TOT Sling and Cystocele Repair

i'm sorry that surgery may have created a new problem for you. unfortunately, as most on here will affirm rectocele is one of the most stubborn conditions.
i have only read chrisitne's first edition book which i got when i first became aware of my rectocele.
there is good advice there and on these forums for conservatively managing your condition, and stopping it getting worse.
ultimately whether you decide to try conservative management or further surgery is a matter for you, but i think you are experiencing first hand the truth that there is no risk free surgical fix. also drs lie and scare us by telling us these things will only deteriorate. that simply isn't true. many do experience improvement (but less so with rectoceles) with the implementation of the "posture" (check the faqs section for details).
i would urge you to try the self help management tools (management not cure) with the realisation that further surgery is unlikely to be a permanent fix, and may well give rise to bowel paralysis, faecal incontinence, chronic pain, and pain on intercourse.
trying to fix a rectocele has been likened to trying to darn a pair of fine nylons! go figure that one out! for me my episiotomy was the first tear in the nylons and i have been left weakened there.

sorry if this message is mixed, but i think the first stage in progress is managing your expectations. if you are expecting a miracle cure which will permanently reverse rectocele either from these forums or from further surgery, i think you are surely going to be disappointed. if however, you want support from many women with many diverse life experiences who know just how you feel, and who will encourage you to accept yourself, surgical injuries and all, and who can offer advice on diet and lifestyle to minimise symptoms, then welcome. i hope you to can learn to live well with prolapse!

hi again tanja,

sorry if i sounded pessimistic. many of the internet sources talk glowingly of a high success rate from surgery, but i guess its how you measure success that matters.

here are a couple of links for your info
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uid...

"Posterior colporrhaphy corrects the vaginal defect in 76% of women. It does not necessarily correct and may contribute to bowel and sexual dysfunction, particularly in those requiring multiple procedures. The presence of the anatomical defect does not imply dysfunction. The prevalence of bowel symptoms suggests the need for close questioning about bowel habits and the selective use of bowel investigations for some women before surgery."

well, no harm, but i'm not that concerned abot the vaginal defect, whereas i am concerned about bowel and sexual disfunction!

http://www.femalepatient.com/html/arc/sig/advan/articles/029_11_030.asp

"Indeed, posterior colporrhaphy may place patients at higher risk for dyspareunia than patients who did not undergo posterior repair as part of prolapse surgery. The negative effects of posterior colporrhaphy may be compounded by the performance of a retropubic urethropexy."

i think all i mean is ask what is aeant by success when the surgeons claim 76% had improvement. if all they mean is there vagina had less bulges, but ignore the other problems that surgery may have created, the claims should be treated with caution.

hopefully your gynae won't just suggest a hysterectomy now. if he does read hersfoundation.org there is a link from one of the other forums. i read an interesting article to day about a 39 year old woman whose cystocele was "cured" by a hysterectomy only for her vagina to fall out of her 4 years later. in the picture she looked pretty slim and fit! she is now refusing surgery and self treating with a pelvic floor exerciser which increases resistance against kegels with springs!

Hi Tanja

Sorry to hear that your surgery has not worked out as simply as you would have wished. Here's hoping we can help you to avoid more surgery.

I haven't had any surgery at all, but have all three 'celes. Babs has pointed out that rectocele can be very stubborn and resistant to management, but I just wanted to point out that it is not always a persistent problem.

Yes, I still am bothered by my rectocele occasionally, but usually only when I have become constipated, usually as a result of being out of routine, perhaps having to get up early to travel and not having time to let nature take its course after breakfast. Or else have become dehydrated or just eating badly for a patch of time. Then I know that I just have to get back into eating properly, drinking plenty, and going to the toilet whenever I get the urge.

The aim is to get the bowel properly empty, and that might mean 7 or eight little visits in a day, but only for a couple of days until regular habits are restored. If it is stress related (and I don't have any control over the stressor), I also know that the stress will pass and my body will get back to normal by itself within a couple of days. I just have to remember not to strain at all on the toilet. If it won't come, it won't come! Sometimes if I can feel the pressure of the rectocele but don't experience the urge to go I do what is called splinting, which is inserting my thumb into my vagina and pressing the rectocele gently to kind of straighten out the kink. This often is enough for my body to take over, and the stool passes quite easily.

I hope you ultimately find it as easy to manage as I do. Others are not so fortunate. Splinting sounds yukky, but the relief it gives makes it quite acceptable to me. I only have to do it maybe once a month, particularly coming up to menstruation which is always a worse time of the month for 'celes (and everything else too! ;-( ) The rest of the time I don't even know I have it.

Just don't rush straight into more surgery. As long as you don't ever strain on the toilet, and look after your diet (plenty of fibre and lots of water), and aim to maintain good Wholewoman posture all the time it is unlikely that you will do any more damage or cause any more celes to develop. You may need a bit of time to learn how to manage your rectocele but if you can it is far better than more surgery.

You can always opt for more surgery later, but statistics tell us that the first surgery is usually more successful than subsequent surgery, so better to avoid more surgery if you can.

Keep calling back. Others will have more tips. You may be fine just managing it.

Cheers

Louise

Hi Tanja,

I am so sorry to hear of your problems. You are going to need to become very proactive now, as you may have bargained for far more trouble than you have any idea.

First of all, I’m quite certain most of the women here with “large” cystoceles would question how in the world such a condition was picked up by urodynamics, yet, you (seemingly) remained completely unaware of a bulge at the entrance of your vagina. You do not mention how the cystocele was addressed…this information is very important for you to know.

The vagina is basically a closed tube with the front wall resting against the back wall. All the incontinence procedures pull the urethra, which is closely related through fascia to the front vaginal wall, forward. Therefore, the front vaginal wall is also pulled toward the front of the body, creating a “tent” instead of a closed tube.

Intraabdominal pressure has a difficult time blowing the front rectal wall into a closed tube, but this process is greatly facilitated when the vagina is being held slightly open toward the front. Hence, the rectocele.

Rectocele is the least of your problems right now and as the study Babs just shared with us suggests posterior colporrhaphy only addresses the vaginal bulge, not accompanying bowel symptoms. By surgically fusing the back vaginal and front rectal walls, symptoms are often made much worse. When the vaginal walls and their adjacent organs are fused front and back, the pelvic interior becomes dysfunctionally immobile – more like a solid block instead of organs moving freely along their fascial coverings to carry out independent functions.

We have at least three women (plus Louise!) I can think of off the top of my head: Sybille, Jane (fullofgrace) and Susan (howdidthishappen) whose rectoceles improved with this work. I’m certain there are many more.

A polypropylene sling placed under the urethra of a young, sexually active woman is a serious problem. Erosions into the urethra are very real, much more common than the public has any idea, and extremely difficult to deal with. Understand that you have been done a grave injustice if you were not fully informed of these facts.

One of the truths about female prolapse and incontinence that urgently needs to be either proved scientifically OR agreed upon by a large body of women and then shouted out to the rest of the world, is that SIGNIFICANT CYSTOCELE PRECLUDES INCONTINENCE. The bladder does this by falling backward and in doing so kinks the urethra. It is true that women then have to deal with symptoms of not being able to empty completely and also the bulge. This seems to be the natural process of prolapse in many, if not most, women. A slight rectocele usually moves into the back wall as well. This is the most common presentation of prolapse in the developed world. However, through postural and lifestyle changes symptoms often become very manageable.

There is no surgery that “lifts” the bladder – only ones that tether the urethra to the front, providing another version of “kinking the hose”. Cystocele “repair” pulls the vagina itself more tightly together down the middle of the front wall, or along the sides/front where the pelvic “floor” muscles attach. Newer, completely experimental surgeries attempt to lay a wall of mesh in between bladder and vagina. These are all fruitless surgeries that almost invariably cause additional, and often far more serious, problems.

I hope you will continue to share your story with us. It is only through the efforts of women themselves, who have been damaged by UNPROVEN operations, that real change will happen.

Wishing you well,

Christine

Many doctors simply do not know any better because the world they operate in is a closed system with very skewed perceptions (we’re about changing that). I would ask him to provide you with long-term scientific data (this means large, prospective studies carried out by completely objective inquiry – not by doctors themselves, teaching institutions that have designed and formulated the medical model, or companies that make the products) that alloplastic slings are being well-tolerated in thirty-to-forty year-old sexually active women (this would mean women who still have their uterus). We know there are no such studies available because these products were aggressively brought to market long before adequate data could be collected.

Furthermore, I would encourage you to ask him to predict how your tissues are likely to hold up around an impervious foreign object thirty or forty years down the line when pelvic structures are known to shrink and thin. Removal of the mesh at that point would be harrowing at best.

i had a look at the forums on that good old site pelvicfloor.com

looks like mesh erosion is quite common guessing by the moans on the forums - just look!

http://pelvicfloor.com/pwrx/pages/page.jsp?P_SITE_ID=12&P_PAGE_ID=293

hey tanja:

i haven't been posting much at all lately, but this thread caught my eye and as i got a shout out on it from christine -- :-) -- i wanted to pop in and just say hi and tell you that i came on this site in december with a verrrry symptomatic recotcele and can confirm for you that, in fact, this work has improved it enormously...ENORMOUSLY! i have read again and again that rectoceles can be very stubborn, but this has become pretty much completely managable for me -- to the point i have to remember i have a rectocele so i don't get lazy lazy with my diet and posture. i felt it constantly at the start, had rectal pressure and had to splint to have bowel movements -- it was a rough time for me. but, now, honestly, it's just a structural shift in my body that is really causing me no problems.

please do educate yourself about what's going on. that's definitely the best way to go. there ARE options out there -- and you have found this site so, in my opinion, you have found the best source out there for non-surgical ways to stabilize yourself. and it is doable. no question. christine is a maverick, really and truly....going where no medical doctor is brave -- or smart -- enough to go. remember, doctors are taught to cut. that is their skill. and i'm glad it exists. however, for this issue, the statistics aren't great for what it can do. the experiences of the women here -- my own experience -- tells me that this is the way to go.

good luck to you, tanja. stick around! there's a huge amount of information and insight here.

xxsusan

I got a bit worried there peeps when i read the words 'mesh erosion' cos I had to have mesh to repair a recurent hernia. I guess this is a very different type of mesh lollll. My Dr told me with mine scar tissue will go through and become part of it?

I guess being flat in the belly is also alot different to being in a place that is such a moveable place?

*Waits to be freaked out*

All I want is for this recurrent hernia nightmare to be permanently over :(
In saying that I feel fine now (3mths post op)

Sue

Look into the eyes - They hold the key!
http://www.bringmadeleinehome.com/img/maddy544x150Banner.jpg

Yeah, you might be feeling a bit stupid, but there are worse ways to feel. You still have your uterus, right? Now that really is important!!

It is so, so hard to be rational in the face of specialist doctors, especially when they change their minds the day before an op. You can't be expected to know everything, and ask *all* the right questions. You are not a person with specialist knowledge, are you?

Just go easy on yourself girl. It may well work out OK. You are now more experienced, and have found this site, so you will now be in a much better position to decide what happens from here on. And you can call back any time for support and encouragement. It really is a good place to be part of.

Take care.

Louise

I just want to comment that good ol’ Dr. Pelvic Floor is a true-blue, dyed-in-the-wool reconstructive pelvic surgeon whom, before Whole Woman™ came on the scene, had no grasp of the actual position of the female pelvis in the body (an error with profound implications for female pelvic surgery), promotes surgery over conservative methods, and is one of the most vocal advocates of elective cesarean for the prevention of “pelvic floor” disorders. Furthermore, after coming out against the new mesh surgeries and proclaiming his team was going back to standard A&P repairs (this was after he had posted on his site that standard A&P repairs should be discontinued in favor of newer and better operations), he has once again flipped his position using the tired “if done by the right surgeon” reasoning. Dr. Pelvic Floor is not an advocate for women’s health at any level.

.... but i wouldn't let him near mr with a scalple in a month of sundays!
i think his forums make for the best advert for conservative management and the rejection of surgery i have ever seen!
it is really depressing, complete with "tish" the unfortunate woman who seems to have endured/ guinea pigged every single surgery out there, and is now counselling others from the wealth of her experience.

woman after woman has had to endure multiple surgeries, with each surgery giving "success" only for a few weeks later for us to read of a new prolapse or problems with mesh, defacation or sex!

i think there has been complaints here before that the women who have repairs don't come back to tell us about success. well, dr pelvic floor's forums are full of women who have had surgery which has compounded and ultimately deteriorated their conditions.

i think you can trust us to be discerning, christine. when i posted the links it wasn't by way of recommendation, and anyone who troubles themselves to read his forums will see the best advert for the non surgical approach that you advocate!

as to his "answer" to pelvic floor, which is let me cut your baby out, well that is simply risible.

someone lefta review of his book at amazon called "untruths" and that sums it up.

many women get pop even with sections as zandria recently pointed out, and for those who don't get pop because of a section, they are simply trading one set of woes for another.

i have a friend from primary school who had to have two sections and now has chronic pain and IBS from adhesions. so no thank you dr pelvic floor, i'll persevere with posture work etc.

christine, i do appreciate your work. it has helped me, butit is a journey for each of us, and sometimes a path which is right for one will not help another. i think that is why we need as many tools as we can get to help.

i would also encourage you to brainstorm as you were doing about the women like me who have a surgically damaged and atrophied perineum, and whose rectoceles were created by deep episiotomies and repeated tears. i do think the normal intra abdominal pressures are interfered with as our vaginas get pulled in strange directions by scar tissue at the rear.

i continue to find the bridging is helping, as i know i will remain prone to rectocele symptoms for the rest of my life.

i am due to go back to the yoga next week. from reading the teacher's site and reflecting on what she taught me last time, i realise that we were practicing "locks". her website refers to "Ujjayi Pranayama (the victorious breath ) which energises and warms the body quite quickly; and Bandhas (internal locks), which help to strengthen the back and abdominal muscles"

my cervix and womb are definitely higher now than they were before my pregnancy. i think the posture is coming to me, but now i try and fill my lungs and ribcage when i breath, walk tall, lift my breastbone. my lower spine naturally falls into line, with comfortable and natural curve in my spine!

i have also bought a kneeling chair!

I guess his humor is lost on me. But not his extraordinary arrogance as he exclaims “ta-ta” before embarking on his fabulous sailing trips…meanwhile ignoring dozens of urgent questions posted by damaged and scared women left twisting in the wind.

... i meant funny peculiar more than funny ha-ha, the distinction behind finding someone's whole concept ridiculous (performing unnecessary and dangerous abdominal surgery which itself is fraught with risks and lifelong side effects, and scaring/ blinding with science a whole generation of women that this is necessary otherwise their insides will fall out), and thinking they are a comedian who you laugh with. although in another sense it is a tragedy and a travesty that this represents the thinking of conventional medicine. (apparently one of our local female consultant obstetricians shares his views!)

he is very arrogant, and my heart does go out to he myriad of damaged women whose pleas for help he ignores.

but his forums are still an education for anyone who might still harbour the wishful thought that there is a surgical cure for pop!