives on how to repair serious tears so I'm pretty confident they did it "right". I have two "flaps" on either side of my scar (I'm told these will even out a bit over the years) so it almost looks like my labia extend all the way back, wrap around the anus, and end a half inch or so "above" the anal opening (so the anal sphincter was torn in two places).

I don't have a rectocele or any bowel problems (other than now-and-then gas incontinence, the odd looking flaps, and the now-and-then pain when a flap gets "torn" a bit by tissue paper) but my OBs were very serious about their healing/down time. I was on several different stool softeners and laxatives for about 2 months following the repair and under explicit orders to keep my poo soft to the point of liquid for at least the first 6 weeks while everything healed. I also used an epi bottle with herbal blend and witch hazel/tucks pads instead of TP for about 2 months as well to prevent any "rubbing" of the area and on Dr's orders "sunned" my bottom (sit in sitz bath, apply aloe gel to healing tissue, lay on bed with nekkid bottom in a sunbeam for 10-20 minutes a day). They told me over and over to avoid any straining while voiding. And I think that really helped since it gave the muscle and tissue time to heal a bit before being "put to the test" so to speak.

Back to the text books... the anal sphincter is one of those infamous "donut muscles". It's a ring of muscle than can pull itself tightly closed or open more or less on command. A tear can either rip into the ring on one side (making a donut with a bite out of it) or it can rip right through (break the donut in half). So imagine the anal sphincter muscle is the drawstring at the top of a pair of pants. The drawstring can be pulled tight or opened up, but it's always a "ring" around the top of the pants. Once it's torn, the best fix is to overlap the torn edges by a bit and sew them together. This means the drawstring is a little bit shorter than it was, but the torn bits are secured to each other with a bit of a seam. The ok but not perfect fix is to sew the ends of the torn section together end to end. This means the drawstring is the same size but the sutures are going to be under a lot more stress and the overall repair may not be as secure. (there are a lot of factors at play during a tear repair so it's not necessarily up to the surgeon which type of repair... overlap or end-to-end... will be possible). And just like a c/s, you can't say much about the underlying repair based on how the skin healed.

So.... your drawstring is repaired. One possible problem is that the drawstring may have gotten stitched or caught on the pants a bit. In that case there will be one little section that doesn't "draw tight" or which stays tight when the rest is relaxed. Or you might find that the drawstring doesn't hold as well as it did and the pants "pop open" suddenly or are always a bit loose. Or the drawstring is uneven and part of the pants slips through the opening and stays there.

Does any of that help you figure out where the problem might be? A surgical repair of the the muscle may not help if the problem is that the rectum was repaired "crooked" (leaving a flap of tissue unsupported by muscle so it falls over the opening) or if the problem is the intestines have fallen out of whack. But chiropractic care (to realign the pelvis) or maya massage (to help soft tissue move into a better place) may be an option to try before surgery. On the other hand, if it's a sphincter problem (too loose, too binding, too uneven) then a surgical correction might work. Just keep in mind that the ideal fix leaves the sphincter a little bit smaller than it was before sooooo.... eventually the surgical option isn't going to be an option if you want to keep things open!