Problems with Fascia?

Oh dear, the abstract and illusive nature of fascia....what it is, what it does, how to fix, how to heal. Please tell me I am not the only one who can't quite wrap her head around this, or I'll feel rather dim :)
Trying to put myself a little in your shoes saddleup....so you are hearing that you have a fascial tear and that fascia is something that supposedly does not heal well due to the reduced blood supply. I have no idea if this is even true or not. If so, then what else can you do? If fascia can't heal due to being bound up, torn and retracted and not able to come together as well as muscle might be able to, then what can help. Is it possible to unbind the fascia, loosen the adhesions (since presumably this is what is holding things apart and not reconnecting?)
The second thing that comes to mind is how you can strengthen the supportive structures that are second in line to fascial support. Obviously this is what WW techniques have been doing so far but it sounds like you are needing a bit more help these days.
I am just thinking out loud here...just seems to me that those big blaring words 'fascial defect' are thrown around so much with so few options for fixing, helping repairing and it bugs me. It may very well be true...BUT the body has an enormous capacity for compensation. It's just the figuring out how to facilitate this that is so challenging.

Hi Saddleup,

It was theorized in 1909 that cystocele was caused primarily by detachment of the front vaginal wall from connective supports along the front of the pelvic sidewalls. This theory was generally disregarded until it was resurrected and again promoted in 1976. Although still controversial, many surgeons were intrigued by the possibility that both cystocele and stress urinary incontinence might be cured by repairing small tears that were thought to occur between the midvaginal wall and its attachment to muscles spanning the sides of the pelvis. Never mind that no photos of these alleged “tears” exist - that I have seen - however highly illustrated they may be in the literature. Not all world-renowned surgeons agree on their existence either:

“As far as lateral stabilizers of the vagina are concerned, one hears a lot about the so-called paravaginal defect, which is likely to be present in 30-40% of cases with genital prolapse. In actual fact, anchorage of the lateral edge of the vagina to the pelvic sidewall is debatable. The arcus tendineus fascia pelvici is not a constant structure. Neither is the pelvic fascia. At least, it is more than easy in normal cases to detach the vagina from the pelvic side wall by means of gentle digital pressure and this disruption, which is performed during radical hysterectomy, does not result in genital prolapse.” (Dargent et al. Vaginal and Laparoscopic Vaginal Surgery 2004).

The rate of recurrent cystocele after abdominal paravaginal defect repair is said to be as high as 41%. I believe it is much higher. I have been doing this work for a long time and it seems these women commonly develop subsequent cystocele that is now termed a “central defect”. Because the fascia has been hitched up all along the sides, what else are they going to point to as the cause?

Saddleup, you say your cystocele is “at the entrance and threatening to descend some more.” Cystocele at the vaginal opening is what prolapse is! If much higher it is generally asymptomatic and neither we nor our doctors notice or are concerned about it. Your statement “threatening to descend some more” is fear-based and not consistent with our experience at Whole Woman. All of us have organs at or near the vaginal opening and the general consensus is they are easily stabilized here. How much reversal you will see over time cannot be predicted. The most common presentation of prolapse is cystocele/rectocele with the cervix above. It seems this is how the mature vagina settles out. A bladder falling further and further out of a woman doing this postural work has thus far been unheard of. If you are holding your organs forward, they cannot fall further back. This has been verified again and again by the women here.

I think 100 years of vaginal and pelvic surgery have proven that fascia is not the problem. Fascia has been sutured, elevated, stretched and secured every which way and always to no avail. Here is my take on the reason some women develop such enormous cystoceles:

You have probably read in STWW and elsewhere of the existence of a pelvic arch at the back of the pubic bones. This arch is conventionally described as the formation made by the bottom of the pubic bones and their symphysis. In reality, the arch is at the back. In some women, the arch is quite V-shaped and the reason why some small percentage of women cannot birth vaginally. This is a genetic/birth defect that before c-section was weeded out of human populations. In most women the arch is wider, known as the “gynecoid” shaped pelvis, which adapts much more easily to the fetal head. I have wondered whether in some women this area of the pubic bones is especially wide and shaped in such a way that more easily allows the bladder to fall completely back. Yes, it is the fascia that has kept it forward all these years, but slowly over time the full bladder is stretching that tissue. I do believe connective tissue health is a factor, but minor compared to basic structural supports of the body.

I do not know why you are having such a difficult time seeing any result, beyond the fact that pelvic fascia is very difficult to remodel. However, it is obvious that you haven’t fully accepted the WW perspective that these organs are held forward and in their normal positions largely by their own weight and in addition to the spine and breath pushing them forward. Perhaps your back vaginal wall has not come forward enough in support of your front wall as it does in so many women.

So...you are left with the choices we have talked about so many times before. I know it is very difficult to accept that this happens in a huge percentage of us and there is no good surgical fix. The chance exists that an anterior colporraphy would fix you right up with no further problems. I have no way of knowing either way - only statistics provided by gynecology and public health studies, and the experience of many women. Of course individual surgeons love to give you their famous “95% success rate”. Mesh surgeries would not have become the gold standard if paravaginal defect repair worked.

It’s really an attitude change that we talked about a lot in the early years of WW, but haven’t visited in a while. You seem not to agree that our worst day is better than the post-hysterectomy woman’s best day. I believe that at any age our mothers have great influence over us. Just like the young woman who shuns vaginal birth because her mother birthed by c-section, I believe women with hysterectomized mothers have a harder time avoiding a similar fate. Holding out hope for a surgical cure seems to keep women from thriving on their own - I don’t know if this is true for you, but we have seen it over and over through the years. Not that a surgical cure isn’t out there for you. It is not only an intellectual exercise, but kind of a spiritual exercise that each woman must wrestle with on her own.

Wishing you well,

Christine

hey saddleup
scoot over and I'll sit on the 'change is slow and hard for me' bench with ya.
I think in my case, my history of fibromyalgia, chronic back pain, arthritic shoulders/hips/knees makes my progress slow and not as complete as I'd like.
I, like you, intend to persevere with the WW approach because it sure does beat anything else. and the truth is, I am symptom free even if I can see my bladder dropping down and threatening to exit my body.
I think that each of us comes to this with our own physical/emotional history and that definitely affects the degree of change we experience.
I know how frustrating it is to hear others reporting so much change so soon when its teeny tiny baby steps for me.
good news is, I'm still improving. slowly, slowly. been, what? 5 years for me. or something like that.
{{{{{hugs}}}}}