Repliform graft results

Hi Saddleup

I like the last sentence Saddleup. I would think you cannot go wrong by giving WW techniques a 6 month trial. You can always go back to surgery as another option, but once you have had the surgery going back to WW techniques will be more difficult, and may not be as effective because the natural structure has been altered.

I can see that you are doubtful about the Repliform surgery option, and rightly so, as the risks and complications of pelvic repair surgery are variable and can be devastating if it all goes pear-shaped.

Having said that, I know zero about the procedure you are referring to, but have done some googling. Amongst the results I found on a search for "Repliform graft" was a glowing report from a gynecologist which gave me the impression that he had done this procedure for 12 years. He may have been doing anterior repairs for 12 years, but Repliform did not exist 12 years ago. It was only launched by Boston Scientific and Lifecell Corporation, its developers, initially in 1999, and the full launch in 2000, according to http://www.123jump.com/10K_Reports/LIFC/2000/2000.htm . The moral of this story is that the truth can be used selectively to give potential patients a (false) sense of security. You will have to do a lot of digging to find out how many of these procedures your gyn has actually done, and how they measure the effectiveness of the procedure.

I personally think that if no changes are made to the way the woman 'wears' her bladder, ie if she still carries it hanging back over the pelvic floor after the op, the fascia is likely to break down again because intraabdominal forces will continue to push the bladder back and down, and while the graft may not give way, (statistically) the fascia is still likely to break down again, maybe in another spot, resulting in further prolapse. Five years only is the extent of 'longterm' results, because 5 years is regarded as 'longterm' medically, and it is very difficult both in practice and financially to monitor patients for longer periods.

In addition to that a Repliform graft is still the same surgical procedure as any anterior repair, and the risks from the surgical cutting and suturing will still be the same, regardless of the material used in the graft. The vagina will remain scarred, and as all sewers know, it is very difficult to put a patch on irregularly torn, 2 dimensional lycra that does not cause the fabric to pull in some spots when under pressure, espsecially if the fabric used for patching is not *identical* in structure to the fabric being repaired.

These surgeons are trying to patch a fabric that is far less resilient than lycra, with a patch that is different fabric, and three (not two) dimensional, where they cannot lay the fabric out flat on the area to be repaired, and are unsure of the integrity of the material to be repaired.

The stories you will read on these Forums from women who have decided not to have surgical repairs will tell you how well we manage, and lead full lives with a few changes in how we do things 24/7. It is not always smooth sailing, and we do have short term hiccups to deal with from time to time, but making a return to natural female posture sets in train an immediate change in the way intraabdominal forces are exerted on our pelvic area and moves the organs out of the line of fire, so to speak. The positive changes continue for years. I have been doing this for nearly four years (I just recalculated), and am more continent and less bulgey than I was when I started. In my opinion, my fascia are remodelling themselves back to where they should have been all along, and are no longer subject to abnormally-directed intraabdominal forces that caused prolapses int he first place.

I can only encourage you to give it a go. You have nothing to lose, and a lot to gain. Call back with further questions and tell us how you are progressing. Together, all the members of WW Forums have the experiences under our belts (haha!)to help you through almost anything prolapsewise.

Horseriding? Who knows. Everyone is different. It is a continual process, challenging your body (and brain) to do old things in new ways. You may eventually be able to do it again, but maybe not competitive, strenuous versions of riding where any injured body parts are inevitably put under stress. The degree to which you can adapt your riding posture will be one of the main factors.

Cheers

Louise

I'm one of the forum pessary "success stories" so I have to suggest you try a pessary. It may allow you to go back to horseback riding. The only downside to mine is that I do tend to leak urine a bit more when i wear it, so I wear a pad. But that is not any worse than wearing a backup pad during periods, if you can ride using that there is no reason you shouldn't be able to ride using a pessary. I'm assuming the riding irritated the tissue that was protruding. Also, do try Christine's balms. They are SUPER for soothing that tissue.

My concern about your surgeon and this great new material is that it doesn't really matter HOW they hold up the bladder, just the fact that they hold it up tends to leave room for the uterus to descend, or for the posterior wall to collapse. If pelvic organ prolapse is a disorder of supporting tissues, then other tissues besides your bladder may already be weakened. Rearranging things in there to support one area may put more stress on another area and cause it to "fail".

If you do decide to try a pessary, beware that your doctor may not really be good at fitting them. They may give you one, it doesn't work out, and you think "pessaries aren't for me" when in reality, fitting a pessary can be an art, and it takes someone who knows what they are doing or is agreeable to letting you try several types and/or sizes. Don't think that because one doesn't work, none will.

Is the esteemed doctor a horsewoman? Or even a horseman? I would think that riding position, posture and saddle design would have more effect than motion and impact. Sure, a sitting trot might be an irritant, but who does a sitting trot for fun??? Part of riding is getting the motion in harmony with the horse, isn't it? There is nothing that feels so good as a comfortable canter!

I have not done a lot of riding, esp since having babies, but my experience is that riding is a lot about using your legs, and all those pelvic stability muscles, which has to be very good for POP. I cannot see why it is not possible to ride comfortably, given the right saddle which supports the right posture.

Straddling a stool is one of Christine's favourite ways to sit. How much difference is there really between stool and horse, except for the cost of upkeep and the nature of the waste products?

It may be that 'good' riding posture might not be 'good' POP posture, but is that because saddles are designed for the male butt, and it looks cool to have your pelvis tilted back? This may work for men, but perhaps not for women? Perhaps a woman riding in WW posture would be deemed to appear 'really stupid', but only because it hasn't been established as a 'good-looking' posture by the purists. Surely good riding posture has to be about comfort and wellbeing for rider and horse, not what looks best in the show ring competitions?

I don't know a lot about this. Riders, your comments on saddles and riding styles and postures, please?

Cheers

Louise

Wow. Well, that's a doctor's opinion, unsupported by scientifically controlled peer reviewed studies I'm sure. If a doctor told me that I would smile and say "thank you" and then go ride my horse.

Hmm, I had a psychiatrist tell me yesterday to go on HRT, and proceeded to tell me about his personal experience with testosterone HRT, and told me that "oestrogen isn't just about reproduction you know!" He also told me another interesting fact. He told me that "you can plant based oestrogens if you don't like the idea of the normal sort". Where does he think I've been hiding?????

At this point I am thinking that I hoped he knew more about psychiatry than he did about women's health. It really undermined his cred as a psychiatrist in my eyes.

I really wish they would stick to advising on stuff they know about, and not chatter about stuff that the patient could know more about than they do. Otherwise how are we to discriminate what to listen to, and what is BS.

Go for it, Saddleup, once you have got your posture organised. Once you get to know that body of yours a bit better you *will* be better equipped than anybody to know its limits. I really think a lot of doctors' advice is fear-based, and is just watching their own back, which they probably have to do to avoid malpractice suits. If we did everything doctors advised us we would all be in cots, wrapped in cotton wool. Now that is not my idea of getting better!

I am not saying he is wrong, and that you will be able to keep on riding as before and go further. I am saying that once you have learned WW techniques properly you will be able to feel your way knowledgeably and you will know how far you can go, just by trial and error. And you may indeed be able to go further than you have before, confidently knowing how to do it.

Cheers

Louise

I have been riding since prolapse. I can honestly say that a day of riding did nothing more than a day of anything else strenuous. It was very uncomfortable to trot- and finding my posture in a western saddle was also rough- because the posture drove my pubic bone right into the hard front part of the saddle- but once I figured it out (for me this was to slightly contract my thighs and butt and scoot back in the saddle) I was pretty good to go. Look if you are serious about this thing then start with a saddle modification- find the best most comfortable way to sit in WW posture and then modify your saddle. Also I know this might sound silly to some but a larger horse might work better- wider spread to the legs.....

Just as I thought. Thanks Alemama. We have discussed horseriding before, but I cannot remember any women who had actually made it work for them with prolapse.

Western saddles look so comfortable, and they probably are if you are male-shaped and like sitting in a kind of big ol' loungechair thing. I am sure Saddleup could do better, as there are so many styles of horseriding, and as you say, so many different shapes of horse. Actually, there are a lot of different shaped horseriders butts too!

It is another example of working out how you can do the things you love doing, and not be held back from exploring the possibilities by somebody else's externally applied limitations.

Good luck Saddleup. Are there any other riders out there who could add their experiences?

Louise