newbie with prolapse and interesting revelation

Submitted by babs on May 5, 2006 - 3:17am
Body: 

hi, i had my 3rd child in january. i now have a rectocele, uterine descent and a urethrocele. (not that surprising as my first child was born with large episiotomy and weighed 9lbs 4oz and my next normal delivery was 9lbs 8 oz. this latest child was born with the head delivered after a single push. it was a relatively easy labour until 10 days after when i felt as if everything was hanging down and very loose.
anyway, i am now having physiotherapy. the physiotherapist had said that physiotherapy cannot restore descent but can prevent its progress. she also said i shouldn't take up running. against her advice i ran 3 times last week. short bursts of 60 secs followed by 3 mins brisk walking, repeated 4 times.
yesterday at physio she was showing me how inefficient my kegels were when standing (using that stimulating probe). she then asked me to jog on the spot and the weirdest thing happened.
my pelvic floor seems to subconsciously contract and stay contracted when i run. this requires no conscious effort on my part. the device measured an increse from me standing and doing kegels with all my might of 20 to 40 with me jogging on the spot and doing nothing in terms of kegel.
can anyone shed any light on this?
also i find that after a session with the stimulating probe that i actually feel my symptoms are worse. is the probe which is supposed to stimulate the slow twitch fibres bad for you?
in many ways my situation is strange. i am not really having bladder problems, but am aware of the rectocele and the fact that my cervix now hangs into my vagina, with corresponding backache.
i've always been able to stop my urine midstream and still can, yet i have this descent and these bulges. is this just due to the perineal damage i sustained with the first delivery?

Christine

May 5, 2006 - 9:23am

Dear Babs,

Thanks so much for this bit of information! It supports my belief that the pelvic diaphragm is at its most contracted when walking and running in natural posture. This is because when we are on our feet and not pulling the lower belly in or tucking the tailbone under, the pelvic diaphragm lengthens and pulls together on its own. You can sense a mild contraction if you think about it. And really, it stands to reason. Nature would have to have protected us from these sorts of increases in intraabdominal pressure by moving the pelvis and pelvic muscles into their most defensive form. I’d suggest printing out a copy of my article (in resources section on home page), “An Open Letter…” and giving it to your PT. From my perspective, you're going through a lot of unnecessary discomfort for little or no gain. Begin the postural work and watch your symptoms change.

Wishing you well,

Christine

mommi2three

May 5, 2006 - 9:34am

Hi, welcome. Good thing you are getting help early. I think it is so interesting about your discoveries with the kegels standing and the jogging. Although the kegels may be stronger jogging, I am not so sure that would help the UP. Maybe you have some nerve damage along with the muscle damage from episiotomy so you have to squeeze very hard down there. Some postions put our bodies into a more natural kegel like the posture. So when i do the kegel standing i don't feel it as much either. I am still experiementing. :)

I'm no doctor but my uro said that i have lost some reflexes down that too. But, I found that kegels help with the stress incontinence/frequency and not with the feelings of pressure when the cervix is low and the rectum/bladder is full.

I think we do have to listen to our bodies. Everyone is different and the prolapses go thru different stages. I have seen alot of changes in the few months since diagnosed. Christine mentioned that would be a good topic so that we can see that it gets better from our more senior members. I wish there were some long term followups on women with UP without surgery. Would just be nice to have some greater understanding of the process. But i believe that it will be better in the long run without surgery.

Thanks for sharing your story and i think amny women here will respond with support and information.

babs

May 5, 2006 - 11:09am

hi there,
its interesting to see your comment about it being good to get help early.
the physiotherapist was unwilling to assess me before 10 weeks were passed. i can understand why from an infection point of view this time limit is in place. however, i instinctively feel that the sooner i got help, the better. if i were to dislocate my arm or leg no one would say you cannot have treatment for 10 weeks. why should prolapse be different?
surely the less time everything has to be out of place the better, and the easier to retrain your body?
the physiotherapist also gives a class in pilates which i went to this morning and found helpful, as they have known some women to improve following pilates.

mermaidsd

May 5, 2006 - 12:25pm

Hi, babs...
First of all, welcome!

As a PT myself, I am quite surprise and honestly somewhat perturbed that your PT wanted to wait until 10 weeks postpartum to evaluate you. I can understand not doing internal pelvic evaluation/treatment until after about 6-8 weeks or so to make sure that the cervix is closed and well after lochia has subsided. However, the PT could have done a musculoskeletal evaluation and started you with some gentle strengthening exercises. Hmmmm, odd. Your point about comparing it to another orthopedic injury is excellent.

In any case, I am glad that you are getting help and that the pilates might be a good thing for you. Please keep us posted on your progress! I can tell you that time is definitely on your side and am sending you healing vibes...

Peace,
Michele

babs

May 5, 2006 - 3:26pm

hi michelle,
just thought i ought to add that of all the healthcare professionals i have met to date the physiotherapist has been the best.
from the outset the midwife wouldn't believe me about the prolapse because she couldn't see it when i lay down. funny that!
my gp, even though she is female seemed to think i was overeacting - "its very early days", and "give it time". again it was only when i insisted that she examine me standing up that she became aware of the rectocele and seemed unable to accept my judgment that my cervix is not were it should be.
by contrast, the physio did examine me thoroughly while standing and confirmed what i already knew to be the case.
she also has shown the greatest understanding of how this affectsme on a day to day basis and has offered practical "lifestyle" advice regarding diet, drinking habits, dealing with my older children etc.
its not her choice about assessment and commencing treatment. this is policy in our health trust. ( i am in the uk).
i think that our thinking in the uk about conservative management of prolapse is about 10 years behind those of our north american friends.
i still suspect that the main value of kegels is in the treatment of stress incontinence. i suspect it is of very limited benefit for prolapse and rectocele. accordingly i am dubious about how much good the probe and my own tightenings can do for my descent and rectocele, as my bladder control has been and remains fine.
how do others feel about this?
btw, thanks for the good wishes and support which i assure you are reciprocated to all who participate or read these forums.

olwid

May 6, 2006 - 4:38pm

Thank you, Christine, for this wonderful site!!! I have found a lot of helpful info here. I had a hysterectomy 17 years ago. Last week I was diagnosed with a moderate rectocele and a badly inflammed cervix and my cervix is low. My exam was the most painful thing I have had done in a long time. (not the fault of the Dr.---just so darn tender in all areas) Dr. said she can fix the rectocele with surgery but that is not an option for me. I am 58, a widow and barely making ends meet so 6 weeks without work is not even open to discussion. Dr. said after the inflammation is gone she can fit me with a pessary. I know I have rotten posture (yes, I am a sloucher!!LOL) I also have suffered with IBS most of my life and that has probably added to the problem. I find that sitting on the edge of my office chair helps to relieve some of the discomfort or being in the recliner with my feet as high as they will go. I am a seamstress by day and sitting on the edge of the chair is not an option. What else can I do to maintain some sort of relief? Would a back brace
help or do more damage?

granolamom

May 6, 2006 - 10:00pm

thank you for sharing your revelations. I have a cystocele, rectocele and perhaps some uterine/cervical descent, and I too have noticed that everything feels firmly held in place while I walk briskly. And sometimes when I'm having a 'low' day I try to convince myself I shouldn't be exercising but I get on the treadmill anyway and everything feels higher up afterwards. So you're definitely onto something!

rosewood

May 7, 2006 - 12:48am

I too am a mother of 3, the youngest just turned one year old. Congratulations on your new arrival.

I've been thinking a lot about the kegels and stress incontinence and prolapse. I, perhaps like others, have found that the kegels (in my case, I've been doing resistance exercises, with the kegelmaster) have totally rid me of any stress incontinence; however, so far, has not "cured" the prolapse. I've found great benefit in doing kegels this way -- I feel really different, especially in intimate relations! But, I still have the draggy prolapse days.

Christine has written a great article (most, not all, of which I understand, btw) to pts about why kegels don't affect prolapse. Very interesting. I'm still doing mine and am committed to doing them, because I do feel that it's helping me.

Keep us posted on your situation and progress. The postures and exercises really help.

Marie

Christine

May 7, 2006 - 10:20am

Dear Olwid,

Women with conditions similar to yours write in on a regular basis and all I can ever say to them is that I really don’t know. Hysterectomy changes everything, and therefore all the anatomical concepts we are working with here go out the window. Diseases of the cervical stump after sub-total hysterectomy are quite common and I so hope you get the inflammation under control. I would never suggest a back brace under normal circumstances because the key to so much of the pelvic organ support system is learning to sit using the strength of the spine itself. However, a brace may give you added strength you may not be able to muster on your own. I would seek the advice of a good orthopedic doctor. Goodness knows they see their share of post-hysterectomy women suffering with back pain. Your story was especially poignant to me Olwid because, as a sister seamstress, the thought of you in so much pain breaks my heart.

Wishing you well,

Christine

olwid

May 7, 2006 - 10:55am

Thank you for your help. I thought (at the time)that having the hystercetomy was the best thing in my life. I felt wonderful afterwards and no more pain. Now here I go again. Well, life goes on and I refuse to let it get the best of me. I guess the best thing now is to have a positive attitude and find little--or big--ways to improve on what I have. I'll continue to check in here in case someone else in the same situation shows up.