new pessary user - I got questions!

Body: 

Hi,
I went to see a urogyn yesterday and he confirmed my suspicion that I have grade 2 cystocele (along with some rectocele and cervical prolapse too, though not symptomatic). I've been seeing a PT for this for about 6 weeks and it's been tremendously helpful but I am still limited in the activites I can do - I have not resumed running and I can't carry my 4-month old baby for more than about 20 minutes at a time before it gets symptomatic.

My PT recommended that I talk to the doc about a pessary for part-time use, and I finally did that yesterday. I had the thing in yesterday and it seemed quite comfortable until later in the day when it started to slide out of place, so I took it out. But today I notice a little bulge of rectocele that I didn't really have before. During my exam he had me bear down several times (which I try not to ever do!) and I am not sure whether that is the cause of the rectocele making a re-appearance or whether this is pessary-related?

I guess I'm just looking for thoughts on the part-time use of this... it makes sense to me to ONLY use a pessary when things start to slip out of place, to minimize any side-effects of the device. Or does it make sense to wear it for a couple weeks and see if my body can do some healing with everything in the "right" place? I'm only 4 months postpartum and I'm hoping things are still shifting around a bit.

Anyway, thanks in advance....

Hi,
I don't know if it is a good idea to use a pessary when you are only 4 months post partum or not. My instinct says no.
If the pessary fell out chances are it is too small. It can be very time consuming to get a pessary that is the right size and fit.
Things certainly are changing down there and you don't know how that wiil affect your pessary use size wise etc.
Why don't you look into getting a v2 belt to support things down there until they return to more normal.
You seem to be in a hurry to get back to normal but it can take up to 18 months for that to happen.
Relax and enjoy your new little one. They grow up very quickly.
Congratulations on the birth of your new baby

Regards,
Flora

Hi Karen

I agree with Flora about using the pessary so soon postpartum, only because your body is reverting to its former self and all your fascia are realigning themselves. My thought is that because a pessary stretches the vagina open to the width of the pessary that may affect the ability of the fascia supporting the vaginal wall to revert to its proper shape or to line itself up again with some chance of knitting back together, rather than gaping where it may be torn.

The other thing to remember about the postpartum stage is that, although you have been given the all clear at your six week checkup to resume exercise etc, your body has a different agenda. I think the six week checkup is mainly to ensure that you are feeding and looking after the baby OK, that the lochia has ceased, there are no things that are left unresolved, that an obstetrician could resolve, and that you have embarked on some sort of contraception plan. Obs are not *generally* interested in Mums after 6 weeks, though the recovery from childbirth takes a lot longer than that, with many bodily changes happening over the following year or more. Listen to your body before you do too much running for a while.

I think you need to get your posture organised, get a V2 belt as Flora suggested, for the time being, and enjoy your baby. The ballet workout in Christine's blue edition will help your muscles strengthen in a way that will work with your posture. It may seem like the V2 belt will let your pelvic floor muscles off the hook and weaken them, but when you are in WW posture your pelvic floor muscles are nearer to vertical than horizontal, and have only a stabilising role from the back, rather than a supporting role from underneath, for your pelvic organs. The posture allows them to lengthen out, rather than stretching them, so they will support your organs better and get their full range of movement in everyday activity. This in itself will strengthen them, so exercising them is not so critical. Muscles can only strengthen if they are allowed their full range of movement. If your pelvic floor muscles are always floppy, as they will be with your butt tucked under and your tummy tucked in, they cannot fully lengthen, so they cannot maintain and develop tone.

Cheers

Louise

Hi Flora and Louise -
thanks for your responses. Yes, my instinct tells me to use the pessary as little as possible, but I also feel like - from a fascia healing perspective - it's better to have things tucked in to close to the right place than hanging low. I've had the thing for 5 days now and I've only needed to use it 3 half-days so far (so about 18 hours total) which isn't too bad. I hadn't really thought about the V2 belt - do they work? When my prolapse is behaving I only have about a half-inch (from end-to-end) bulge of cystocele. When it's bad it's more like an inch. I guess I'm wondering if a V2 will be able to help with this small degree of prolapse or whether it would only help if things were sticking out a bit more. Also, since it's a compression type garment, is it likely to cause a yeast infection or similar? I tend to be prone to them.... I agree that at 4 months postpartum there is still a bit of healing to do, so I remain optimistic.
karen

Hey Karen- don't know anything much about pessarys or V2 supporters- but wanted to say that @ 4 months postpartum I still had the lion's share of healing left to do- I didn't even begin to feel good until a year or so -
I think you might like to check out Nauli.

I'm glad to hear that there's still lots of healing to do! I try and stay optimistic about the whole thing. Really, most days are good days, but it's a bit frustrating to feel like I'm modifying my activities to achieve that. The only thing I'm NOT doing now that I really really wish I were doing is wearing my 4-month old daughter (in a baby sling) more. This predictably bugs my cystocele, so I've stopped doing it, which makes me sad. But, she's huge (like 18 lbs) and it's just too much.