RECONSTRUCTIVE PELVIC SURGERY – A MATTER OF BALANCE?

Submitted by Christine on September 9, 2007 - 3:41pm

As 21st century women living with symptoms of pelvic organ prolapse, it is reasonable to bring our hopes for a cure to the surgical arena. After all, medical science continues to astonish us with ever more advanced solutions for amputees, heart patients, and those suffering from brain tumors. Mesh used in reconstructive surgery is ever improving and there is no doubt the elusive “perfect mesh” will be developed…perhaps a bio-compatible carbohydrate fabric that encourages perfect lines and planes of scar tissue before dissolving completely. But no such mesh has been developed and the technology of reconstructive pelvic surgery remains a very blunt instrument. It is time to leave behind the argument whether the surgical fix does or does not work. The deeper truth is that it CAN’T work.

Surgical entry into the spaces surrounding the vagina is itself very damaging. To dissect the bladder away from the front vaginal wall, or the back vaginal wall away from the rectum is to lose the fine tissue (fascia) that allows sliding movement between the organs – movement that is essential for independent functioning of the pelvic organs. Surgeons have conceptualized prolapse as a need for strong barricades behind the vaginal walls, but have given no consideration to what happens when the organs can no longer move independently of each other because they are fused together with mesh-enveloped scar tissue.

Indeed there are women whose symptoms are improved after hysterectomy, vaginal bulge-reducing colporrhaphy, and incontinence-alleviating urethral sling placement. Yet, surgeons have known for over a century that these improvements are usually very short-lived.

This is because dissecting, narrowing, and “strengthening” the vaginal walls has done nothing to address the underlying cause of prolapse. It has merely treated the symptoms. The bladder, urethra and rectum are still prolapsed and will most likely become symptomatic again, often in far more serious ways, such as the rectum bulging through the perineum or the small bowel herniating behind the bladder (anterior enterocele).

It has been a grave mistake of gynecologic surgery to treat prolapse in such concrete ways by immobilizing organs that are meant to be highly mobile. And that mistake is echoed in post-surgery women who repeat over and over again, “In order to have the best possible outcome, I must move very little and not lift anything over a few pounds”. Such reasoning is missing the point entirely.

SIMPLY STANDING AND BREATHING CREATES TREMENDOUS INTRAABDOMINAL PRESSURE. The pelvic interior is constantly moving, moment-by-moment, hour-by-hour and the ONLY thing keeping the bladder, uterus, and rectum from being pushed out the hiatus is an elegant design created over millions of years of evolution and/or by the grace of God.

Intraabdominal forces will move through the pelvis no matter what and the configuration of the pelvic interior will define whether the organs are pinned into position or blown out of the body. Because the organs are wrapped in and suspended by endopelvic fascia, that configuration is dependent upon the shape of the spine and pelvis.

A call for balance becomes meaningless when the system itself is faulty. Certainly in cases of trauma and gross disease reconstructive treatment is justified. But it should never be performed as a “fix” because there remains no viable surgical solution for prolapse.

Women will always find reasons to be the exception to the rule and doctors will always find further justification for the surgery. However, until it becomes possible to recreate natural female pelvic anatomy through reconstructive surgery it is a foregone conclusion that these operations make women more, not less, vulnerable to prolapse, as well as a host of other disabling post-surgical conditions.

Comments

Clonmacnoise

September 9, 2007 - 4:12pm

Christine,

Thank you very much for a beautifully defined reason not to tamper with this and to avoid surgeons. Many of us who live as natural a life as we can in the 21st Century appreciate your work and what you have to say.

Is there any realistic hope for natural repair? Can we hope to strengthen the whole area? Doctors say this will simply get worse; is that necessarily true? Louise talks a lot about stabilization.

Judy

Change what you can change; be happy with what you cannot.

Christine

September 9, 2007 - 8:26pm

Thanks for joining us Clonmacnoise and for working to understand the concepts behind the fallacy of the surgical fix.

I think it’s very common for women to get to a point where they understand, at a visceral level, that their prolapse has stabilized for the long term. Many women seem to reach this stage, yet there are also women for whom prolapse seems to steadily progress. Why this is so I do not know, but I fervently believe if you are honoring the natural shape of your spine, are no longer straining on the toilet, and are exercising regularly, in all likelihood your prolapse will not worsen to any significant degree…for the rest of your active life.

MeMyselfAndI

September 10, 2007 - 10:59am

This is a great post Christine...

I really think that sometimes Doctors think they can fix all - And they really cannot and lead us into a falso sense of security beieving what they say. We blindly believe then because we are scared and desperate and they see dollar/pound signs a flashing - Or maybe they just think they are God - Who knows.

Either way - They know it wont last that long - Nobody asks them HOW MANY YEARS WILL THIS LAST FOR ME. Cos their answers would be 'I don't know'

I still fear the mesh for my hernia breaking down and causing a whole host of problems - A HUGE fear of mine...

Fantastic post - Very informative.
Sue

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

goldfinch1

September 10, 2007 - 3:17pm

MeMyselfAndI:
A lightbulb just went off after I read your post - I had an inginual hernia 12 years ago on my left side. The surgeon put in mesh and I've never had any problems with it. Only once in awhile I could feel the scar tissue around the mesh pull if I strained lifting, etc (which I don't do anymore now that I have a uterine prolaspe). I was never told that this mesh might not last. Something new to worry about? Thanks for any info you might have.....Goldfinch1

MeMyselfAndI

September 11, 2007 - 1:04pm

I have nt been told in any way that it will not last - It is just a worry I have. man made things have a tendency to not last but if yours has lasted 12yrs then that is pretty cool :-)

Sue

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

Patricia

October 11, 2007 - 9:23am

I'm so happy to have found this site as I was just diagnosed with Uterine Prolapse at Stage 1. I am currently waiting for an appointment with a D.O. who has suggested via a phone call that she will look at pelvic positioning, posture as well as natural hormones as possible avenues for treatment. I am still reeling from the very insensitive appt. with my GP in which no other info was given (exercise suggestions, precautions, etc.) except the diagnosis. I have read several other posts and now understand that my sadness, fear and grief are simply all normal parts of this.

Surgery is not a viable option for me as I have a platelet disorder and need to be concerned about excessive bleeding. After reading the various posts here, it's a bad idea anyway so I'm relieved at that!

Thank you to all of the women here and Christine who have posted their true feelings and expressed them so well. I'm at the beginning of this new journey and I look forward to being a part of this community along the way.

I will gladly offer help and information to anyone in need as well. I have 20+ years of homeopathic experience as well as potentailly helpful information with regard to good sources on natural treatments should anyone be interested.

Thanks for the opportunity to join and post!

Christine

October 12, 2007 - 10:31am

Thanks so much for joining us...I think your post kind of got buried over here in the blog section.

Yes...the surgery argument really has nothing to do with "moderation" - a point some women refuse to understand or accept.
Pelvic surgery to remove an ever-growing dermoid cyst is good and right and healing. Conversely, the pelvic support surgeries are misconceived and disastrous. Do we need them for cases of trauma, gross disease and malignancy? By all means. But the majority of women are far better off without them.

Thank you very much for being here!

:-) Christine

Maggie123

October 22, 2007 - 5:28pm

I have been diagnosed with Pelvic Organ Prolapse for several years. My bladder, uterus, and bowel have all descended. It is the result of hyper-flexible connective tissues and 3 vaginal deliveries. I do not know at what stage I am classified. I do know that my doctor told me my cervix is less than 1.5 cm from the opening my my vagina. Just sitting here typing I can feel the same pain in my cervix I felt about 3 weeks before I delivered my children. Intercourse is out of the question. I cannot even wear a tampon because it gets pushed it out.

I am not yet 40 years-old. I am very fit and slender. I do pelvic floor exercises every day.

The surgeon and I discussed both a hysterectomy and leaving in my organs and supporting them with this new mesh manufactured by Johnson & Johnson. After reading some comments about how the mesh immobilizes organs that are supposed to be mobile, I do not know what to think.

I am tired of being in pain, urinating on myself, not enjoying sex, and not being able to run. I feel like I am at my wit's end, yet do not want to make a choice that I regret (that's what ex-husbands are for).

What advice and/or guidance can you give me?

Thank you in advance!

wenz

October 27, 2007 - 10:55pm

I am sorry that you are in such an uncomfortable position with your prolapse. I am 53 now and my prolapse worsened about 2 and a half years ago after a bout of constipation (sorry if that's TMI). Anyway, my GP referred me to a surgeon and almost guaranteed that I'd have to have surgery. I wasn't in pain, but I had a definite bulgy feeling around my vagina. The surgeon examined me, didn't give me any specifics but left it up to me basically as to whether or not to have the surgery (he also prescribed hormonal pessaries). Not long after this my husband left me. I was in shock and having the prolapse issues didn't help at all. I decided to put off the surgery, start pelvic floor exercises, walking and fixing my constipation probs. I also lost about 2 stone in about a month through the nervous shock of the separation. Anyway to cut a long story short, I never went back to the doc about surgery after I found this site. Gradually over the last 2 years my prolapse improved almost to the point it was before I started having problems with it. What I am trying to say is that it takes time, a lot of it in my case, but my last examination, my doctor said that there was a good finger length to my cervix now, and that I should do the pelvic floor exercises for the rest of my life, and surgery didn't always work ie, some women end up with the prolapse coming back. So I thank goodness I made the decision to wait and see. When I think about it, I was almost convinced I should have the surgery. I'm really glad I didn't and every day when I feel that things down there feel great, I thank my lucky stars. All the best with whatever decision you make.
Hugs,
Wendy

Christine

October 23, 2007 - 2:13pm

Hopefully you've had a look around the site to see how many of us are living well with prolapse. Everything you need to know about the work is contained in my book Saving the Whole Woman, 2nd ed. (www.wholewomanstore.com)

You will find untold cases of women suffering with the effects of surgical mesh implanted behind the vaginal walls at www.hystersisters.com. It is an epidemic, but doesn't stop women from continuing to sign up for the surgeries.

This work does require physical, mental, emotional, and even spiritual commitment to trust that our original design has the capacity to respond to prolapse. It is not for everyone, but many women have found it useful.

Wishing you well,

Christine

binskella

November 17, 2007 - 5:47am

I have a question. I am 34 years old and pregnant with my third child. I just went to the doctor's yesterday because I felt like I had a tumour in my vaginal area. He said I had a cystocele and that I will probably need to have an operation after I give birth. Will this not interfere with the whole delivery process? I can't find much info on the internet about it during pregnancy.

Thanks,

Robyn

alemama

November 17, 2007 - 6:37pm

Welcome Robyn! thank goodness you found us before your delivery. Gentle birth is the way to go. Look at the FaQs and ask any questions you might have. Oh and use the search engine too-

Arosebud

November 25, 2007 - 5:30pm

I am new to this forum and have read with interest about living with prolapse, and the descriptions of what the various prolapses are. I have been diagnosed with enterocele, classed as "severe" I can see it as it is down so far. I also have to struggle a bit to pass stool. My new gyno diagnosed me, but did not check the rectal aspects as she said she didn't want to put me thru it at that time. I guess my question is, can a person live with a severe enterocele comfortably by reversing it in some way without surgery? I had a vag hysterectomy including ovaries, and A & P repairs 15 years ago with a bad side effect of overshortening or over-tightening up a muscle or something so I have had chronic pain ever since. Mayo says this can't be fixed. So now I feel I am headed for surgery again and it scares me to death! Interested in any helpful comments. Thanks Sylvia

Christine

November 25, 2007 - 9:15pm

Hi Sylvia,

Sorry to hear you are dealing with this common, yet serious post-surgical event. I wish I had a pat answer for you but I do not, mainly because I do not know the risk ratio of a low enterocele suddenly becoming a life-threatening evisceration.

It may be that another surgery to close the gap at the top of the back vaginal wall, where the bowel is dropping down from, would be in your best interest.

Women with surgically managed prolapse (and this includes all post-hysterectomy women) really need these questions answered by their trusted physicians, as all bets are off regarding natural approaches since the internal pelvic anatomy has been so greatly altered.

I am sending you lots of love and hope for a healing outcome.

Wishing you well!

Christine

ChannelD

June 15, 2008 - 11:39am

I am so grateful to you for your clear, concise blogging. When my doctor first diagnosed me with what turned out to be a rectocele although she couldn't tell right away, just gave me a choice of urethrocele, rectocele or whatever-the-fancy-word-is-for-bladder-cele which I forget now, her first suggestion was that I be evaluated by a gynecologist (who turned out to be a urologist) for surgery to repair my pelvic floor. She said this like it was the 'of course' next step, as if she were diagnosing me with appendicitis with surgery being the logical outcome.

By the time I got to the urologist I had read your blogs and the other comments on your site so I ixnayed the urgerysay which (only after that) he agreed would probably not really help. So thank you thank you thank you, and I am fully aware I have only brushed the surface of this site.

Cynthia

traffic101

November 13, 2008 - 11:22am

Your blog is nicely written and very helpful.Medical technology has a great contribution in our everyday living.The real meaning of balance on this is,clean and safe living.And awareness of what we do,eat,etc. and the effect in our health.

Beauty