New to prolapse need advice

Hi Shiloh
Our stories sound almost exactly the same...I too have an 8 week old as well as a 22 month old...I am on the same journey of unknowns. I sometimes have thought I was going a little crazy trying to pinpoint and then describe what I have felt is wrong with me. (See my last post titled "37 year old...")
I am hanging onto hope as well that there will be room for improvement. I can tell you that I did feel better just over a year after having my first and then I was pregnant soon after. The cystocel is worse this time around but I hope the sensations I have are not as intense...kind of a pinching feeling, discomfort during bowel movements and a strange pressure feeling...
I will check in with you again soon...I hope that you are doing well this past couple of days.
Keira

Hi Shiloh
How are you doing? Hope are feeling okay.
I ordered Christine's book and I am awaiting more information...
Kay

Be extremely wary of doctors who tell you surgery is "needed" for this condition. They'll tell you all sorts of reasons you really should get it "fixed" while at the same time NOT telling you the failure rate of such fixes and the high complication rate. There are non-surgical ways to treat it. Unfortunately, no there is no real way to reverse it. (Although since you are still in the postpartum period I don't know if you'll see improvement til you get to your new normal.) Doing the program of exercises and lifestyle changes Christine developed is the best way I've found to maximize comfort and acceptance of the condition, and to PERHAPS arrest its progress, but once the tissues are torn and weakened, you don't really unboil the egg. Now having said that, much of Christine's program and other things can give you the sense that the condition is improved. The posture tends to keep the tissues "tucked up" perhaps a tad, the balms will make anything that hangs low feel really good, even to the point you don't pay attention to them, and so on. With menopause, the uterus shrinks and a low cervix can then actually back up a bit. This is not improvement of the prolapse, but it is an illusion of improvement. On the other hand, menopause is also a time prolapse can worsen due to the loss of hormones and their effect on supportive tissues.

Please do not think of yourself as dysfunctional. The only "disabling" thing about this condition should be that you are very careful about lifting heavy things, and you never allow yourself to strain very hard at stool. Do anything you can to avoid severe constipation, and if you get it, do anything to resolve it without straining. Urine symptoms, such as stress incontinence can be a bother but should not be disabling. By contrast, the type of bladder problems after "corrective" surgery, constant dribbling, ARE much more disabling.

The worst possible thing you could do (other than surgery) is to let this damage your sex life. Sexual activity is actually good for prolapse, in my opinion and my personal experience. Arousal and orgasm brings blood flow to the area and lubricates the tissues, and some of us have found that penile penetration actually can "tuck" stuff up a bit and make you feel less prolapse for a while - it does me. However, sex can also irritate your prolapsed tissues, especially if they dry out from being exposed to air. I highly recommend using something like Christine's balms to avoid that problem, if that is an issue for you.

But whether or not you get any physical benefit from sex, the consequences of forgoing your sex life can bring damage to your emotional health and your marriage. Prolapse is a condition that does not shorten your life, and does not (per se) give you any major disability, therefore it is important to keep all the other areas of your life as healthy as possible, because you can expect to live a full lifespan. That includes the emotional, psychological and sexual areas of your life. It is important to continue viewing yourself as NORMAL, not sick or damaged. Many women feel their genitals are now "deformed" and they withdraw from their men, or feel that they are no longer sexy. DON'T DO THIS. Men DON'T NOTICE prolapse and if they do they don't care! What men want is a happy wife who loves them and shows it physically. Any "change" they notice "down there" they will easily accept as a consequence of having given them children (unless you picked a man who doesn't love you for you, in which case sex and prolapse are the least of your problems).

I'm telling you things that probably aren't applicable to you right now, but that I foresee may become issues as you grow older, because I want you to see the road ahead, as compared to the road ahead if you get surgery. I was visiting a gynecology website yesterday that had a "question/answer" column by one of the doctors, and one of the questions was "how long does a mesh correction last?" The doctor replied something between 5 and 10 years. Wow. I applaud this doctor's honesty in not letting you assume it's a one time fix, but he also did not talk about all the people who have horrendous complications with that fix from the get go.

But my point is, even this doctor, who wants people to do it, is admitting that once you start, you're buying into a lifetime of additional corrective surgeries. What he is NOT telling you is the pain, sexual dysfunction and bladder dysfunction that will be brought on by these surgeries, all of which you do not have right now, or only to a minor degree, and will likely ALWAYS be only a minor degree.

If I were in your shoes... I would seriously consider how much I want that third child, and unless I REALLY REALLY can't live without it, I'd consider not having it. They don't really know what causes prolapse, but there is strong evidence that episiotomies and other obstetrical interventions point you down that road. There is a familial relationship (I have read one source that says women with prolapse have some defect of collagen in the pelvic tissues, so this may be an inherited component) and age is definitely a "cause" of progression of the condition (it's not really age so much as time... straining, gravity, reduction in hormones) so that even if you do not have more children your prolapse may worsen with time. But it may not. However I think if it were me, I would ere on the side of not traumatizing the canal further. This may incline you to consider a c-section for a third child, but that surgery has its own attendant risks, including damaging supportive structures for the uterus, damage to the bladder, and most importantly, instant unplanned hysterectomy! That would be a disaster for your pelvic support system; much worse than another vaginal delivery. Although the same thing can happen with vaginal delivery too in rare cases. I don't want to derail your plans to increase your family, just sharing the thoughts I would have if I were in your place.

If you definitely want that third child I would strongly recommend having as natural a childbirth as possible, going with a midwife, and avoiding episiotomy if at all possible. You can best avoid medical interventions by doing an active, drug-free birth. This would give you the least chance of further damaging your tissues but is directly opposed to what an OB/GYN will tell you. There is a direct down hill slide from the first drug all the way to C-section... it goes like this: you take the narcotic to take the "edge" off. It makes you drowsy, you tend to stay in bed. This is bad for labor, as it slows it down. Time goes on and you get irritated with the slow progress. They decide to "help it along" by giving you pitocin. This of course makes the contractions harder and more painful. You head toward transition, which is the time most women feel they "can't do it" and demand an epidural. You get the epidural. Now you're pain free and tired so you doze. You aren't actively participating in your own labor, so it does not progress like it should. When it is time to push, you do not feel the normal sensations that guide you to expel the "mass" coming through your vagina. (I use the word "mass" not to depersonalize your baby, but to illustrate the importance of the VISCERAL sensations you feel that help you complete the delivery in as harmless a way as possible for your own tissues.) You aren't allowed - nor does it even occur to you - to stand, squat, or be on all fours, all ways to avoid damaging the perineum and to hurry along the birth. Being in danger of legal liability until a healthy child is produced, the OB feels the time pressure and starts suggesting things like vacuum extraction or forceps, and you end up with a big episiotomy. Or, they start seeing stuff with the baby's heartrate that they don't like, and you're whisked off to have a C-secion. Unfortunately this scenario has become de rigeur for childbirth in the Western world. But this, more than anything except perhaps genetic tendency, contributes to pelvic floor prolapse.

Hi Anne

So glad you have done a couple of posts. It is good to see you back. How ya going? Many of the newbies won't have read your story from way back. Feel like doing a little synopsis for them? It is really hard on these Forums to search a particular member's posts and find the first post so you can see how they started.

I wrote my story for a Member who emailed me the other day. It was an interesting and very long exercise, but at least I have it all written down now. The beginning was so long ago, and I hope I can iron out some of the time sequences as I remember more bits over the next few days. I am teetering on the edge of menopause at the moment and my memory is never good, but it is like fishnet stockings with holes as well, at the moment. Very frustrating.

There is a lot of meat in this post you have just done and some very sound advice for Shiloh. The more different experienced voices newbies hear the better, as far as I can see, as they sure aren't going to hear these voices on other sites!

I would, however, like to pick up on the point you made about risking an unplanned, instant hysterectomy by choosing caesarian section. I'm *very anti* elective hysterectomy, being a natural active birth promoter from way back, and still am. I am wondering what you are referring to when you warn Shiloh of this possibility? Is there something horrible I have missed about the risks of CS? What is the incidence of this, as far as you know? I imagine it would be different in different countries. You are from Canada, aren't you?

I only recently found out that my aunt, who is now 88, had an instant, and as far as I know, unplanned hysterectomy as a result of a vaginal birth back in 1963, when her uterus came out of her birth canal when her third child was born. She had an hysterectomy straight away. That's all I know. I must catch up with her and find out more, as she now has, and has had for some time, "terrible bladder problems", according to her daughter. This practice may still be done, for all I know. I haven't looked on any of the surgery sites to see, and quite honestly, these other sites give me the creeps, so I rarely go there. But we have had at least one woman on these Forums who has had the uterus come out of the vagina at birth, but it has been put back in and, after a while, in the normal postpartum way, enough healing and recovery has happened for the woman to be able to live with the remaining prolapse. Talk about a close escape!

If the Member concerned is reading this, could you please post about it under a new topic which has "hysterectomy at birth" or something identifiable like that as the subject, so we can find it, and other Members will be able to search for it easily??

Anne, we have also had a Member recently asking about bicycle riding. Weren't you a part of that discussion a couple of years ago? And you do horseriding as well, don't you? You were also studying Chinese medicine or acupuncture?

Hope you will post back with answers to these questions. I am going to start another topic for personal stories in a minute, so we have somewhere to put them where they can be found.

Cheers

Louise

Great to hear from you again, Anne. I guess I feel a little more hopeful regarding post-prolapse pregnancy and delivery. I SO wish we still had those early posts of Jane’s when she and I would speculate on how her gentle delivery-with-prolapse would go. We even imagined the possibility of a very natural birth correcting her cystocele/rectocele! In reality her prolapse wasn’t improved by the birth, but she was certainly no worse for wear and in the following months became better than she had been in years. Granolamom has told us much the same thing.

As for us, I’m greatly anticipating the first generation of firebreathing crones to see just how we fair in our golden years. There is more to come in the WW pipeline and I feel certain most of us will be able to mitigate the physiologic slings and arrows brought about by the loss of our youth. I, for one, have plenty of data that my hormonal oasis is dry as a bone, yet my prolapse is better than ever.

Glad you love the balms! C.

Hi Louise, no I am in the U.S., not from Canada and it isn't me that talked about riding; you must be mixing me up with someone else.

Anyway, I am referring to the risk of unplanned hysterectomy as one of the complications of C-section. Just like with vaginal deliveries, a hysterectomy may be done if the uterus fails to contract and hence fails to stop bleeding. This is a life threatening emergency. If the placenta fails to separate from the uterine wall a hysterectomy may be necessary. These complications occur more frequently with C-sections than with vaginal deliveries. Especially with planned C-sections, where the incidence is three times that of planned vaginal births, according to a study done last year. The study found the incidence of "severe complications" to be 27 per 1000 for C-section as compared to 9 per 1000 for vaginal delivery. This includes all complications, not just hysterectomy; I don't know how many of those were hysterectomies but the other complications - cardiac arrest, hemorrhage, bacterial infections - are also not things you want. So to schedule a C-section to avoid traumatizing the vaginal canal is to put yourself at three times greater risk of all of these complications, some of which can kill you, and the removal of the uterus of which will almost certainly worsen your POP. It just doesn't seem like a really good idea to me to take the greater risk on the gamble that I might "spare" myself further prolapse by passing the baby through the natural way.

Christine, I am convinced that a truly gentle, natural delivery would do minimal damage, and most women with prolapse would do fine. The problem is, that unless you have an unattended home birth, it is very difficult to achieve a TRUE natural delivery. You cannot even depend on using a midwife as a guarantee of an intervention-free delivery. You have to find the right midwife, and she is often outside the law. Even when you do find midwives who claim to deliver naturally, it's difficult to assess how they are going to actually perform when the moment of truth is at hand. And even if you do find her, and escape the risks of hospital birth, you must accept a certain risk of something going wrong, and you're not in the hospital and must transport. It takes a very centered, independent, libertarian-minded woman or couple to do this, and with all due respect, most women simply ARE NOT THERE. They are WAY too programmed and pampered by our modern lifestyle and enmeshed in our medical establishment to even consider such a thing; it is as alien and unthinkable to them as using an outhouse. Sadly, I have to count myself among them; I chickened out of the home birth with the "illegal" midwife; went the route of "decorated-like-home labor/delivery suite" with the Certified Nurse Midwife, and ended up with the episiotomy that tilted me over the hill toward prolapse.

Hi Anne

Thanks for that info. I did not know that, but it makes good sense. I guess I have always steered away from detailed info about risks from CS delivery, as it is a no-brainer. I needed no convincing to avoid CS.

Yes, your episiotomy may have been a major cause of your prolapse, as with many of usbut there are also a lot of other factors in maintaining or damaging fascial integrity. Hope you are going OK with your POP's these days.

Cheers

Louise

Well anyone with common sense knows that major abdominal surgery is going to carry more risk than any natural process humans have been doing for millions of years. You don't need to know the gory details to be right about that!

Yes I am doing great with my POPs. Since I had the big "worsening" a few years ago, and the resulting debate with my doctor about corrective surgery, I have remained stable. I still use the pessary at times, but mostly not. Quite frankly, we have sex too often to be worth all the putting in and taking out. ;-) I'm completely adjusted emotionally to the point I don't even think about it much. In fact, that's why I hardly ever come here anymore, I just never think about it. It's there... SO WHAT?? There are much worse things I could have that I don't... I focus on being grateful for that. What's a little bulge between my legs?? It's not like I have to deal with a colostomy or being in a wheelchair. I am SO grateful for what problems I DON'T have... Life is GREAT!

Anne

Hi all, I'm pretty new here and have been enjoying absorbing all your sage advice. Thanks for sharing your stories and helping all of us newbies out of our panics and into a more I-can-live-wth-this attitude!

I just wanted to comment on the birthing options. I had 2 very natural home waterbirths with basically no help other than emotional support. My midwife didn't even make it for the 2nd one because it was so fast. But I prolapsed too. I would still wholeheartedly recommend this form of birthing, simply because it's AMAZING!! My first was gentle and magical (5hrs). My last was more like birthing a freight train (2hrs). My water didn't break until she was crowning, and I'm sure the next srange pop I felt was my cystacele happening.

I've decided that I'm probably not going to opt for the third child that i'd wanted to have, partially also because I get blood clots in my legs too which leave large bruises in their wake. So between bruised legs, stretch marks, saggy boobs, and a vagina that seems to be falling out...well, this mom feels I've given enough to the cause. :) Thank god we can still laugh, even if it is with our legs crossed!

Shiloh, I'm in your boat too. I'm 32 and have a 3 1/2yr old boy and a 2 1/2 mo old girl. We can do this thing. Breathe sweet mama. Our amazing womens bodies will prolly fix themselves up somewhat. I hope. But in any case, look what we accomplished...we MADE beautiful people!!!!! Wow to us!

I hear ya with the 2 hour labor; that was my second too. There is "conventional wisdom" that precipitous labor is a cause of prolapse but I don't know if there is hard evidence to back that up or its just an old wive's tale. In any case, your births sound so awesome...

my second birth started with my water breaking. I felt a distinct 'pop!'
with my third, the water didn't break until he was crowning, I felt that same 'pop'. same with number four, water broke with a 'pop!' at crowning.
I missed it completely with my first, actually have no idea when my water broke with that one. for all I know the ob did it for me @@

I am so glad to hear about your births. Sometimes I think we women on our way to figure out WHY this happened to us like to put the blame right on ourselves. I know I will always blame my extensive tearing during my first birth for my rectocele that I found after my third birth. But hey- maybe it just happened. I tore. Now I have prolapse. But maybe it was already there during my first pregnancy. Who knows.

The choice to have another baby or not is so personal. Many factors play in to the decision. For me I just know my heart and I know we will add to our family. And I would never ever let my prolapse make the decision for me. I might let it seal the deal if I was already leaning towards not having any more children- but in no way would prolapse change my mind. It might make me wait a little longer than I'd like to to get pregnant again. Maybe influence my birth plan and what I do postpartum but not to have or not to have another baby.
Fear is a great motivator. I refuse to make decisions in my life based on what bad thing might happen.

Please give yourselves a year or two before even thinking about having another baby. So much changes in a year.

Well, you know, shiloh, I was feeling some strange feelings postpartum after my last birth. I was never sure if they went away from being postpartum longer or if I just got used to them, but now as I really feel and think, I am sure it was a matter of getting more postpartum. I would say, Give it time. 8 weeks is so just postpartum still. Your hormones that soften tissues and such are finally working out of your body completely and you are coming out of such a transition time with breastfeeding and healing. Hopefully, you are still taking it easy.

I don't have any advice and am still trying to figure out my own POP picture, but I wanted to offer that you are still early postpartum. At the point you are at, I was still feeling heavy vaginal pressure by the end of a busy day, an unusual bulge that lasted a while after a BM, and strange outward pressure in my vagina when I picked up my older toddler. The first two sypmtoms are way long since gone. The third occasionally creeps up, only as I am coming out of Lactational Ammenoriah at 18 months postpartum. I can't say why, other than possibly the changing hormones again, but this sensation when pressure is on my abdomen is returning.

Essentially, I'd advise that you find calming activities and peace-giving exercise that respects this tender healing time of still being newly postpartum. Just think how long it takes for some people to lose pregnancy weight. Healing is gradual, as well as hormone changes. Only after 6 weeks does breastfeeding hormone finally balance out to have the breasts meet the demand of the baby, not too much, not too little. The body is so smart, we just have to deliberately seek peace and have patience.

Take care. (((hugs)))

Ooooh. I almost got myself to not comment about the third child thing. Oh well. Have that next baby, Shiloh. My life is so totally enriched from my third child, whom I would not trade for the most thrilling vaginal health in the world, and my fourth baby has been even more joyful as my heart has grown and opened. The suffering and challenge we have in bringing these babies here does add depth to our soul if we open our hearts. I am not speaking from a martyr-mindset, but a finding-joy-in-the-journey-mindset. Read Pema Chodran, Hidden Places that Scare You or other such books and relish in the full experience of life. (thank goodness for ups as well as downs.)

Oh, and I enjoyed the birth info by AnneH. I agree pretty well down the line. I'll always side with the natural approach to birthing practices, where possible. I liked my UCs! (but that's another forum ;)

I just want to clarify I wasn't saying to Shiloh that she shouldn't have another babe. Babes are great!! I was merely saying that I think I'm done. Who knows? It's not like I planned either of my other children either! :))

Shiloh -

I haven't been on this forum much because it's been so busy at school. Just read your post about another child. Just want you to know that from an older woman's point of view several years later, the third and the fourth children were the best thing I ever did. Giving life is the most remarkable thing we do in our lives. My third and fourth children are the most remarkable people I know. Don't hesitate to bring life into the world. Your only regret will be not doing so.

Judy

whatever anyone decides about having more babies is one thing, I'd just recommend not to decide against it because of a newly developed prolapse. wait a year before saying never, and when you've got confidence in your body's ability to handle it without falling apart, you'll be able to make a decision without fear.
that's my $.02