Getting worse

Hi Anita,

Well, the best of the gynecologic literature explains it this way:

“Destruction of the perineal body and alteration of the puborectalis muscles comprise the first pathophysiological events in the natural history of genital prolapse. The buffer of the core of the perineal body disappears. Once the puborectalis muscles have been destroyed or thinned and weakened, the urogenital hiatus becomes widely open. The ventral (front) vaginal wall sticks out. It pulls the uterine cervix downward, reduces the physiological anteversion of the uterine body and facilitates eversion. Fascial thinning is the second event that encourages the development of pelvic relaxation. This thinning is at the same time both cause and consequence of the bulging of the vagina. The vagina will not bulge if the fascia resists. It is because it bulges that the fascia becomes thinner.”

I would not say prolapse is a natural condition, but like Alemama just said, it is so common to be almost normal. I don’t believe it would happen as often and in the same way to women who ate, lived, and birthed in more natural ways than we do in modern society.

In many of the women practicing the postural work, prolapse seems to progress to a point and then stop. As you have already read, many experience the continual falling and finally a point of stabilization. What is so bothersome to the younger woman is usually very manageable in the older woman. It’s my feeling that in most women the vaginal walls eventually “settle out” to significant bulges in front and back. The uterus is often just above this configuration. This happens to women of all ages and I bet a clinician would tell you it is how the normal, mature vagina looks.

The very best we can do is hold our body in such a way as to tip the organs back toward their rightful places so as to ease tension on the fascial planes. The vaginal walls are also stretched and flattened along their natural direction. Manually massaging the fascia is a reasonable adjunct to this work, but the major part of the reducing and stabilizing prolapse gets done when we are upright (seated or standing) and creating the anatomical support network that has developed to keep the pelvic organs in place.

I know it is hard, but I hope you gain strength from all the young women who have come before you and prevailed.

Christine

Hi Christine and Anita

Christine your years of work and wonderful explanations, both on this site and more so in the second edition of your book, Saving the Whole Woman, have basically taught me about 80% of what I know about my pelvic region, plus more about other aspects of my womanhood. All this has happened in the last three years, since I found this site. I am so grateful for everything you have taught me. We are so lucky to have the Internet, in spite of all the bad things that it enables.

Your knowledge that you have so freely shared has enabled me to have enough knowledge to be in charge of my own body and what happens to it, and to pass this knowledge on to others, which I feel is now my continuing responsibility. What use is knowledge if it is not shared?

When I was diagnosed with rectocele first by my family doctor and subsequently the cystocele by my gynaecologist, I already knew from my own sketchy reading that I had pelvic organ prolapses, and that my rectum, bladder and also uterus were not where they used to be. In the meantime I had found this site and decided that surgery was too risky, and a stupid option for me, so even then I was starting to think for myself, mainly as a result of several previous failures of medicine to solve medical problems in our family.

Just a few weeks ago a new doctor sent me for transvaginal and renal system ultrasounds to investigate some nasty uterine pain which turned out to be simply a grumpy perimenopausal uterus whingeing about the state of affairs it was in. The test showed no abnormal masses fortunately, and everything is fine except for a prolapsed uterus. That is all this fine piece of technology could find.

I seem to be the only one who knows what is really going on in my body, as I deal with these prolapses 24/7. Sometimes they behave, sometimes they don't. They always get over it to a point where I am back to where I was at diagnosis time. It was interesting to look back at a list I made before that initial gynaecologist visit three years ago, and to observe that I am currently experiencing less problems than I was then simply because of some techniques I have learned on this site. So I guess my prolapses have stabilised after announcing their arrival in all their glory. They have not become worse, but as the cystocele is now hiding over my pubic bone and my rectocele rarely appears because I look after my diet better, the uterus has simply descended to fill the gap that has left. My plug is now complete!

As my periods become less regular, there is no longer the guarantee of a 30 day cycle, and the timing of the different parts is a bit erratic, but the same basic pattern is there. I now look at menopause as a change, rather than the end of my reproductive life. All the good eggs seem to have been released, but there are probably some still there that will never be released as the oestrogen levels seem to have fallen too low to start the ovulation process. My ovaries do still have a role producing some oestrogen, and the levels will be low, but still cyclical after menopause.

They will also continue to release androgens along with the adrenal gland. These residual hormones will both keep me attractive to my husband, and keep my libido going into old age. Yes, women without ovaries are, without HRT, eunuchs, as only the ovaries produce the pheromones that men pick up as "There is a woman around here somewhere!" No ovaries, no attraction! If the adrenals become exhausted from having to make up for the androgen production of lost ovaries, less androgen is produced, which means reduced libido as well.

The end of this story is that with an intact uterus and intact ovaries, the only two things that really change as a result of the ovaries producing less oestrogen are that no more eggs are released, and at menopause itself no more endometrium is formed, so there is no longer a period of menstruation, but oestrogen is still produced cyclically by the ovaries right into old age. It is a little more complicated than that, but this is the basic truth. This means that there must be things happening cyclically (a little bit) in the pelvic cavity, which may explain why our prolapses change all the time, depending on what has been happening with intra-abdominal forces and what mood the pelvic organs are in. In addition to that there is always the possibility of continuing sexual activity, and especially penetrative sex, and wonderful orgasms (however you get them!), which is just wonderful for giving everything a sizeable shove upwards and getting the juice flowing to keep the area engorging every now and again.

I think that the ability of the pelvic organs to engage in all these 'moving around' activities, both hormonally and physically is the key to keeping them up high. If you let them stay down, they will stay down. If you shuffle the cards regularly, they at least have the opportunity to move up again. Neglect can be a terrible thing in this respect, and I think may contribute to the worsening of the falling down.

So my advice to all the newbies is to learn all you can. Knowledge is confidence and confidence is power over the fate of your own body. Then observe your body carefully, and care for it and respect it as best you can. Expect prolapses to come back, and then go again, sometimes in their own time. And give those pelvic organs the opportunity to move around a bit and go back up again with appropriate exercise for all your active years.

We have this for life, and most of us *can probably* manage it, some more harmoniously(?) than others, rather than resorting to surgical intervention. If we decide to go for surgery at some point only the woman herself can weigh up the possible outcomes either way, and decide which way will be 'less worse' for her as she grows old, which is inevitable for all of us.

Cheers

Louise

I have three children. I have always been very active and fit. Never in my life have I had constipation. I have had beautiful pregnancies and births-the first in birthing centers- my last birth at home in the water with no forced pushing. I had no idea I had a rectocele. I am now very sure I have had it since my first pregnancy. But until my last birth I had absolutly no clue. I had an unstitched tear. At my first postpartum visit I told the midwife that my tear site was still sensitive. That it felt heavy at the end of the day. Then she noticed the bulge. Then I freaked out.
It was silly.
If I hadn't mentioned to her to really have a look at my tear she wouldn't have found the rectocele and I would still be unaware- because the thing is I don't have that sore feeling at the end of the day anymore. I have no symptoms except the bulge- that I would never have gone looking for it.
Since finding my bulge I have discussed it with other women in my moms group. All the women I gave a copy of the self exam have one form of prolapse or the other. One lady that I am very good friends with has that drain pipe feeling to her front wall- she noticed around AF it gets much more prominant and she has to pee more frequently- she made an appointment with an OBGYN and was told she was in perfect health. That she most certianly didn't have POP and all was well.
I don't think Gp and Obgyns really know how to diagnose POP. In a way it is a good thing- ladies can have the bliss that is ignorance but it is also a bad thing because they will not know to start the postural work.
I know Christine has a theory that if we lived and birthed differently we wouldn't have prolapse- but these ladies I know also birth at home gently 2 of them even do UC. The eat organic and vege and some of them even vegan. They make their own breads out of older grains. The move gracefully through life. and yet they still have some settling of that area. I really think it is normal. especially in the case of multiple children in a short amount of time.

I am thankful to know about my rectocele. I am greatful for this postural work that is going to keep my organs inside my body for years to come. I look forward to the future and all the changes in store for me. Nothing in life is certain and I still hold on to the hope that my bulge will get smaller and smaller- as it has been for the last year.

I guess see the future differently. When I look at the short term I can get upset. This is a hard pill to swallow. But as I look to the future I see myself surrounded by my children and grandchildren (who knows if I will be in a wheelchair or not-in a diaper or not- with it mentally or not-disease free or not) my husband is there- we are enjoying the slower pace of our lives.....
Surely I see chalenges along the way. Sickness. even death. but POP is almost nonexistant in my future visions.

a bit TMI, so beware. i haven't been on this site as often as i was in the beginning of my POP. partly because i just don't have the time. partly because i found it made me obsess about things even more, and partly i was angry that i couldn't be as accepting of my POP as some of the women on the site seem to be. i am now 7 months postpartum. what started as a cystocele with urinary incontinence and frequency and uti's, has changed and not necesarily for the better. now my uterus is prolapsing and my vagina doesn't go a day without being heavy. luckily, i don't have the same urinary frequency and can leave the house without fear of incontinence, but instead i have the ever growing discomfort as the day progresses. my lovely new addition is a rectocele which i didn't even have til a month ago. it only seems to get worse and now i find i can barely have a bowel movement without manually removing feces. i don't get grossed out easily, but this is disgusting. i always try to do it in the morn before a shower so i can get really clean, but there is no guarantee that i won't have to deal with it later in the day. a question for those who have to do this "the smell does not come off my finger no matter how much i wash and scrub, what can i do". also, does manual removal cause things to get worse?
so yes, A...i think i feel similar to you. i keep waiting for it to be better...i take good care of myself and have read "the book" and forum, but don't seem to have the same results as these women. i can see how the uterus and vagina can improve postpartum, but i don't understand how damaged rectal tissue improves. it is like a big soft tissue bulge in my rectum, how does that improve and become the narrow passage it once was. i have never had constipation issues, and have a bowel movement daily...so what gives?
i was put on the pill by my GYN/uro surgeon who is monitering me. i had a serious depressive episode that i am still fighting and went off the pill 4 days ago. i am not coping well with this and i am grieving the old me pre baby. i am grieving my normal bowel movements, and my vagina. i can't seem to wear tampons comfortably and that bums me out terribly since i spend all summer at the beach. yes, i have my beautiful baby...but i can't get over what i have had to give up. i use to be very active, but the hanging concerns me and limits my activity. i am going on vacation to mexico next week and don't even feel excited. i haven't been swimming with my POP, or in a jacuzzi since before i was pregnant. i am sorry to be so negative...but you are not alone. if anything you sound like you are doing better than me. i am jealous of those who are coping. i am at a loss and angry that surgery is such a bad option.

Dear Jsnyc,

SO HARD!!! I’m so sorry you are experiencing this. The vagina becomes vulnerable to encroachment by the rectum once it is being held open by either a pessary or cystocele. There is a tremendous amount of intraabdominal pressure moving through the pelvis at all times when we are upright and this work centers around manipulating the body in ways so that we benefit from the pressure instead of the opposite.

I hope you hear from some of the others with rectocele, but I just have a couple of thoughts for you. First of all, I wonder what would happen if you inserted one, or even two, sea sponges before your b.m. You’d think they might hold back the bulge and therefore straighten out the rectum. I would love to see a new line of pessaries developed for just this purpose. If the bulge was being reduced from the vaginal side the rectovaginal fascia just might knit back together over time. Internal massage might be helpful as well…there are PTs who specialize in this area.

The risks of posterior repair are very real, but you cannot live your life in this way either. I don’t think emptying like this will be healthy over the long run.

Keep exploring and please do not lose hope!

Christine

Hey I remember you- sorry to hear things aren't going great. I have been swimming with my prolapse all summer- mostly in the springs- the only thing I can tell is is that I "take on water" so that when I get out of the water it may come out right away and it may wait a little and come out later- not funny. so enjoy- it feels wonderful to be weightless- but have a towel handy.

why do some women prolapse and others not at all? why do some of us have a mild and reversible POP and others are still struggling after 2 years of trying to manage this?
I have no idea, but I think you can't look at POP in isolation. each of us has our own specific set of physical strengths and weaknesses. I think that POP occurs within that context. I've always been prone to trouble with fascia and muscle support so its really not shocking to me that I've developed a prolapse. not to say that I ever expected it to happen, least of all when I was only in my early thirties!
as far as looking at the big picture and wondering how you will deal with this for 50 years, yeah, that can be scary. but think of it this way, if everything else goes well and this is all you have to deal with, the next fifty years will be easy living!
seriously though, I do find it much easier to take it one day at a time. and for a reality check, I read the obits in the sunday paper.
now you all know I'm certifiably nuts.

I've been thinking about you lately, wondering how you've been. I'm really sorry to hear that things have gotten so much worse for you.
I want to apologize if I've responded to your posts in a flippant 'it'll all be ok' way. truth is it took me a very long time to get to this state of acceptance that I am in right now. and I did not cope very well at first. It was easier for me I think, as I was not postpartum when I found my prolapse.
I spent alot of time grieving and crying and just being plain old angry. the losses are real. I still have an ache in my heart when I think back to my pre-prolapse body. I miss it so and want it back more than almost anything in the world.
but hang in there, jsnyc, you sound like a fighter. I still believe that at some point this will take a turn for the better.
{{{hugs}}}

Hi Jsync

Christine's suggestion of latex glove is a good one. Another throwaway suggestion is a condom on the finger involved, then just chuck it. Alternatively, if you want to just use a finger, you could try washing in cold water with soap. Another thing that often works for smells is vinegar or lemon juice after or before washing. It really canes on any cuts, but both are quite acid, which will kill smells, even that of bad meat (if you want real TMI!). The cold temperature of the water is important because it keeps the pores of the skin closed, so the smell cannot get 'into the skin' before being removed.

Good luck.

Louise

Hi ATS, I have had a problem with my bladder for a long time, I sometimes leak when I get up first thing in the morning. Sometimes I only just make it to the loo. Even though kegels have helped a bit with it, I don't think I'll ever get a properly functioning bladder back again. I know how you feel, it's awful when things don't work as well as they used to. I think it helps to focus on the things that aren't too bad, for example, my cervix isn't very low either, although it's up and down a bit, overall it's pretty good. I guess when it comes down to it, I wouldn't trade my kids in for a perfect pelvic floor, ever.

This site has been a really great inspiration for a lot of women, including myself. I felt so alone and isolated when I first had prolapse problems. I was thinking surgery was the only way to go and had no idea that women were working on different ways to manage it. Anyway, hope since you wrote the above message you are feeling more positive.

Hugs,
Wendy

first i want to thank you for how you are all so tremendously supportive and helpful. i am sorry about my often angry tone, but damn i just am angry alot these days. i was never an angry person, so that in itself gets me down too!!! as some of you may remember, i was hit by a taxi when i was 7 months pregnant (last february), had to have surgery and was and am still waiting to be my normal self when this crap happened. so it has been a bad year that has completely changed my life. i am looking for a good psychotherapist (aetna insurance), if anyone wants to email me this info.

so, i know i can go through the search engine and look up maya massage and sea sponges, but i was hoping someone would give me a quick summary. (as well as where to buy the sponges). thanks for the ideas for the gloves, etc. this need to manually remove only started about a few weeks ago, and hasn't been very well thought out but usually occurs as spur of the moment need. now that i see this isn't going away..i can get smarter about this. also, i am rarely constipated, so i don't know if the laxative type cures are still a good idea for me. to tell you the honest disgusting truth, it is easier to pull out a few pellets and golf ball...then mud....TMI!
thanks again

My heart was breaking when I read your story. I am so sorry for what has happened to you. I am fairly new to this site (6 months), but I did try out the sea sponges. You can purchase them from www.jadeandpearl.com. In the comment box on the order form, make sure you tell them you are using them as a pessary (I am assuming this is what you will do). Then they will automatically send you two large sponges. Otherwise, you will get 1 large and 1 small (the small ones are usually used as tampons). I found them a little scratchy amd rough, even though I wet them as instructed. But maybe that's just me since I have gone thru menopause and everything had gotten dry. There are cleaning instructions for the sponges sent with your order. Good luck, and let us know how you make out with them.

Goldfinch

I've been using them for the hard days with relief. I'm paranoid about how long they are in and I apologize to the reefs for
my selfishness every time I use them. Here's what I've been doing - I add a healing oil after wetting the sponge and It's doing
wonders for the sensitivity. At present sesame oil is what I have on hand... Coconut oil might be nice and you wouldn't smell
like stir-fry.
Zelda

HI Anita,
I am so sorry you are having such a rough time! i've been wantin g to reply but n ot had my computer so i couldn't find my login!
first, that funny feeling inside...it may be an awareness of stools moving down. not nice, but something you just had to get used to. once i knew what it is then i've just learned to tune the feeling out and it doesn't bug me so much (most days!!!).

i think stress and trouble with BM's is so related. it's fight or flight...if you are stressed you either get an upset tummy or just can't go because you need to go fight that lion.

i think i might go start another thread on stress....i is all so interelated!!!

but hope that you figure out what hte funny feeling is and it's nothing too much!

kiki

hi there,
finally i get to reply! i'd been thinking about you, wondering how you were getting on. so sorry to hear you are having a hard time too ;-(

i really understand that desire for things to get back to normal, and just get on, and how frustrating it is. i had a very hard pregnancy and could barely walk / move, so i was really ready to be mobile again. when this happened i was doubly devastated. i'd had a horrible time, and then this???? i think it is so imp't to deal with the grieving / devastation, as it's part of the healing on every level. i do have faith things will improve, it's just about finding the way. i hope you find someone good to help you through the emotional side of the process.

re your toileting troubles. i don't know if it helps, but... i know that even though i always ate well i have found that i've really had to shift my diet. i've had to cut out ALL dairy, all chocolate, & really reduce carbs. I have to aim for about 10 servings of fruit / veg a day, eat loads of seeds, nuts, lots more pulses, & drinks tons including at night (preferably warm water). really, i should live on lentils and stir fry. then i'd be fine
i find this the hardest, as i want to indulge every now and then!!! but when i don't stick to this, everything goes awry... i don't know what you tried, but i really think diet can do a lot. if you already eat well then unfortunately it's about figuring out perfection.

also about relaxing. i imagine that if every time you have to go to the toilet you are having to deal with all this, your body is really tense (understandably!!!) which stops everything. do you every meditate, do relaxation,etc? i find relaxing everything, especially my face / jaws, really helps (your pelvis and mouth are linked). maybe that would help you? having a relaxation CD to listen to, even in the bathroom? something to stop you anticipating, to see if it helps.

i definately don't have all the answers--last week was terrible for me. but i hope that maybe one of these ideas will spark something that helps. i know it's the sharing on this site that has been crucial to my living with this.

take care,
kiki

Hugs to you Anita!
It will get better. it sounds to me like you are just having a slower curve in terms of how long you are taking to hit the bottom, before things get better. Mine appeared and hit their worst all in a matter of weeks. it was scary, but at least it was over with then. But it sounds like your POPs are taking their time to show themselves. i know a lot of people have said that when a cystocele starts improving is often when the rectocele makes itself known, so that may be what is happening. then it's about their finding their own place to settle down.

i often think of my prolapses as doing a little dance, back and forth as the day goes on. a full bladder pushes the rectocele away, and vice versa. it's their little dance.

i'm thinking of meditation as well...will go ponder for a bit and then post...

but huge hugs to you
Kiki