4 months postpartum - cystocele - stage 2 or 3 - surgery now? too soon?


Well after 9 months, he was born in June. No complications - total of 6 hours - pushed for 2. He was 9.5 at delivery and I had a 2nd degree tear. No big deal. The 6 week check up - no problems. The 8th week - packing to move, nursing (no estrogen) and a strain in the bathroom - welcome Mr. bulge! Now at 4 months PP, the doctor says it's a vaginal muscle tear and I tore open the episiotomy too - great work huh? Anyway, at this point I have some options - but first some about me. I am (was) a very active 39 y.o professional. We would like to have another child - maybe 2. I am in shape (135 at 5'10"), a non-smoker (although right about now I am considering starting)...

1 - Have surgery at 6 months PP to repair the bulge and pull back the uterine ligaments (he says are weak/stretched/torn - not going back into position)

2 - Forget the surgery until after we are done having children

I am currently in physical therapy learning how to strengthen the pelvic floor muscles - before this happened, I had never even heard of a kegel - and am seeing slow results. I am on my feet all day and gravity is working against me, especially by the end of the day. I am getting more depressed about the way this feels - the bulge that is - and that I just don't feel sexy/attractive anymore. My husband is very supportive and understands most of what I am feeling, but like I told him - he's use to something hanging between his legs, I'm not.

My questions are these:

1 - How long does it take for the pelvic floor to heal after childbirth? It seems to me that dr's recommend waiting a yr between pregnancies so the body can heal, but the surgeon is suggesting surgery at 6 mos after the birth?

2 - Can this ever heal? Can muscle heal or is the only option surgery?

3 - Can I have more children if I have to have the surgery?

4 - How effective are kegels/physical therapy - long term that is?

I want my life back -

Hi Snook,

From my point of view your present problems have nothing to do with your pelvic “floor”. There is a split down the entire length of these muscles – from pubic bone to anus – like a part in your hair down the middle of your scalp. The superficial muscles of the perineum, including the sphincters, fill in the split while providing opening and closing of the apertures. You can tighten those muscles all day long, but it’s not going to help the weakening of the central tendon of your pelvis, which exists at the lower level between vagina and anus. This weakening occurs from both structural and nerve damage of the episiotomy. The blowing out of your vaginal wall happened as a result of living and straining in unnatural positions rather than any defect in your pelvic diaphragm.

If you feel that your vagina is gaping, perhaps a superficial repair will be of some benefit, but understand that surgeons have long known that sewing together the deeper pelvic wall muscles down the midline can have disastrous effects, like pain with sex and difficulty emptying your bowels. Opening of these muscles is really more important than tightly closing.

Working to gain strength in closing them is beneficial too, but for reasons other than the goals you seem to have in mind. They are a significant part of your urinary continence system and also are what hold the penis during intercourse. Your vaginal opening can be as gaping as can be, yet your husband will not know the difference because it is the friction from the pelvic wall that counts. Kegels will do nothing to reduce the cystocele and anterior “repair” is fraught with failure and untoward side effects like urinary incontinence and loss of clitoral sensation.

Understand there is no viable surgery that “pulls back the uterine ligaments”. First of all, these are not true ligaments, but stretchy vessels that carry important nerves from our spine. There is great risk of chronic pain (lower back to legs) when these vessels are “shortened” and “strengthened” by wrapping them with permanent suture material.

Many of us have learned there is no easy fix for the disruption of the back vaginal opening caused by ill-conceived obstetric practice. However, when we begin to re-configure the pelvic contents as well as the entire surrounding support structure, our organs move back toward their natural positions.

To answer your last question, post-pelvic-reconstructive -surgery pregnancy is risky to both mother and child.

Wishing you well,


Dear Christine,

It has taken a long time for me to visualise all of this even after so long but I think I am getting there finally! However, I have a question for you if you don't mind? Why would someone like myself have seen such a quick and dramatic improvement in my original uterine prolapse unless it was something to do with softening of ligaments and "stuff" holding the uterus up post partum? I literally pushed it back up, kegeled myslef to death for weeks, (which I now know was a complete waste of time), and yet it never prolapsed again, and I hope never will! :) Also, I didn't start the postural weeks until several weeks after all of that. Can you shed some light on all this? I have asked Dr's the same question and they all make reference to those soft ligaments, and stretched pelvic floors etc etc! I would so appreciate your opinion on this! Thank you as always!


Hi Michelle,

Well, first of all I think we have to consider just how strong and stable the natural design of the female body is. How amazing ALL of us don’t pop our uteri out with every birth and yes, even more astonishing is the post-partum uterine prolapse that recedes completely with no further problems. This includes women who “deliver” their uterus during birth and have it immediately replaced with no lasting ill effects. But is it really so amazing?

My explanation is that the young body corrects toward its natural anatomy. This is accomplished with every breath you take by the respiratory diaphragm pulling the lumbar spine forward and flattening the pelvic organs toward the front of your body where they are pinned into position. In a strong body trying to correct toward normal, manually replacing the uterus would sometimes be all that is necessary for the natural pelvic support system to once again take over and maintain it in that position.

How odd that “we” (medical science) focus on a couple of basically static structures – the uterine ligaments and pelvic diaphragm – as the mechanisms gone awry in prolapse instead of considering the whole, dynamic system from which pelvic organ support is truly derived.

Hope this helps!


It does help! Thank you Christine! :)