Can pessaries make things worse???

Submitted by Lindsays on September 21, 2007 - 12:04pm
Body: 

I was fitted for a pessary a week ago Wednesday for a stage 2 cystocele and uterine prolapse. I was at the urogyn's office for more than an hour. She gave me a ring pessary with support and kept on going up in size as she thought I would lose it. I ended up with a size 5. I could not remove it in the office, however I thought perhaps it was because I was tense having eyes on me in a most undignified position. The urogyn told me to call if I couldn't get it out, make an appointment and she'd remove it for me...there is no way I was going to run back and forth to the office to have this done on a permanent basis!)

When I got home and relaxed, I tried again. I could barely reach it, let alone pull it out. Finally, after much pushing (which panicked me...) I was able to get it out. It was so stuck that I actually had a tear in it near the larger hole. I could feel it in me, and thought it was too large.

I felt as if my anatomy had been "sucked down". When I looked I could see my cervix. This happened on Sunday. On Monday morning I called the urogyn... They told me to come in on Friday. I just came back and not have a retrocele that didn't exist a week ago! Could this be from my pessary? I had to see a nurse practitioner today who gave me a dish type pessary that she thought was too small (they didn't have the next size.) At least I could get it out. Has anyone had similar experiences?

Christine

September 21, 2007 - 12:30pm

Hi Lindsay,

Yes, we’ve had enough women experience new-onset rectocele after initiating pessary use that I wrote about it in my book! The last time I removed my ring-with-support I had to dig it out from being completely enveloped by my back vaginal wall. It didn’t do any permanent damage, but I knew that was the last time I wanted to wear it.

Christine

Lindsays

September 21, 2007 - 6:27pm

Thank you Christine for your reply... I have your book and have been reading it in sections, but somehow missed that section. I also bought the dvd. I don't even know where to go at this point. I cannot completely empty my bladder. I went in telling them this and they had me go through the delight of urodynamic testing for them to tell me that my bladder didn't empty completely!!

The pessary did enable me to empty completely, and I thought, this is great... not too uncomfortable... I will get used to it. That was until I had to remove it... a nightmare... I could barely reach it, let alone get my finger in the little hole to pull it out and down. I am working on the posture and exercises... I cannot always sit in posture because of my work (I am a school principal and straddling a bench isn't always a great way to sit in the skirt of my suit :-). I also drive a great deal. At school, I sit at the edge of my chair with my back straight, and as much in the posture as I can be. In the car, I attempt to sit as straight as possible. I know that the exercises, etc. will take time.

Meanwhile.... I was told that surgery is pretty much inevitable. I am looking for Connecticut health care practitioners who will consider long term treatment of uterine, cystocele and now retrocele! without surgery... any ideas? Also regarding self-treatment... aside from the recommendations in your book, what do you recommend?

Christine

September 22, 2007 - 11:33am

Well Lindsay, about everything I know is in the book. You could try a daily program of firebreathing (in the book) or even more intense stomach lifts such as Alemama has described (see the Bodywork forum “How do I describe it? And does it really work?”)

There are lots of good adjuncts to this work (massage, craniosacral work, etc.) but it’s clear that for many of us, the key is in the way we hold our spine and pelvis throughout the course of the day. For me it is posture, diet, clothing, no-straining, and my exercise classes. I just love the firebreathing, but often don’t take the time to do it. However, when I am having a bad bout – like after my last (hopefully ever) period – I am so grateful I have the firebreathing to help bring me back to baseline.

The pessary issue is complicated. First of all, it is a reality that the most common presentation of prolapse is cystocele-rectocele. Many, many woman discover first one, then the other shortly thereafter – pessary or not. You may well have developed rectocele all the same. Therefore, if the pessary is greatly helping other symptoms, it may be worth it to continue with it while keeping an eye on what’s happening with your back wall. I understand that it was very difficult to remove, so you will have to weigh the benefits over the risks.

You have that sort of panicky edge to your “voice”…something we at wholewoman are very accustomed to hearing. You’re in the early stages of prolapse recovery and it will take some time working with the posture to understand that it is within your power to stabilize your condition. You will probably always live with some bulging, but hopefully a point in time will come when you will know it cannot get any worse if you keep holding your organs over their natural floor – the pubic bones.

I think it is good you are looking for a healthcare provider, but I would like to ask…what is it that you expect them to do for your prolapse? The only way they can help you empty your bladder is to provide you with a pessary, a catheter, or a trip to the OR. Just what is “long term” medical treatment for prolapse? We know it is not endless series of kegels, variations of which are standard PT protocol. What can medicine do for you? The truth is, medical science has not performed one study inquiring into the natural progression (or not) of prolapse.

You might have heard me say that these are not even medical conditions. If we must give them a medical name they are really orthopedic conditions. When they are responded to by gynecologic surgical treatment, the underpinnings of our natural pelvic organ support system are usually ruined.

We women are coming to our own conclusions that this work is in our hands. Only we can change our posture, our breathing habits, our toileting habits, our diet, clothing etc. etc.

Anytime we want the medical system to take over they will certainly oblige. But we all know that after a pessary trial standard treatment for prolapse is major reconstructive surgery.

The results of this work are usually not earth-shaking and it takes time and effort to make such deep and lasting change. Some women are up for it and others are not. Sort of reminds me of my perception of the difference between religion and spirituality. One relies on faith and a higher power to do the work for them, while the other relies on their own experience and effort to create change.

I believe you can do this, Lindsay.

Christine

louiseds

September 23, 2007 - 12:05am

Hi Christine

Thanks for saying all this. I was wondering how to say something similar re medical help.

Re religion and spirituality I have a slightly different take. Belief in a higher power enables me to ask Him/Her to take me by the hand and walk beside me on any difficult journey I embark on. It also includes asking Him/Her to help me to come to grips with the time, effort and self-discipline that I need to drag out to do the more difficult things that are required of me, and to actually follow through and do what I do not want to do. There is no less effort but I can share my load.

Cheers

Louise

Christine

September 23, 2007 - 11:28am

yeah...I pray a lot too! :)