Newbie: Cystocele, Pessary, Bladder Infections, Kidney Pain, Bloating - I Am Conflicted

Body: 

I am unable to sleep due to pelvic pain tonight - this has been going on for the last three nights, so I am exhausted.

I have a cystocele, urethrocele, and a tiny rectocele, and use a dish pessary w/ support - have had a pessary on and off since 2004 - took a break from it from 8/28/07 to 7/23/08, but now have one again. Going without it was problematic because of the bulge and a couple of bladder infections, and kidney pain that landed me in the ER (on a weekend). I'd never had a UTI in my life until 2/2007 - but I also had a bladder infection when I was wearing the pessary. (I also had a pessary for each of my pregnancies due to a retroverted uterus- from about week 11 to week 25, but that was decades ago.) The gyn or women's physical therapist has been placing and removing it at intervals, so I don't have experience dealing with it myself.

I am wondering if I might have another UTI right now, though I am currently on a low-dose antibiotic for 90 days (today is day 30), in hopes of resolving any lingering bacteria and the risk of sepsis. I hate the idea of being on an antibiotic for any length of time, really, but I also hate the idea of surgery, especially with the documented complications. I also began using D-Mannose with CranActin on June 17th of this year.

I do not want to run to the ER tonight (it is actually 12:54 am Sunday morning), but I am wondering if this pain is a UTI, or maybe a sort of toxic shock situation due to the pessary - though I have had this one since July 23rd, and it was taken out and checked and replaced on August 5th. It sems that if it were a toxic reaction to the pessary, it would have occurred sooner. (But I am allergic to bandaids and IV tape unless it is paper tape.) I have used pessaries for up to 12 weeks from 2004 to 2007 without any problems - the gyn would remove and replace it at twelve-week intervals.

And then I also wonder if the abdominal pain and bloating could be a reaction to the low-dose antibiotic, though I had no adverse reaction or other symptoms for the first 28 days. I do take probiotics when I must use antibiotics, and also I am eating Brown Cow yogurt with live yogurt cultures daily.

So I don't quite know what to do. It seems that continued infection could force surgery because of the life-threatening risk of sepsis, and if it comes to that I will likely see Dr. Steege at UNC Chapel Hill - about 3 1/2 hours from me (unless I get directed to another skilled physician, though I'd much rather not face surgery at all). If infections are completely resolved and become a non-issue, I see that there is some specualtion that pessaries can play a role in forming a rectocele, but I must read more about that (I have a tiny rectocele now).

It seems that there is much to be learned from this site, but right now the most acute situation for me is this pelvic pain tonight - I don't want to go to an ER before morning, and would like to get some sleep as I'm very sleep-deprived. But I am concerned aout the possibilities of infection and toxic shock.

Any thoughts would be appreciated. Thanks!

Hi Christine S

You raise some big medical questions that I cannot answer. However, in your situation I would be investigating further.

You do say about the pessary that "The gyn or women's physical therapist has been placing and removing it at intervals, so I don't have experience dealing with it myself." Not sure that I would be so comfortable being dependent on somebody else to insert and remove it. I guess if you could remove it yourself you could see if it improved the pain situation. The pessary may indeed be the root of the problem, putting constant pressure on your pelvic tissues.

I guess you just gotta find out which of the many factors is causing the pain and do something about it. Has anybody done any cultures or palpation to find out where the inflammation is? I suspect you need a good diagnostician rather than thinking about surgery.

I suggest you visit www.wholewoman.com and check out the FAQ's, and learn Wholewoman posture. Many women with pelvic pain find that it does resolve after a while, once all your pelvic organs are positioned more forwards, which is one of the main effects of amending your posture.

I have had a retroverted uterus all my adult life, have had three pregnancies and vaginal births and have never worn a pessary, except for after the first pregnancy, when I wore it during the day just before and during menstruation for a few months, but abandoned it as being more trouble than it was worth.

Pessaries are way down the list for me as being helpful. I understand that there is little that doctors can offer, other than referring women for pelvic floor physiotherapy and pessaries. Just because they offer pessaries does not mean that they will necessarily be helpful or indeed risk free, especially if you cannot manage it yourself.

Wholewoman posture has been the five star solution for me for my POP's, along with careful attention to diet, clothing modifications and rethinking the way I do some tasks.

The sooner you start learning your new posture the sooner you may find some relief. Get any possible infections investigated, and the source of the pain uncovered. Good luck. Call back with progress. You have a lot of things you can do before saying that surgery is the next step.

Cheers

Louise

if you suspect
UTI
sepsis
allergy to meds

then you need medical attention. quickly.

also, of crucial importance is to make sure you can fully empty your bladder at least once a day. the cystocele/urethrocele makes it harder to do so. try getting on all fours in the shower to pee. puts the angle between the bladder and urethra closer to 'normal' (or should I say closer to its non-prolapsed angle) so its easier to fully empty.

and I agree with everything louise said. get a good diagnosis, treat any acute infections, and stick around to learn more about non surgical ways of managing prolapse.

good luck & I hope you start to feel better soon

Thank you so much for your kind help, Louise & granolamom!

After I posted, I used some vaginal bioidentical estriol cream and took a benadryl, the latter allowing me to sleep for about 4 hours (I have slept no more than about 4 hours for each of the last three nights). I have a call in to my doctor right now and am waiting for a response.

I agree that it would be a good idea for me to receive instruction on dealing with the pessary myself. You are absolutely right - I am sure I would feel more peaceful about it if I had the freedom to remove it regularly. I am also concerned about the risk of pessary use, yet I feel that I am in a catch-22 situation, because my symptoms are even worse without one, and it seems that I am quantitatively more prone to infection without one as well.

(BTW, the pessary was required during pregnancy because at 11 weeks, I suddenly was unable to pee and had to go meet my ob-gyn at the ER. The baby had grown to the point that my retroverted uterus was compressing my urethra. Over a liter of urine was drained with a catheter, and the pessary was installed to hold my uterus in the anteverted position until the baby grew large enough that the uterus could not retrovert and interfere with urination again during the pregnancy. The doctor told me at the time that most ob-gyns never see this, but that it is in the textbooks.)

I have been around this mountain before re: my present symptoms, and it is perplexing. I have had nearly identical symptoms at different times with both the pessary in and the pessary out. Bladder infections were discovered in both circumstances, but more often when the pessary was out. And I have also had these symptoms once when there was NO clinical result of infection, though it is possible that I had a subclinical infection even then. But in that instance, the symptoms resolved within 24 hours.

I do know that UTI's can lead to sepsis (and kidney involvement and damage) if left untreated, and must be addressed promptly, but it does get exhausting that this is the 4th time in 2 1/2 months (since June 17th) that I've had to be checked for this. So though it would have been more ideal to deal with it in the middle of the night, I knew I had to face it first thing in the morning anyway...

I have had cultures done, and there is also an excellent women's physical therapist in the area (one of two in the state) who has worked with me and done pelvic exams. She also performed a couple of EMG's on my pelvic muscles. After about 4 weeks with the new pessary - after being without one, the EMG results showed that the resting pelvic muscle tension was reduced from a 17 to a 5 - a vast improvement.

As far as medication allergies, I wasn't really suspecting an allergy to this particular low-dose antibiotic, but rather to the pessary material itself, since I am allergic to band-aids and IV tape that is not paper tape. But that is a rather small suspicion as I have used pessaries without problems in the past.

Antibiotics can also cause GI distress (which is not usually an allergic reaction to the med), yet with my regular use of probiotics and live yogurt cultures, it is unlikely that GI symptoms would appear after 28 days of the antibiotic usage.

I can't thank both of you enough for your encouragement, and also for the tip on position for fully emptying the bladder. I have been into complementary medicine and natural foods for more than 30 years (since my late teens), so now I will begin to learn the helpful postures and other modifications. I will be soaking up all knowledge that I can from this site.

P.S. The doctor called as I was typing this, and my husband and I are off to Patient First for a white blood count and urinalysis. The doc said to make sure that PF sends it out for culture whether it appears positive or negative, as sometimes a negative specimen will still start to divide with an identifiable organism after a few days.

sorry if I sounded overzealous, christine
I'm still reeling from a kidney infection scare I had last summer. my first uti rapidly progressed to severe kidney infection which almost landed me in the hospital. thankfully I had access to (and was able to afford, don't get me started on that issue) top notch dr's who have a full lab in their office. so they did a cbc, culture right then and there. started me on a few antibiotic injections and even called me at home every few hrs. I've never been so sick in my life.
It was weeks until I was feeling healthy again. so I get paranoid about uti's

sounds like you're really on top of things, I hope all went well today with the blood/urine culture and that you start to feel better

I am so curious about the pelvic emgs you had. I don't know much about that and find it very interesting. do you mind questions?

granolamom; I don't think you sounded overzealous at all - many people don't realize that delaying treatment for a UTI can lead to permanent kidney damage or even death.

I am so sorry to hear about how ill you were last summer. Thankfully, that is behind you, and I hope you never experience anything like it again.

That is fine to ask me any questions that you want to.

The website for the P.T. that I use, where I had the pelvic EMG's, is obgyn-physicaltherapy dot com. I work with Cora Huitt, and she has been great. Some people drive for a few hours to go to her for help, but if you are far away, it may still be worth a call to her office to see if she has info on anyone close to you doing similar things.

We just returned from Patient First and there is no acute infection, so that is ruled out, thankfully. There was just a small amount of red blood cells in my urine, but that is nothing new. The pain continues, but the urologist told me just to take more benadryl at night to try to catch up on sleep until I can be seen after the holiday tomorrow. Though I don't see the point in them seeing me, as I've been in for a similar situation last year when there was no infection - at that time the gyn did order a pelvic ultrasound which turned out to be ok. The doctors really can't do anything (except give me pain pills, which I will not take anyway), but it probably wouldn't hurt to have another pelvic ultrasound.

My goal in going to PF was just to confirm or to rule out infection - I can wait a bit to deal with the pain while trying to catch up on a little sleep tonight. :-)

thanks for the website christine
I'm not so much interested for my own prolapse, I'm happy with the way things are now, its been stabilized and has been getting progressively smaller with the posture, firebreathing, plies and nauli (love nauli!). just so curious to learn more about what they are doing. whenever women mention PT around here its usually kegels (some estim) and when I ask well, what else, I rarely get answers! maybe the therapists aren't explaining it well? don't know. in any case I plan to check out their website.

you mentioned about resting muscle tension decreasing after regular use of a pessary. what's the theory here? is high resting muscle tension indicative of something? decreasing that tension have implications for bladder control/function or prolapse? I guess what I'm trying to figure out is what's the connection between the emg results and the symptoms? and assuming that the high tension was abnormal, what would cause that to happen?

Hi Christine

Just wondering why our doctor is telling you to take Benadryl to help you catch up on sleep?

Louise

benadryl makes you sleepy
don't know if that's why christine s's dr recommended it, but it'll knock you out pretty quick. unless you're like my dd, she gets hyper from it