my rectocele, my cystocele and me

I am glad you found the forum and are getting into the posture. I bet you will see some improvement in your cystocele now that you are changing your posture! Just wanted to say welcome and I do wish you the best with your surgery!!

mzimm

You are absolutely right, Nordic31, this is a wonderful forum, and there are others that have been here for years, always trying to give you positives. You will see!

I am fairly new myself, so all that I can say is I wish you all the best in recovering from what ever lies ahead of you.

Lots of hugs for you,

Oceanblue

p.s. have you got Christine's book, or dvd? I find them both to be very helpful. Also, if you go to youtube and search for 'first aid for prolapse' you may see Christine talk and share some of her exercises. I am forever grateful.

Hi Nordic

You have had a very unpleasant series of experiences and have come out of it with a wonderful positive attitude. Sounds like you did not have any infection issues with the repair surgery, which is very good news. Let's hope it is a successful repair.

Just for the record, exactly what did the surgeon do? Did he just repair the sphincter, or did he do some surgery in the posteror vaginal wall area as well?

Your experience will be very useful for other women experiencing the same episiotomy complication. Please keep us posted with your progress. There is no TMI here.

You may have been told that it is an unusual type of vaginal tear. We have had a few women turn up here with it, and I have a personal friend who had it when she birthed her first baby. Coincidence? Episiotomy is a twin-edged sword, because the initial cutting often deepens with further tearing. Your Ob may have cut deeper to reduce the risk of further tearing. Go figure!

Now we know from our Members that deep vaginal tears are not necessarily the end of the world, I don't think I would be keen to have one. I had one with my first, which was a fully managed labour for pre-eclampsia. I was totally immobilised by the epidural I had to have, and I could not push at all, so forceps were used. I am sure I was given the epi so they could get the forceps in, not so they could get the baby out! What a disappointing nightmare it was, with a cascade of one medical/surgical intervention causing the next.

I will never know if the pre-eclampsia would have damaged my or my baby. I will never know what would have happened had I declined the epi. Would it have hurt the baby because they couldn't get the forceps in properly? Would they have been able to get him out? All unanswered questions, but both of us came out of the experience very much alive and well, and for that I am grateful. He is now 27 years old. Time heals. My souvenir was POP!

BTW, Wholewoman is only against surgery because so much of it is totally unnecessary and so many women are not told all the possible risks and complications, let alone that they will probably need further surgery as the initial repairs often fail or cause other POP. Also, these procedures change the way our pelvic structures support our organs. This sets up a woman to suffer further prolapse because she is unable to protect her own organs by moving them forward. That sound reasonable?

Re coughing, it seems to be instinctive to bend over, and tuck the butt in, but it will be better for you if you can cough in WW posture, even if you bend over from the hips with your butt sticking out, your tummy loose and your knees bent a bit. The reason is that when the pelvic organs are further forward and pinned there by the sacrum, they are protected from the force of the cough. When you are bent over from the hips gravity is acting through your abdominal wall, keeping your organs against the front abdominal wall and out of the way, and the pressure of the cough will be less likely to push them uphill into the vagina. Jusst hunching over with your butt tucked in is the worst position because it is the position we instinctively use for birthing a baby or having a BM, perfect for letting things out but useless for keeping things in!

Cheers

Louise

Hi Nordic31,

So glad you posted, although our experience with these sorts of injuries and repairs is very limited. I did a literature review on the subject a few years ago, which you can read here:

http://www.wholewoman.com/forum/node/1242

It would also be good to read the account of a real woman with the sequential loss of her sphincter muscles.

This is not to frighten you, but to alert you to the fact that the sphincter muscles do not lend themselves well to surgical repair. From my review, it seems clear that colorectal surgeons often ask women if they can live with their symptoms because there is no guarantee that the post-surgical result will be any better.

Taking the pressure off that area by learning to live in WW posture may make a difference in sphincter control as well.

Wishing you well,

Christine

welcome to the forums nordic31. What type of repair are you going to have? Is it a perineoplasty? Which sphincter did you tear through?

Hi Nordic

You might find this post of mine confronting to your way of thinking. It will probably challenge some of your beliefs, and hidden thoughts and feelings. I apologise in advance if I have misunderstood your or if you are offended by it, but I have to say what I have to say. Read on.

I hear you saying that you trust your doctor very much. I am *not' saying you should not trust him. Trusting a surgeon is the only way we can mentally survive the prospect of a person putting us to sleep, and cutting and sewing a repair to the anal sphincter. When you say, "I feel better when I trust him", I can hear you saying that you are not happy about the prospect of surgery and you feel kind of pushed into it as the only option, and that trusting him is the only way you can cope with being 'pushed into a corner' like this.

I realise that this is a 'defined obstetric injury', a term that I think the doctor has used to differentiate between medical reasons for reconstructing the vagina, rather than cosmetic, vanity reasons. There are health insurance implications in the term that is used. Doctors tend to be rather cut and dried about the terms they use. They may strongly recommend surgery that is only slightly better for the patient in the longer term than the alternative of not doing it (in spite of the pain, scarring and post-surgical recovery, etc that you will endure, maybe chronically). His reasons may be masculine 'engineering' reasons, ie get the inner anal sphincter sewn up so it can close again. He wants to fix you, which is laudable. However, your reasons may be to have your vagina made whole again, and more useable, for the next 60 years, and for the rectocele to disappear.

That's why I am interested in exactly what the surgeon is planning, because your most recent post still did not specify. You *need* to know exactly what he is planning to repair, and how he plans to do it. You *need* to do more than just trust him. By booking the unspecified surgery in two weeks you have just absolved yourself of your responsibility to your own body that will carry you around for the next 50 or 60 years. You have handed the problem over to him. You will have to live with the results of what he does. You will have no choices at all after the surgery, when you cannot go back, no matter how hard you try.

Read "The Two Doors" under the "Readers Write" link on the main homepage. If you have given informed consent to this surgical repair, then I strongly suggest that you are *fully* informed about what you have given consent to, and that you withdraw than consent for now, until you are fully informed, and have had all your questions answered, some of which you may not have even thought to ask because you don't know what he is going to do.

Once you know what he is going to do in there you will be able to ask him about all the things that can go wrong, and ways in which your body may be changed, including sexually, scarring and possibilty of chronic pain. You will be able to ask him what he means by 90% success. Is it that the anal sphincter will stay joined up? For the next year? For the next 5 years? Is it that you will have better flatus control, which you have not mentioned? Is it that your rectocele will disappear and not come back for 6 months? A year? 5 years? 90% success can mean many different things to different people. What do you think 90% success means?? You two need to discuss this.

You can read in Saving the Wholewoman very clear, and well-referenced descriptions of all the repair procedures (except perhaps the anal sphincter part) that involve the vagina, complete with the incidence of things that can go wrong as a result of the repair.

You said you are having some good days. I would strongly suggest that you put the surgery off for at least 12 months so you can do your homework and get to fully understand how your pelvic region works and how much it is tied up to other parts of your body.

Firstly, allow your body to fully revert post-pregnancy and birth. This reversion will go on for at least another 6 months, maybe another 18 months, then several years of fine-tuning after that. You have only just come through the worsts bit in the last few weeks. It is hopefully all improvement from now on, even though you will, like all of us, experience temporary setbacks.

Secondly I would strongly suggest that you put surgery off for another 12 months to allow your body to get used to WW posture, diet, clothing and adjust the way you use your body in its working environment. It can take a year or so before it becomes second nature, and the longer term changes seem to kick in. It is something you implement 24/7. It is not something that you do a few times a day.

If, at the end of another 12 months, you still want to have surgery, you will certainly be well informed, your body will have done its major healing, you will have allowed your body to do what it can to manage it, and you will be able to go ahead, knowing that you can really trust the surgeon to do what you have consented to.

On the other hand you may decide to give it another 12 months.

I have probably given you a lot to think about. There is no hurry for you to rush off through that surgical door. Chill, and think clearly before you turn the handle, walk through and close the door behind you, for it doesn't have a handle on the inside.

Take care, and call back.

Louise

Hi Nordic

Firstly, I just went back to your initial post, where you asked if anybody has experienced an undetected damage to the internal anal sphincter. Nobody has responded, but I feel sure that there are women amongst us who have experienced this, even if it was from a tear, rather than a straight surgical cut. So keep looking. Hopefully somebody will pop up.

Secondly, I put myself in your position. I don't yet know what benefit I could get from Wholewoman posture because I haven't tried it over a period of several months, and I am only seven months postpartum, so my body is nowhere near finished reverting after pregnancy. I trust a surgeon I have not met, on the heresay of my doctor, and I have not discussed the procedure with the surgeon. I still do not know what "90% success" means (and I still trust this surgeon).

Nordic, knowing what I know now about how the body reverts after pregnancy, and how far my body has come in the last five years of Wholewoman work, I now cringe at the thought that I could so easily have trusted the gynaecologist I visited to get my diagnosis, had I not found Wholewoman a few weeks before the appointment with him.

This is why I have posted again, because if I was in your position I would have been very grateful if a woman who had experienced enormous and continued improvement had continued to post replies that attempted to show me how I was not thinking straight, and needed to take the time to allow my postpartum body to complete its reversion before assessing the remaining symptoms, and to give Wholewoman techniques a fair trial, before embarking on surgical repairs that have by your own admission require moderate expectation of significant success in the longer term and will leave more scar tissue in the vagina and have a fair chance of resulting in further prolapse as a result of the removal of tissue producing uneven stresses on the remaining repaired fascia.

I can see that you are not collecting the information that you require to make a rational decision. I can see that you want to go ahead forthwith, and get it over and done with (so you don't have the prospect of surgery hanging over your head any more). You have said you are scared about having the surgery. That is not a sign that you are prepared fully for it. I just want you to get answers to these questions. Once you have the answers you can assess what you need to do. This is not something for you to hurry into. It will take time.

What is the hurry??????

Sorry if you feel that I am harassing you. I would want to be harassed if I was about to do what you are about to do.

Women with damaged internal anal sphincter, where are you???

Louise

Hi Nordic,
Is it your EXTERNAL sphincter that was damaged? I didn't think it was possible to have internal sphincter damage without external sphincter damage as well. I, too, had an undiscovered vaginal tear after the birth of my daughter 16 months ago. I'm thinking it may have extended into my external anal sphincter. My doctors are pretty sure my internal sphincter is intact. By the time I saw the doctor after the birth, my vaginal lining had healed so now they said the only way to be sure that I have sphincter damage is by performing an anal ultrasound. Did you have an ultrasound? How do they know that you have the damage? Are you able to tell when you examine yourself? You should do some reading on the effectiveness of delayed sphincter repairs. I see some really well known urogynecologists and they said that a repair is absolutely not an option for me. They said that they may end up doing more harm than good. If it really is your INTERNAL sphincter that was torn, that may be a different story...but it seems to me that if your internal sphinter was badly damaged you would be experiencing severe incontinence now. External sphincter damage does not always mean that you will suffer from incontinence.
I'm glad that you found this site...please keep us updated! This is such a hard thing to be dealing with and I know you just want to feel better!
kath333

first, let me say that I know very little about sphincter tears, but it sounds awful.

I have pretty significant perineal tears that were never stitched. maybe they should have been at the time, but no one seemed to notice them, and even though I thought I was all torn up it didn't occur to me that I needed stitches or that it was as bad as it is.

as this point, I wouldn't go in and attempt to fix it even though it is obviously 'broken' and I believe that my tears limit my ability to reverse my prolapses. I would rather work with what I know I have rather than risk more scar tissue. scar tissue is not always predictable. you can end up with weak scars which split open or contracted scars which tighten up more than you expected causing pain upon intercourse. not willing to risk good sex for a 'fixed' perineum.
fixing whats broken is one way to look at it
I see it as well, its working good enough, why mess with it?
but again, each person has their own set of issues. If I were leaking stool I'm sure I'd feel differently. we all have to weigh our problems against risk of fixing those problems.

Hey Nordic- what exactly are you dealing with symptom wise? I tore my external anal sphincter and it healed back very well- Internal tears are very easy to find- you can check yourself- and I would never trust someone to tell me something I could check on my own- (especially when they offer surgery).
a quick google search will pull up a ton of documents (try 4th degree tears midwife) with illustrations.
you have a rectocele- how do you know when they go in to repair the tear that that is the only procedure they plan to do- will they go on and do a perineoplasty? will they try to repair the rectocele? These are all questions you NEED to have the answers for.
I know this is a bit annoying- but I will guarantee you that if you choose to go forward with the surgery after thinking of all these different questions and seeking answers to them - then you will be going forward with informed consent. Which is the most important aspect of all.

as to your question about not sewing back the tear inside the mouth-
what would you do if I told you that everytime you ate it would hurt at the repair site? Right now you have no pain and can eat easily- you just don't like how it looks. This is what can happen in the vagina- you could be in pain every time you have sex. For me it isn't worth it.

Hi Nordic,

The core of the problem is, you never should have been so terribly injured in the first place. Many of the arguments over women’s pelvic floor health tend to be invalid because we are arguing over “downstream” issues. There are huge arguments put forth by proponents of c-section for all women to avoid maternal injury. Never mind the fact that serious vaginal tears are a rarity in the home birth population.

Some women have reported improvement in certain symptoms following repair of a prior episiotomy and we do not want to discount that.

There does not exist a General Manual of Gynecologic Surgery that makes the distinction between beneficial surgeries and those that are unequivocally damaging. To answer your question, let’s say a revision of an episiotomy is in the beneficial category, even though the literature states that it is extremely difficult to locate and repair vaginal sphincter muscles that have long-since retracted and disintegrated. Suturing together the pelvic floor muscles, which happens when the surgeon goes higher and deeper into the back vaginal wall, not only can destroy the muscle tissue but is also suspected of causing a particular tightening and spasming in that area.

I believe I would’ve wanted my (2) episiotomies sutured, for sure. But that doesn’t discount the fact that even with “proper” repairs in my twenties I have very little perineum left. The vaginal sphincter muscles are simply gone in that area. I believe it is as difficult to repair the vaginal muscles as the muscles of the anus, but the implications are far more grave in the latter.

Interestingly, this never interfered much with intercourse. Alemama and Granolamom have the same experience. It is really the pelvic floor muscles that provide the friction necessary to hold a penis. They know that and that is why they caution for preservation of these muscles. Changing the shape of the pelvic floor muscles through this postural work (instead of kegels!) may lead to the vaginal tightening you are looking for. I do believe that an uncut vagina is much more conducive to achieving orgasm, because the legs of the clitoris actually wrap all the way around the vaginal opening. The diminishing of sexual experience through episiotomy is a terrible shame, but not something that is recoverable.

The problems with rectocele repair are many and varied. Vaginal axis - or direction of gravitational pull - is of primary importance in pelvic organ support. Your surgeon is planning to remove a triangular wedge from your back vaginal wall. Given what we know about the dynamics of vaginal support, it is likely that this tightening will pull your front wall - and with it your bladder - toward the back. We have heard many times on these forums from women who have had just this experience. A prolapsed back vaginal wall supports the front vaginal wall.

Your pelvic fascia and vaginal wall will be thinner - like the surface of a stretched balloon, which seems to make the tissue far less supportive. The preposterous idea of scar tissue from these repairs somehow creating more support has been refuted over and over. This is why vaginal mesh implants are such big business - because conventional rectocele repairs do not work. Maybe you will be one of the lucky ones and have improvement with no new problems. But we simply cannot discount what the medical literature itself says about the extremely poor success rates of posterior colporrhaphy.

Who knows why your surgeon is not telling you these things. Who knows why you do not seem to want to hear them from us.

No one knows more than this population of women how desperate the desire to be fixed can be. Yet, Whole Woman is all about informing the world of women, and their care takers, that there is no surgical cure for these disorders. We have been led like sheep to slaughter to believe that they are curable when in fact they are not. Some symptoms may improve, while others may worsen. And by far, the most tragically disabled women are the ones who have had the most surgical procedures.

The human female body’s capacity for compensating for serious perineal injury is astonishing. That is what so many of us have done. However, let there be no doubt that there is no substitute for wholeness and it is simply inexcusable that women are still subjected to obstetric practices that place them at risk of losing precious and irretrievable vaginal and anal sphincter function. That is the primary issue here.

Please know that we wish you well, Nordic.

Christine

Hi Nordic,
You have had a lot of good information to ponder over. I just thought i would share one thing...I'm not 100% clear if you are having just the tear fixed, or the rectocele fixed as well. soudns like both. I just wanted to share what the surgeon i saw who is top in our area (big city!) and his preferred physio said. Know that i'm not saying this to be anti surgery--rather, i think we should all be very educated, and being educated means you can ask the right questions and make a fully informed choice. and trust me, when i first got my POPs i was desperate for it just to be fixed! than i read an article on What Doctors Don't Tell You, outlining the risks of things that often go wrong, and got really freaked. then i found this site, and have never looked back--my body doesn't resemble at all what it did post baby, 6 months on, a year on, or even two. I'm now approaching three years PP (well, in a few months) and even my rectocele which troubles me the most is amazing. The latest huge diet changes have revolutionised my POPs, and my skin (I have an inflammatory skin condition). the healing is amazing...

but anyway--when i saw the surgeon, his view was surprisingly anti the surgery. he said that it was there, but try to live with first. There was no way they would even reassess me till 1 year post birth, or once i stopped feeding--whatever was later. He said if i did ever choose surgery do not go near mesh, but really, think carefully as it was not guaranteed.
he then referred me to a physio who only deals with prolapse and incontinence. I asked her why with rectoceles they don't recommend surgery as much as for cystoceles, and she said it was because often, even if you "fix" it, the symptoms still remain of bowel problems. She really said diet was most crucial to dealing with it. Also, she said that at my age, with young children, i should expect it to fail about every 5 years--10 if i was lucky. she would say if i even considered it wait till i was happy just sitting around doing nothing so that it was more likely to hold longer...

I hope that helps you in formulating your questions to the doctors.

I hear what you are saying about sex but it seems odd to me that that would be related to POP or tearing. I also have had a lot of tears and a huge episiotomy--and the surgeon did say my perineum (or the little that is left of it) had definately healed open. but, i don't find that to be an issue around sex. It doesn't affect how things feel inside--i think Christine is right, that that is much more about inner muscle tone... it's definately gotten better the longer since the birth.

it just seems to me that 8 months post partum is so early--my body really didn't feel like me for about 2 years, and so many women say that. I know we all make our own decisions--but if I were you i would make a long list of questions and get them all answered first, so you know exactly what to expect if you do go down the surgery route.

good luck!
Kiki

Hi i just wanted to let you know i am Norwegian,So perhaps we are from the same part of the world?