I do not want surgery

Hi Iva, regarding the bladder urges I had a similar problem after the birth of my first child and greatly benefited from physical therapy. It wasn't a benefit for the rectocele but was incredibly helpful for the bladder urges that would come on very strong and in preventing accidents. Find a PT who has a machine to measure the strength of your pelvic floor (with a vaginal probe-not bad at all) and has the biofeedback equipment. My PT also did a vaginal exam and found that an internal muscle was in spasm and was able to get it to release. I was also given a voiding schedule to help me relearn to not run franticly to the bathroom. Within months the problem was under control enough that I was able to exercise including running and not leak urine. Be prepared for some aching of the pelvic floor as the PT exercises will exhaust the muscles but this didn't last long and the results were great! Also some on the forum have found that kegels in excess worsen their prolapses. I haven't had a problem with this and feel that learning to do them correctly from the PT was the key. I got results without having to a crazy number of repititions.

Good Luck!!!

Well I like to think about this one in reference to men- weird right? But just like men are all different sizes- so are women - so when you go searching for your cervix it could be in 3 inches or 8 inches-
you have to look for yours at different times of the day for a few weeks- because your cervix moves- so for me some days I can reach it and other days I can't- and that is just the way it is.
And on the other note......It is not abnormal to need to pee at least 1 time an hour if you are properly hydrated. Way before I ever had kids or prolapse - when I was an athlete- I peed sometimes 2 times an hour- here is a test- how often do you wake up at night to pee? Can you sleep for a good long while or are you up every hour? I think if you can sleep at night then you should just try to empty your bladder at least once an hour. It is funny- The mental component- I got that when I first discovered my cystocele= I thought I had to pee all the time- but when I actually watched the clock one day and made myself wait a little- I realized it was all in my head......

Dear Iva,

Thanks so much for joining us and I understand your desire to work with your condition naturally.

Regarding your prolapse, you didn’t really explain your symptoms. Is there an external bulge? I find that many women are extremely anxious about their prolapse, but when you really peel the layers they are most concerned about what might happen in the future. I hear a bit of that in your voice as well. Let’s not worry about what might happen next month or next year, but work on getting you comfortable today.

I do not believe kegels are going to help much with the bladder urgency. And I’m very suspicious of this non-relaxing “muscle” we hear many women being diagnosed with by PTs. Your levator (“pelvic floor”) muscles must completely relax every time you poop or pee.

I think more plausible reasons for your bladder spasms are both mechanical, from the severe prolapse, and biochemical. pH balance within the body is extremely important and when that is altered many systems can get out of whack. The urinary tract takes the brunt of clearing much waste and restoring acid/alkaline balance.

I think Alemama has given you very good advice about peeing when you first get the urge. Also be mindful to send only nourishing food and drink through the bladder. I experience a bit of urgency sometimes too and in my case it is very controllable. Posture, diet, exercise, manually pushing your cervix up morning and night, firebreathing, calming meditation/prayer, comfortable clothing, lifting your weight off the toilet seat, and joyful activity should take care of it.

I understand the need for improved external support garments.

Wishing you well,

Christine

Christine, I believe the muscle that was in spasm was the internal obturator (spelling???) which I took to be separate from the "pelvic floor". I did not ask the PT for specifics on it's role and had not found this site at that time. The PT accessed it vaginally and went up and to the left quite a ways. When I looked it up on a muscle chart it was difficult to see it and where the label was pointing. Is this muscle connected to the pelvic floor? At the time I just thought of it as being a small piece of the puzzle with the problems I was having and after getting it treated my pelvis felt much better.

Thanks.

I just wanted to add to this that I too have been told that specific muscles on either side of my vagina are very "tight" by my nurse practitioner. I can feel them and they do indeed feel tight, but they are not uncomfortable. They feel like two tight bands either side of my vagina.

I haven't a clue what these are exactly, I still find the musculature down there very confusing as well. I was told to back off on the kegels as this was making it worse. (It was about this time last year I heard this when I was in one permenant kegel from morning to night).

The main thing my NP was worried about was that they would cause sex to be uncomfortable. Not sure if they are technically in spasm, but they definitely don't feel soft and giving like the rest of that area that's for sure! :)

Oh man…you guys make me sing for my supper, don’t you? I REALLY need to practice for my piano lesson tomorrow, but this is such an important and many-faceted issue…

Let’s begin by understanding where the internal obturator and its neighboring deep lateral rotators of the thigh – including the piriformis – are located. Stand up and move your right hand along the outside of your thigh until you run into a large bump near the top. This is the great trochanter, or knob, of the femur. Don’t confuse it with your hip bone, or iliac crest, which is further up. With your left hand, reach across your back side to feel just above your right sit bone. This is the outside route of the internal obturator once it leaves the pelvis. On the inside, it lines the front of the pelvic walls above the iliococcygeus. In the back, the piriformis muscle exists as the uppermost of the horseshoe-shaped muscles commonly known as the pelvic floor, reaching from sacrum to the great trochanter. The piriformis runs above the foramen (or hole in the pelvis), deeply under the buttocks, and hooks on to the trochanter as the other rotators do.

Now let’s talk about the fast-growing knowledge of trigger points within the broader science of myofascial pain and dysfunction. This discipline comes from Western medicine, has been recognized for 150 years, and was first named in the literature in 1942. It is completely distinct from Eastern acupressure points, which are believed to be focal points along meridians of energy flow through the body.

Trigger points are small contraction knots in muscle that develop from basic misuse…this can be too much activity, too little activity, forced stretching of muscle or general stress. Unlike acupressure points, which are difficult to prove, trigger points can be felt, measured and photographed. Trigger points affect muscle by keeping it both tight and weak. Over two hundred pairs of trigger points, and their specific symptoms, have been described.

Alternative disciplines working with trigger points are rapidly replacing medical practice in many areas. This is because the science of myofascial pain and dysfunction is reliable and valid. IT IS A COMPLETE PITY THIS WESTERN SCIENCE IS NOT PART OF WESTERN MEDICAL EDUCATION. Doctors and most physical therapists remain woefully under-trained in trigger point therapy.

With the above as background, I would like to make the argument that a large percentage of PTs specializing in women's health, like the medical schools that train them, perform inaccurate assessments, carry out faulty treatments, and give wrong diagnoses.

PArunner, I have no knowledge of your condition, or what your PT did or said. Therefore, I hope you won’t mind if I just use your statements in hope of getting my points across. You tell us:

“My PT also did a vaginal exam and found that an internal muscle was in spasm and was able to get it to release…I believe the muscle that was in spasm was the internal obturator… At the time I just thought of it as being a small piece of the puzzle with the problems I was having and after getting it treated my pelvis felt much better.”

The science of myofascial pain and dysfunction describes the symptoms of a trigger point, or spasm, in the obturator internus as pain in the sacrum, buttocks, hips, and when severe, the upper hamstrings. And, the well-known PT, Diane Lee, describes state-of-the-art treatment for spasm in the internal obturator:

“Hypertonicity (spasm) of the obturator internus (together with the piriformis) has a marked impact on the femoral head position and consequently the range of femoral motion. A tender trigger point is often found medial to the inferior attachment of the inferior arcuate band of the sacrotuberous ligament.” THIS IS LOCATED DEEPLY UNDERNEATH THE BUTTOCK.

What I’m getting at is that you would not have internal pelvic symptoms with a spasm of the internal obturator. Rather, when the deep rotators are tight, they tilt the pelvis forward and limit turnout at the hips. The lower back becomes strained and the ligaments at the hip become slack – decreasing stability and increasing wear and tear on the joint.

Piriformis is the uppermost of the six rotators. When it shortens it gets bigger in diameter,sometimes resulting in sciatic nerve compression, which manifests as a whole different set of symptoms – pain at the back of the thigh, calf and sole of the foot.

Now…an enlarged piriformis CAN impinge on the pudendal nerve, resulting in genital pain. But by the time it got that bad, you would have a host of other symptoms unrelated to your pelvic interior. And after systematically moving and stretching the leg and hip in attempts to ease the spasm, the last resort would be a gloved finger in the rectum. These muscles are in back of the rectum, not the vagina.

From the perspective of much of our experience here, I think it’s fair to conclude that our pelvic reconstructive surgeons have made significant errors in diagnoses and treatment. Those errors have filtered directly to their subordinates, the physical therapists. And it’s time to question their authority, as Sarah Hackett Stevenson, M.D. (1882), tried to do so very long ago:

“[Routine vaginal exams are] both fortunate and unfortunate for women – fortunate when operations and applications are needed and skillfully performed; but unfortunate in that it has been the means of building up a routine practice as useless as it is demoralizing.”

I know most women find the PTs who serve them to be kind, gentle, and supportive therapists. And there is nothing wrong with vaginal exams. My daughter had her first (and probably only) postpartum exam yesterday by her midwife and appreciated having it confirmed that she is not at all prolapsed.

My gripe is that the vagina is virtually the ONLY focus of this area of women’s health when the irony is, there’s not much inside the vagina that will improve these conditions, but rather all the things we do with our larger frame.

Furthermore, I think there are some internal treatments that might be beneficial to women who have issues with scar tissue, but these myofascial aspects remain totally ignored!

The knowledge is out there. Let’s insist our health care professionals locate it and apply it correctly.

Christine

I so enjoy your anatomy lessons!

and HOORAY for your dd, no prolapses!!!!!

way back when I was in PT school we did have a *few lessons on myofascial release and trigger points. all I can remember is the shoulder girdle, I am almost certain we did not address the hips in that context. I have to say that I was surprised that a PT could release the obturator internus from inside the vagina, so thanks for clearing that one up.

as far as trigger points, I know when I get 'em in the shoulder girdle, I've taught my dh to release them and then my shoulders literally drop an inch or two and I feel oh so good.

I second that Granolamom!

Do you know then anyone if the "tight" bands I feel are a usual occurence or not? Just wondering! :)

I am STILL having problems visualising all of this stuff. I think I need to really sit down and study it.

I have no idea what they are. going to have a look at my anatomy atlas when I have a chance.

Wow, thanks for the time and effort you put into in sharing your response!!! Your dedication to improving women's health is greatly appreciated. This is certainly information I can share with the PT in the event of a future visit. I felt better after the treatment so it was helpful and when the PT pushed on whatever muscle it was it was very tender. My question for myself and my provider is what muscle or structure was or was not treated and which were connected to what symptoms. It is empowering to go into an appointment armed with as much information as possible as we are the only ones who in the end will advocate for ourselves.
Thanks again.

I'm not too optimistic at this point. I have a stage 4 uterine prolapse. I've been doing the exercises religiously, changed my sitting/standing everything. The only time my uterus is inside my body is after I do a "downward dog" yoga position (your butt is in the air, hands and feet on the ground). Or, if I put my legs on my bed, and hang the rest face down over the side - especially before I go to bed. Then my uterus stays in place while I'm in bed. The second I get up, it slips down. I've been told that I have a tilted, uterus - so now matter WHAT posture I do, my uterus does not lie flat on top of my bladder. ( AND enlarged with fibroids!) All the firebreathing does is raise my uterus up until I stand up straight.

The pessarys don't stay up - except for the donut - which I found to be one of the most painful experiences imaginable. I can't image that being raped would have hurt more (only longer & emotionally) - and I don't know which was worse - it going in or coming out. I actually bleed from the experience. Sea sponges stay in for a little while, and then I'm constantly having to go to the bathroom to push it up. And when I'm in a public place, I'm frightened that it will fall out completely.

Even though I haven't had surgery, I have vaginal wind! I can't imagine how much worse that would get WITH surgery??!!

I used to love exercise. Now when I walk, I feel like a wet superlarge tampon is hanging out of me and rubbing me raw. I'm afraid to go back to yoga, thinking that it could make me worse - but I really don't know what would be worse.

I'm going to start physical therapy, hopefully next week. I'm praying, and trying to stay positive. I'm calling all my women friends and explaining to them how to prevent this from happening to them - which I think may be my only way of feeling this makes any sense in my life.

I'm sorry you're having such an awful time. have you tried the external supports (the v2 I think its called?)? not that I imagine that will solve everything but maybe it will at the very least, keep things supported while you go about your day.

you're in my thoughts and prayers.

Can someone explain how these are supposed to work? It seems like it's for women who don't have strong stomach muscles - but it actually seems to go against the concept of NOT wearing tight clothes? I'm confused!

Also, will this hold my uterus in if I put in on after I over the bed to get my uterus back higher in my body?
thanks -

Hi Yogam,

The external supports are like jock straps, except they hold tightly to the perineum.

I know this work seems magical in some of the younger women who see improvement almost immediately. In older women it can be a much different situation. How long has it been since you have make these changes? You may have to work several months to see much improvment.

Another idea is to dampen three or four organic cotton balls and insert them vaginally before bed. Push them all the way in so that your uterus is pushed up as far as possible. They are easily expelled in the a.m.

Christine

Thanks for your answer Christine. I've been working at this 2x per day for about 3 weeks - my back pain has improved at least.

My uterus stays place while I'm lying down in bed, so I don't think the cotton balls are necessary - it's during the day - especially when I'm standing, that is the problem.

Walking slowly, or faster for exercise is rubbing me raw - and the exposed cervix tends to be very wet, (no infection - I think it's just trying to sooth itself), so my panti-liners have to be changed all the time. I'm trying to stay positive, but wondering if stage 4 is just too far gone to be helped?

The point of the cotton is to push the uterus well back into place and the connective tissue into its “fascial planes” for several hours at a time. You may notice that your uterus is slightly higher during the day as a result. Every little bit helps and for many it all adds up to a livable condition. Every woman must decide for herself whether surgery is a viable option.

It is hard to know what to say - I am so sorry you are having such a hard time. I wish I could say something that would really help. Can only send my thoughts and best wishes that your situation resolves.
Hugs,
Wendy

just to let you know...I didn't see any real changes until I was working at this for quite a few months. I know my situation is vastly different from yours, I don't mean to compare, just to let you know that it took a while for me.
Its frustrating to be working so hard and not see results. I think that things probably are changing for you, just not visibly. if you're doing these exercises twice daily, and diligent about the posture, your body HAS to be changing in response to all of that. I don't know if or when that will translate into your cervix pulling up into your body, but I hope its soon.
what you describe sounds terribly uncomfortable to say the least.

Women are truly special beings - thanks to you all for your support and encouragement from my heart! I'm committed to working hard for 6 months, and then I'll re-evaluate my situation - and I'll try ANYthing!