Doctor doubts - need a little support...

Dear Michelle,

I am sorry that your Dr put doubts in your mind. It is difficult for us I think when we see medical professionals who have conflicting ideas to our own, as we are conditioned by society to see them as "powerful and knowledgeable". This is especially difficult if you have been seeing this Dr for something else, and trust and like him on other issues.

I had a similar experience shortly after my prolapse occured with a nurse practitioner who I saw for an issue entirely unrelated to prolapse. She made the comment, "you will need to wait to get your repairs done until after all of your children are born." I was aghast to say the least! I hadn't even mentioned surgery. After I questioned her on this, she back tracked in a hurry. These people are trained to view prolapse in a certain way, and that usually means surgery, as this has been the traditional mode of treatment for all these years. A Gyn at the same office as the NP said I should go home and forget I have prolapse if I had no symptoms, and that there was no reason to think it would get worse. (Pretty good advice now I come to think of it!)

Over the course of my own experience I have really tried to step back and go with my heart, even though what I feel is often in conflict with opinion of regular medical professionals. Remember, your urologist however skillful he may be is a surgeon, this is what he does, and so he is bound to look at your prolapse from that viewpoint.

I have heard so many different viewpoints relating to prolapse from "getting surgery done when you are young", to "waiting until you absolutely have to", to "not getting it done at all". It can be a confusing condition because none of the "experts" even agree what is the optimal care.

If your prolapse is not bothering you right now why would you need surgery? Don't let a Dr put fear in your heart, in fact don't let anyone put fear in your heart. You know your own body and mind, go with what it is telling you. I have had to make a conscious effort to do the same.

Recent research has shown that prolapse is not the chronic, progressive condition Dr's have believed it to be. (I will try to find the specific research which stated that). There is also research by Dr Linda Brubaker, a "prominent urogynecologist", which Christine quoted recently that states many women have rectocele and don't even know it! It seems to be a very common, and frequently benign condition.

This process is a difficult one for us all because no one can tell us what will happen in the future. I simply try to take it a day at a time, and do all that I can to prevent future problems with careful lifestyle choices. (I don't always succeed).

Work out what is right for YOU Michelle! You seem to be getting great relief from the lifestyle changes you are working on from here. Continue with these and see what happens. You are still only five months post partum, early days. I did see improvement with my rectocele particularly in the months after my daughters birth. Take care!

Michelle. x

Michelle,

This guy sounds like he'd make a good used car salesman - trying to sell you something you don't want or need. I would be very leary of anyone using such high pressure techniques/scare tactics and obviously taking advantage of your state of mind. What is the harm in taking a few more months (you're only 5 months postpartum!) to work on posture, exercise, etc. to see if you improve without surgery?

I think most of us feel scared and depressed about our prolapse issues from time to time, but that should not be the reason to opt for surgery. I hope you will take some more time to think about this. If, as your doctor pointed out, you are still young, you won't be that much older in a few months...

Sorry if I sound preachy - I really sympathize, and I hope you will not rush into a decision with such lifelong consequences.

Congratulations on your baby (-: and peace,
J.

Michelle,

Here is the research:

Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD 21287, USA. [email protected]

OBJECTIVE: The purpose of this study was to describe the natural history of pelvic organ prolapse after menopause. STUDY DESIGN: Over 2 to 8 years, participants in the estrogen plus progestin trial of the Women's Health Initiative at the University of California Davis had annual pelvic examinations, with an assessment of uterine prolapse, cystocele, and rectocele. The findings from these examinations were used to describe the incidence of pelvic organ prolapse, the probability of progression or regression, and the associated risk factors. RESULTS: At baseline, 31.8% of women had pelvic organ prolapse (n=412 women). The annual incidences of cystocele, rectocele, and uterine prolapse were 9.3, 5.7, and 1.5 cases per 100 women-years, respectively. Incident prolapse was associated with increasing parity and waist circumference. The progression rates for grade 1 pelvic organ prolapse (per 100 women-years) were 9.5 for cystocele, 13.5 for rectocele, and 1.9 for uterine prolapse. The annual rates of regression (per 100 women-years) was 23.5, 22, and 48, respectively. CONCLUSION: Our data suggest that pelvic organ prolapse is not always chronic and progressive as traditionally thought. Spontaneous regression is common, especially for grade 1 prolapse.

PMID: 14749630 [PubMed - indexed for MEDLINE]

(Remember too, this study was in post menopausal women).

Michelle.

Dear Michelle,

There is no way I can tell you not to take your doctor’s advice. What I can do is write about the broader issues. We are living in an historical period of discovery as information from all viewpoints is available in real time to all people.

It is very hard to trust a doctor who would push such a sketchy surgery on a young mother with mild symptoms. The Hers Foundation (www.hersfoundation.org) has a video clip available on their site of a recently produced play. I think it would be good for you to watch. And the surgery IS very sketchy. One of the most respected reconstructive pelvic surgeons in the US, a man by the name of J. Thomas Benson, wrote a now classic textbook in 1992 called Female Pelvic Floor Disorders – investigation and management. Here are his words:

“Throughout the years, the diagnosis and management of rectocele has been an uncomfortable arena for the pelvic surgeon. The results have been disappointing and in many places rectocele repair has given rise to more dissatisfaction than satisfaction, and the procedure has been abandoned.”

As another classic text, Vaginal Surgery, by Nichols and Randall, points out, the problem is in obliterating the rectovaginal space between the two organs. When that is fused, the anterior rectal wall and posterior vaginal are forced to act as a unit. Now, the authors get around the problem by advocating extremely careful plication – or gathering and sewing together - of only the fascial layers. As if that were possible. A slew of other researchers say you cannot tell the difference between “fascia” and vaginal wall. It is a moot point anyway, because the walls are indeed lined with fascia that melds into scar tissue when disrupted.

Like anything else, outcomes will vary widely. Some surgeons may not even dissect all the way through the vaginal wall. Others also plicate the rectal wall – a technique described in classic texts.

At 54 and menopausal, my most severe symptom has become extremely thinned tissue at the site of my episiotomyX2 scar. Just like the newer textbooks describe, my perineal body has “disintegrated.” I would love it if a perineorrhaphy could give me a “brand new one”, but the reality is the only thing that could be used to do that is the levator muscles. Again, from Nichols and Randall: “Most so-called levator stitches result only in increased approximation of thinned or separated layers of the perineal body and do not usually result in a buildup of the levator itself. If placed far enough laterally to include only the fascia of the pelvic diaphragm, they may reinforce a defective pelvic diaphragm; but if placed directly into the belly of the levator muscle, these sutures may actually destroy portions of the muscle, eventually resulting in a shelf-like ridge of nonelasctic fibrous tissue within the introitus and immediately beneath the posterior vaginal wall.”

These doctors go on to talk about possibly using “superficial, side-to-side stitches”, but the reality is THERE IS NOTHING THERE to rebuild with. It is like baldness – nada, zip, kaput. The fibrous core of the perineal body is very precious and cannot be recreated through surgery. And if nature weren’t superb and protective enough, I just found a study showing the perineal body increases in size during pregnancy! The best I can do now is support the area through posture and naturally medicate the thin skin. Routine episiotomy is a horrendous practice.

Christine

Michelle, I totally sympathize with you...I don't know how old you are but if you have a 5 mo. old baby I figure you are still young. I know the interstitial cyctitis is very painful but surely there are exercises and medication that could help at your age...(Christine's advice is good on that)...Let me tell you my experience when I was 38. I am almost 57 now. My kids were 16 and 11 at that time..I was having terrible bladder infections almost every 6 weeks. My gyn. was very pushy and arrogant about surgery..I was scared to death..Finally after my best friend had her hysterectomy she told me how great she felt and how wonderful he was. (she really needed the hyst.) Finally I felt so sick I agreed to surgery..He also told me I had a rectocele, cystocel and needed a hyst.(he said why don't you just get rid of all that, you don't need it if you are through having children. I can make you feel 16 again) He even showed me a picture of my bladder protruding out the vigina with a mirror..That was scary. I told him I wanted to leave at least one ovary..I was young and back in 1988 I just didnt do much research. Wish we had had internet back then. I did feel terrible in my bladder and rectum..Always very constipated and hemrroids. Long story short. He ended up doing a complete hyst. vaginally..He repaired the cystocele and the rectocele...I was so upset he took both ovaries but he said they both looked like prunes and suspicious. Even though my husband had had a vasectomy I still felt sad that I really couldn't have any more children. I still don't think I needed the hyst. I can say that was 18 yrs. ago and I probably went about 15 yrs. with very few bladder infections. I've still had a hard time with constipation.No other problems like sex though..This past year though I have been so sick with bladder infections, high fever, high liver enzymes etc. I've been in the hospital 4 times. My Urologist took over. He is wonderful. Great bedside manner, highly recommended and is not pushy. He did do a cystascopy while I was in the hospital. He sedated me heavily so I didn't know anything..He ended up enlarging the opening to my uretha and decovered a stage 3 cyctocele and rectocele. He does recommend surgery but hasn't pushed me..That was in August and he's just waiting for my decision. He has explained it all thoroughly..But this time I'm older and have been doing extensive research on the internet...I would give anything if at 38 I had waited...My hormones were gone and that has caused me problems. Also has probably thinned out my tissues and caused the cystocele and rectocele..Mine are extreme. I can feel them and feel tired and in pain all the time..My lower back kills me. My husband and children are very active and I usually back down from a lot of activities..I also have 3 wonderful grandchildren who don't understand why Nana won't pick them up or play real hard. (although I usually give in and pick them up. age 7,3,1) My son is a college baseball coach and I can hardly walk up into the stadium to watch his games or sit very long..I feel old! I go to the Urologist tomorrow to make up my mind and probably set a schedule for surgery...What I'm saying is you are young so give it time and really pray and research this matter. God Bless You, from heartfelt
P.S. I've been trying to find out if a Urologist is qualified to do rectal surgery..Can you or anyone else tell me any info on this?

Come near to God and He will come near to you. James 4:8
God Bless All Women

For what it's worth, if I don't like a doctor's attitude - I don't go back. Whatever the issue, if they aren't willing to work with me on MY terms, they aren't worth my time. I once flat out told a podiatrist that I had no intention of doing what he was telling me to, and he threw up his hands and said he couldn't help me, then. I got better on my own faster than he had predicted with his outdated methods.

I also dropped a family doctor when she expressed shock that we used a chiropractor. I didn't need that kind of bigotry.

Don't let the doc scare you into doing something you don't want to do. Doctors like to act like they know everything, but there really seems to be a lot of guesswork involved- especially in predicting outcomes. Every body is different.

Christine,

You mention naturally medicating the thin perineal skin of your episiotomy scar. I was just wondering what you use - I am still pre-menopausal at 47, but I am concerned about further weakening and disintegration (I also have an epiX2)... Is it possible to strengthen the skin through some type of massage, or are thinning and weakening inevitable? I have to agree with you - routine episiotomy is barbaric!

J.

Hi Jean,

I’m just using a couple of different salves I bought at my local herb store – neither specifically for this area. I use one with calendula when the area is really sore and another routinely with chamomile and lavender. There really needs to be a whole line of salves for old episiotomy wounds. Don’t be paranoid about it, but do stay mindful of that area. Our hormones do keep it plumped up there and when those decline that exact spot can get very attenuated.

Christine

Jean...you asked about the book...we're almost there! :-)

I'll keep the salves in mind - so far, I don't need anything, but nice to have something to turn to if and when. Glad to hear the book will soon be re-born - I'll be first in line for a copy - maybe a signed edition?
(-:
J.

Michelle, I just read your posts with my jaw dropped and my heart leaping out of my body to you! I can not believe that you are only 29 and only 5 months postpartum and that your doctor is pushing surgery. I find that shocking. I was 36 when my baby was born, and when I was five months postpartum, I thought my cystocele would never get better. Now my son is 15 months old and I feel soooo much better than I did ten months ago. You have so much going for you: your age, the fact that you're still in the healing phase of your post-delivery, and the fact that you found this website. Do the postures, keep your bowels "light" and stay positive. You are going to feel so much better in the months to come.

Since you are dealing with IC on top of this, I highly recommend finding a new doc. Sounds like your guy is not to be trusted. There are uro-gynos and physical therapists out there who are incredibly successful at treating IC with massaging "trigger-points." A dear friend of mine tried all sorts of therapies for her IC with no luck. Then she started working with a PT who released tension spots in her pelvic floor and it helped tremendously. I'm not sure where you are, but it would be worth researching this therapy in your area.

I wish you all the best luck and am sending good thoughts of healing your way.

And congrats on your baby!

Ann