Cystocele post hysterectomy

Hello Kate and welcome,

I’m very glad you found us too, but cannot give you a definitive answer to you question, because we do not yet know. I can look a wombed-woman in the eye and say, “It is very likely you will improve with the WW work”. However, I cannot give the post-hysterectomy woman that same assurance. This is because it is the uterus that lifts the entire pelvic contents into their normal positions. This sounds odd until you learn that the uterus is constantly being pulled forward - and brings everything forward with it. These organs do not fall down, they fall back from the abdominal wall.

An analogy I often use is that of an umbrella. Even when turned completely inside out, an umbrella is still an umbrella with its hub stabilizing the entire system. If you remove the hub, it becomes something else entirely - something completely destabilized. The pelvis is really no different.

What now? From my perspective, you are far better off avoiding further surgery. The operations are not based in anatomical reality and seem to simply cause further damage. You give no indication that you had vaginal wall surgery along with the hysterectomy. This is good. It is important now to create as much natural anatomy as possible. This means your bladder and intestines still need to be carried forward and your vaginal walls need to flatten against intraabdominal pressure. The top of your back vaginal wall is likely still connected to your intestinal fascia and by carrying everything forward, hopefully your vaginal walls will be pulled up into their normal axes as well.

This work is not at all about how much exercise we can do. Rather, it is how we breathe and how we hold our body throughout the course of the day. This is head-to-toe posture and we never “try” to curve our lower spine - you will see when you watch the dvd.

Please keep us posted, Kate, as we are genuinely interested in hearing how you do. If you sense this or any other exercise is aggravating your symptoms, you should stop and reevaluate.

Wishing you well,

Christine

Dear Kate,

The problem with “core” work is that sort of exercise often places the pelvis in counternutation (explained in the book), which destabilizes the supportive mechanics of the pelvic interior. The female core is at our hips and building the buttocks is far more important to pelvic organ support than standard Pilates-type abdominal work - which is stressful in many ways. Kegels are the wrong concept as well. For the pelvic floor to be truly supportive, it needs to be stretched to its full dimensions so that it rebounds intraabdominal pressure like a trampoline. We do not have a hole in the bottom of a floor. The hole is at the back in the middle of a wall. In normal anatomy you carry your pelvic and abdominal organs toward the front and away from the back.

This is key:

Although cystocele and rectocele can be problematic in post-hysterectomy women, it is enterocele - or loops of bowel pressing down on the top of the vagina - that causes the severe kind of prolapse requiring surgical intervention.

I ask, if you are habitually holding your intestines toward the front, how can they prolapse out the back? You may have vaginal bulges, but if they can be managed with posture and external support garments is that not preferable to having the top of your vagina tethered to your spine by way of a deep and risky surgical operation?

I hope this makes sense to you and that you stay connected with us over the long term so we can know how you do.

Many blessings for good health,

Christine

thank you for your wisdom and I hear that much of it comes from your real experience. I am learning and this is a great site with a wealth of information. I have avoided a pessary because I have spoken with women who have had repeated infections as well as tears in the skin from having thin skin. Since I have not taken hormones and am well beyond menopause what do you think of a pessary?

I think at least going through the drill of trying to find a pessary that works to hold the vaginal walls back is a good idea. Use a good, organic lubricant and see if it eases your symptoms. The ring with support will sit vertically in between the vaginal walls and hopefully hold the bulges back while still allowing the walls to flatten against intraabdominal pressure.

I am dealing with cystocele as well following hyst-- also mesh infection and am having trouble deciding the path i wish to follow and will reverse my decsiion so frequently that it is stressful for me-- obviously i can live llike this but a better quality of llife may be there for me... I cannot stand too long - can't bear it ... did harldy any christmas shoppin this year... am delighted to just sit and stare sometimes -- sitting is such a relief..

Hi Sammy

I don't want to make light of your plight, but I figure that anything that can cut down the amount of Christmas shopping has to be a bonus! ;-)

However, it is times like Xmas when we are really pushed, that all the rules of looking after ourselves seem to get swept under the carpet in the effort to have everything shopped, cooked, wrapped and done to perfection. I think that is the trap. We do need to respect our right to be kind to ourselves on a regular basis, and take time out when necessary, even if somebody else has to step into the breach as we would do for them.

Louise

Kate...I'm sorry I missed your questions. It's really difficult for me to keep up sometimes!

Yes, some post-hyst women wear pessaries successfully and that is certainly an avenue you should try. The goal post-hysterectomy is to keep the front and back bulges at bay without holding the vagina open so much that pressure coming from above starts to turn the entire vault inside-out. My hope, as I have mentioned to you, is that by pushing the organs forward with WW posture that the vagina will fold down enough to protect itself from this occurrence.

You just have to play with clothing. Nothing tight around the waist, lots of room for a rounded belly and good, supportive shoes (and barefoot!)

:) Christine