In the good old days

Well, I think it’s safe to say doctors HAVE tried to do EVERYTHING about it for well over a century. Hundreds of experimental surgeries and every conceivable pull-n-tuck have proven female pelvic organ prolapse to be irreparable. Unless, of course, a woman is willing to be completely strung up inside like a trussed bird. And then, as we all know, her problems just begin…even if she’s lucky enough to have several years reprieve. Uterine suspension is all the rage again – even after hundreds of variations were tried and failed in the early 20th century. Laparoscopy, mesh, and long, threaded needles that tunnel straight through from underneath our butt are only technological advances that have no bearing on the basic truth...that internal “corrections” cannot be truly successful. The force of our breath is the bladeless scalpel that has literally sculpted the natural form and function of our pelvic organ support system and it is only by going back to this form that we can begin to reclaim the way we are meant to be. Not all women can or will be able to accept these truths and for them there is surgical intervention - but only at a very high cost.

Just a thought..................surely if the original damage were repaired within the pelvic floor muscles which caused the prolapse, could it then not be corrected? I know they are doing site specific repairs for rectocele with variable results, (variably bad from what I can tell), could they not do the same for other forms of prolapse? Would this then prevent the problem of having to attach everything in a very unnatural way and thus leading to so much surgical failure and suffering? Why isn't this angle being investigated more? Any thoughts Christine?
Michelle.

I think it’s actually very rare that the pelvic floor is the cause of prolapse unless the muscles have been cut or torn, as the only movement the "floor" is capable of (outside flexion and extension) is a mostly passive opening and closing of the pelvic sphincters. Urethral stabilization and sexual enhancement are the main factors that can be affected by consciously contracting the pelvic floor muscles. It is just an opening and closing movement – nothing else – and bm’s, babies, and prolapsed organs come down tight sphincters just as easily as weak sphincters. There is nothing more to it than that and I ask all of you to become very clear on this point.

Personally, I believe it’s the fascial structures that change and these are impossible to try to correct without causing more damage, because the fascia-lined negative spaces in between the organs must be preserved if the organs are going to be able to slide past each other to perform their various functions. Site-specific repairs fuse the back vaginal wall in certain areas, while full-length repairs along greater areas. Those places of fusion create a dead space in the natural sliding motion of the rectovaginal septum and force the vaginal wall and rectum to function as one organ. Sooner or later, pressure forces a new bubble somewhere else along the wall or perineum.

Say we have a suspension bridge like the Golden Gate Bridge in San Franscisco, where there is a multi-lane road with cars going past day and night. Imagine the level of steel beam architecture it takes to hold up that road! Suppose one day (without an earthquake) the road buckles and cars begin to fall through. Where would engineers look to locate the source of the problem? At the asphalt road? No! They would make a thorough investigation of the intricate network of steel beams and cables that suspend the bridge.

The difference in the female body is that the steel beams and cables are replaced by skeleton, muscle, and fine gossamer tissue holding everything perfectly in place and allowing the interior of the pelvis to function both as one unit and as separate organs. If you could reach in with magic forceps, gather the gossamer in certain areas and tighten it up a bit here and there that would be the ticket. Unfortunately, all our operations are much more macro than that, and even so, where and what would you grasp without damaging the essential nature of fascia?

The little nips and tucks simply do not work and that’s why we now have surgical experiments going on where a piece of mesh the size of a disposable diaper is implanted in hopes of creating an artificial support structure underneath the organs. And no one but us :-) is looking at the obvious. It’s not the road…it's the larger framework.

Here's an interesting article about the outcomes in the U.S. U.S. has second worst newborn death rate in modern world. http://edition.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/index.html

I think our society expects doctors to be miracle workers, and they try really hard to be our salvation. But there is no improvement on nature. They even know that all they can do is cut, but the body has to heal itself.

I do not think we should look to them for a solution to prolaspe, anymore than to a solution for an improvement on the birthing process.

Countries where midwifery care and homebirths are the norm and you have to be referred to an O.B. because of some risk factor or you insurance will not pay for it, have much better maternal and newborn outcomes. I was obviously not around during the pioneer days, but I know in my case the difference between obstetric care and midwifery care made all the difference between a gentle birth and a violent birth. Midwives watch the mother in labor and allow her the freedom to move as she feels fit. O.B.'s don't have time to watch the mother so they hook her up to machines to monitor her and keep her in the worst position possible for labor and birth and put unnecessary pressure on the pelvic organs and create a situation where the baby's oxygen supply will be compromised. Then they continue to intervene in the labor by making it even more difficult and stressful for both mother and child with the introduction of pitocin that creates unnatural, fast, and extra strong contractions.

When birth moved to the hospital, dr. claimed it was the safe place to birth. Women of affluence were the only ones who could afford to birth there so it also became a fad among the rich. As goes most things, as the "underpriviledged" began to have more resources, they too wanted to move to birthing in the hospital. Stats are misleading that hospital birth was safer, because what actually was improving the outcomes of birth was the advent of antibiotics. I cannot deny that in some cases (the WHO estimates only about 5% of all births require a c/s-- U.S. rate is climbing to a whopping 29%!) c-sections have saved the lives of mothers and infants; but the risk of this surgical solution can be very costly and the death rate as a result of c/s is often skewed and presented that the death was the cause of an infection, an embolism, etc. which were all consequences of the surgery, but they are often not portrayed that way. A dear young mother paid for her c/s with her life 5 years ago as she was birthing her twin sons. During surgery a blood clot formed, broke lose, hit her lung, and despite all the doctors attempts she died. I do not know whether or not her c/s was necessary, but at any rate they are not the risk free solution that doctors tout them to be.

Sorry about my disertation on our modern birthing practices, but this illustration of doctor's inability to improve on nature is what prevents me from looking to them for a solution to prolapse. I think that's how everyone landed her: we were looking for a natural solution. Which I firmly believe is the only solution. Prolapse is multi-faceted; it is not the failure of a single muscular system, it is a strutural problem. Reshape the structure and you gain some leverage against the prolapsing organs. Some things doctors can't fix so we have to look for alternative ways to deal with them.
Jane

Christine,
Just another question....................I hope you don't mind! How come not more women get prolapse? Does this illustrate the fact that the women who don't have naturally better posture than those of us who do? Also, if the pelvic floor is not a cause of prolapse, why does it emerge so often post partum? Is this due the the lumbar curve flattening during pregnancy more than the actual birthing process itself?
Thank you! :)
Michelle.

Thanks Michelle! ;-)

Well, I think the reason so many (maybe half?) don’t prolapse speaks to the strength of our natural design. Posture certainly isn’t the only factor in the development of prolapse, but I believe it’s the major one. I agree with our old pal Jonathan that toilet seats have a lot to do with it. Also, as I’ve been developing this work further at the Center I see how completely dependent the health of our structure is on the form of our feet! Lesser, but still notable factors are clothing, furniture, and car seats.

As far as postpartum prolapse is concerned, I think pelvic surgeons Nichols and Randall described it pretty accurately, as I wrote about in my paper on maternal injury: the basement layers underneath the vaginal walls stretch and tear. If the bladder and rectum are already malpositioned, which they could be for a huge percentage of asymptomatic young modern women, then when protection of strong vaginal walls is suddenly lost, prolapse results. Fascia holding the organs in place could also be pulled toward the vaginal canal during a traumatic birth. Postpartum spinal shape is just a theory of mine, but as time goes on I’m quite certain it will become a major factor in both preventing and stabilizing these conditions.

I really want to try to understand why you think the pelvic floor might be responsible for postpartum prolapse – or any prolapse. Do you think it’s because the pubococcygeus opens up like a sink hole and the organs fall through? I just think it’s kind of unlikely that such a highly stable evolutionary design would allow organs to perch on top of such a treacherous situation. Clearly the organs do fall through, but what’s going on beforehand? In normal anatomy the uterus and bladder are positioned well away from the diaphragm. The diaphragm is stretching up and back, while the organs are positioned down and forward, and the vagina is the flattened space in between.

PTs already know there’s about zero correlation between strong pelvic floor muscles and prolapse. Anatomy experts tell us the pelvic diaphragm has lost much of the muscle mass of the primate tail-wagging wall, having been replaced with sinewy connective tissue better suited for acting as an immobile stabilizing structure. And it doesn’t help that almost all illustrations in books about female anatomy are a joke. We know where the bottom of our tailbone is located and we also know where the bottom of our pubic bone is (if you don’t, it’s like the straps of a saddle underneath the pelvis, the back of which is directly behind the urinary outlet) and we can feel for ourselves the approximately 45-degree incline of our “floor.” It is actually a WALL that the organs fall back against. There are drawings everywhere that depict it as a completely horizontal floor, a huge boo-boo first suggested by medical men.

I hope this helps, Michelle. Keep asking questions until you are satisfied that either you understand or I am crazy.

Hugs,

Christine

your opinion on Dr. Kegel's original research paper. In particular, these statements:

"Our own study in the dissecting room, in surgery, and in animal experiements, as well as observations of the effect of exercise in several thousand patients, has led us to conclude that the pubococcygeus is the most versatile muscle in the entire human body. It contributes to the support and sphincteric control of all pelvic viscera and is essential for maintaining the tone of other pelvic muscles, both smooth and striated." and,

"Palpation demonstrates that in a normal pelvis with the viscera in their normal position, the pubococcygeus and all of its components are well developed. However, when genital relaxation has occured,this muscle is found to be weak and atrophied.

"Genital muscle relaxation, as manifested by urinary stress incontinence, cystocele, or prolapse of the uterus as well as certain type of lack of sexual appreciation, is always associated with even if not directly due to dysfunction of the pubococcygeus. Thsi fact has been borne out by the success of non-surgical treatment of these conditions, applying the general principles of muscle education and resistive exercise to the pubococcygeus as the pivotal structure of the pelvic =musculature.

"The fasciae are not discussed here forthe reason that, whether injured or intact, they depend upon their muscular attachments for nourishment, viability, tone and tensile strength. When grossly disrupted they remain a surgical problem."

Anyway, I'm sure you're familiar with it all, and I am curious of your opinion.

Marie

Thank you so much Christine for your thoughtful replies to my questions, I do truly appreciate your time!

I guess the reason I still focus on the pelvic floor so much is due to the fact that I am still a LITTLE in the "how did this happen to me?" stage, and I am still trying to unravel it all for myself. (I know, why does ANYTHING happen to any of us?) I am tons better than I was, both emotionally and physically, mainly thanks to the support here, and my progress of course, but I still wonder!!?? Please understand, I am totally with you on the whole posture scenario and I am still attempting to put this all together for myself too :)

It is truly irritating to me that so much of what the so called professionals dictate is so inaccurate, and quite honestly so disfiguring. I think I am truly still in a state of disbelief actually over much of what I am learning.

Thank you again. I am feeling so very much stronger and happier these days. I really feel (almost), like my old self again!

Michelle.

Hi Marie,

I think his first point is both true and grossly overstated. True in that the specialized pc muscle does a marvelous thing in rotating the fetal head in preparation for delivery – a wondrous feat Kegel misses entirely. We know it’s the stabilizer of the pelvic sphincters. His other examples of versatility are lost on me. The iliopsoas and gluteals are pretty essential for “maintaining the tone of other pelvic muscles.” And your point is, Dr. Kegel?

His second observation is valid. However, he mistakes the symptom for the cause.

His third statement is utterly fallacious. Decades of kegel-crazed prolapsed women will tell you his findings are not reproducible.

His fourth statement is false – here’s Te Linde’s: “Substantial support is provided by the endopelvic fascia. This strong tissue surrounds the vagina, is attached to the symphysis pubis anteriorly, passes beneath the bladder in the anterior vaginal wall, attaches laterally to the arcus tendineus, and extends superiorly beneath the peritoneum of the cul-de-sac of Douglass and lateral pelvic sidewalls. The endopelvic fascia derives additional strength from its broad attachment to blood vessels, nerves, and the levator muscles in the pelvis.” He’s right however, that fascia remains “A surgical problem.”

:-)Christine