hysterectomy - rectocele

Hi dearie and welcome to WW,

Please know I am wrapping my virtual arms around you and hugging with all my might!

This is a serious situation, but I believe it can be made less so with a few basic understandings.

First of all, I want to acknowledge that in all probability, the “grapefruit” was the most common prolapse of all - a large front wall bulge containing half the bladder and cervix. So much prolapse is called “uterine” when in fact, a true uterine prolapse is more rare (and rarely that large!) For the sake of other women reading, this type and level of prolapse is highly responsive to the WW work. Unfortunately, women are told that prolapse is a one-way street and surgery is the only or ultimate answer.

Okay...now what? It will serve you to understand that if you learn to hold your bladder and intestines in the hollow of your rounded lower belly and over your true pelvic floor, which are the flat pubic bones between your legs, your organs will be more protected from being forced toward the vaginal opening, which is at the *back* of your body (not underneath you).

Yes, it sounds like you do have some paralysis of the back passage and are probably developing a significant rectocele. A daily stool softener will likely help and light enemas when needed. Use your thumb to press on the back vaginal wall to see it that reduces the rectocele pocket, allowing evacuation. *Importantly* lean forward with all increases in intraabdominal pressure - even to push out the last drops of urine. You very likely have some level of cystocele as well, which will trap urine if you don’t empty completely. All you need to do is lean forward enough to get your weight off the toiled seat - it becomes comfortable in time...rest your forearms on your thighs.

The rectocele mesh surgeries come with great risk of further injury and are not anatomically sound. It’s not about strengthening the vaginal walls, but rather aligning the anatomy in a physiologic way. The term “sling” sounds catchy, but in reality there is no such thing - either for the bladder or rectum...only for the urethra to treat incontinence. The "sling" is a large patch of highly-erodible plastic mesh implanted into the vaginal wall.

I doubt you would find the sponge useful and they require more care to clean and keep safe from harmful bacteria. Some women love them, but we don’t hear of their usefulness in more severe cases. I'm not sure a ring pessary would even be worth the hassle for you.

I use a little bit of honey for the symptoms of vaginal dystrophy - please see my article on vulvovaginal health in last month's edition of the Village Post (Christine’s Column). I think it works great, but you have to be willing to suffer a bit of the sticky inconvenience of applying it. Please don’t call it “medical honey” - (laughing out loud) - but wondrous, Mother Nature honey. Some women do find satisfactory results with oral probiotics used vaginally.

I find olive oil a bit irritating. You might go to the health food store and see if you can find an organic aloe-based salve.

Please also check out the V2 Supporter. I don’t have a direct link (as I recall they are distributed through sports and wellness outlets) but use your search function and you will readily find where they are sold. This is a garment that is worn over your undies and under your clothes to snug up your “crotch”. It adds a level of security that post-hyst women find greatly beneficial.

There is no surgical cure for prolapse. Not on the front end (first surgery) or on the back end (12th surgery). It just means more tissue lost and more nerve damage generated. Palliative care is the best we can do for all common disorders of the female pelvis.

Please have a look at YouTube (wholewomaninc) for a good review of the WW posture. My hope for you is that you’re able to become strong in posture when sitting and then are able to spend more time comfortably on your feet. I really see no reason why this needs to progress if you are supporting your body in these ways. The most important concept is that the whole pelvic contents need to be positioned toward the front and away from the outlet at the back. Take the work very slowly, as your lower back has become destabilized from loss of its muscular hub - the uterus.

Please let us know of your progress.

Lots of love and hope for your well-being.

Christine

All you need to do is lean forward enough to get your weight off the toiled seat - it becomes comfortable in time...rest your forearms on your thighs.

Bearing witness to that :)

Hi Mer-sea

I am still wondering about the permanent pessary your gyn was referring to? Did she mean a large pessary that she would insert, and that you would come back periodically to have it removed, cleaned and replaced? Or did she mean mesh, placed surgically, for ever? I think you would have to ask her that question.

Louise

Hello Christine, this morning I started my new DVD on the yoga, and since I've had a hysterectomy, I realize that it won't be a better than average fix, but I need to do all I can - so thank you.
As far as for the V-support, I was able to order mine off Amazon at what I suppose was a reasonable price, at least I felt it was worth keeping my bulge from going any lower.
Now my question, how far out of the body can a rectocele go before you say, I have to do something drastic? And it it hangs out of the body, does it swell and become a health concern? And if it goes that far, what is left to do? Thank you for your take on this.

Dear Chihuahuamom,

These are questions without clear answers. My hope is that you’ll be able to avoid further surgery for the long run.

You are at risk of vaginal vault prolapse, a euphemism for what is truly a closed evisceration. This means the top of your back vaginal wall could come further down until it turned the vagina inside-out. The ensuing large balloon would contain part of your bladder, part of your rectum, and a significant length of your intestines. A complete vault prolapse requires surgical intervention. For some time it was standard practice to tether the top of the vagina to the spine at the time of hysterectomy in an effort to prevent vault prolapse. Unfortunately, that surgery (sacrocolpopexy) fails much of the time as well. This is why we say, quite rightly, there is no surgical cure for prolapse.

The WW angle on the matter goes like this: If you had a “simple” hysterectomy without A&P repairs and it’s been some years since your surgery, we have to assume you probably have enough vaginal length left to close down against intraabdominal pressure.

If that is the case, we’re going to also assume that if you learn to carry your abdominal and pelvic contents toward the front, you will be able to protect your organs from spilling out the back. Your rectum is connected to your large and small bowels. When you hold your intestines forward, your rectum is pulled up and into a more natural axis. If everything is being held toward the front, how can things prolapse further out the back? This is the simple truth of female anatomy and the WW posture.

Baby your rectocele along for as long as it takes. This means never straining against the toilet seat, but rocking forward onto your feet when you have to raise internal pressure. When you drop your bladder and intestines into your lower belly in this half squat they are protected from being literally blown out the back.

I hope you can find a combination of posture, good food, comfortable shoes, herbs, salves, and external support garments to live well with your condition. The only surgeries left are ones that take more vaginal tissue until your vagina is like a shallow cave. Cup your hand for a fair representation of a post-hyst-and-A&P-repairs vagina, which is too short to protect itself from the tremendous amount of pressure that moves through the abdomen and pelvis with every breath.

Sincerely,

Christine

Wow, there is some interesting information on this thread! Reason why I keep reading this wonderful forum!! I keep learning and reinforcing that I am definetly going down the right path! You ladies rock!!