menopause and uterine prolapse

It can be difficult to get into posture in a car ride. If you search on the search tab you will find many references to what people have done to get into comfortable WW position. I am wondering if anyone has researched cars for good WW posture? Not that I can buy one, but it would be great if we knew there was one out there:) For me, I have found that putting a pillow on the seat and then a lumbar cushion in back is very helpful. It means I am a bit too high (but still not touching the ceiling) and my back is free from the back of the seat (which is a very bad angle for prolapse---at least in my car). That is very helpful for me and also, I stop as often as possible and get out and walk around when it will be a lengthly ride. I am not that experienced here but it sounds like maybe your issues with bladder might be that you are not emptying completely when you do go. Have you searched here for positions to completely empty? For me, the forward (kindof) position described in the book works quite well, but I also move around a bit too just to be sure...I think Surviving or Louise called it jiggling around or something like that. I hope that you were able to enjoy your holiday and all the best to you!

Dear pompom

How you describe menopause and uterine prolapse is unfortunately how it is and continues to be post menopause as well (if, as in my case, you had not heard of WW and continued to bumble along on your own mostly ignoring it). When it gets worse as you describe, it is very difficult to track the cause. I used to drive myself mad wondering, was it that pub lunch I ate 72 hours ago or was it the prunes I ate last night, or is it a side effect of the tablets I am taking, or is it just some germ I’ve picked up that is causing wind which is pushing my uterus back? Am I peeing so much because my kidneys are flushing out after some allergic response? Or, is it just all hormonal?

I had to start somewhere and to follow a multi strand approach including, posture, diet, exercise, and lifestyle change as recommended here on WW seemed to me the wisest course of action. These all help to lessen the effects of intra-abdominal pressure which push the uterus back where it definitely does not belong as well as working to counteract this backwards trend.

Re travel, I have learnt to be much kinder to myself and punctuate long distances with regular breaks. I find sitting in posture in the car with backward sloping seats is possible for an hour or two and then I should take a break. Cushions I don’t find helpful, I’m better without, stops me getting sloppy and giving myself a back ache. This is possibly an individual thing according to the make of car and the occupant. If possible I limit my travel time to about 6-8 hours so would have an overnight stopover on a 14 hour trip like yours. We don’t of course always have the luxury, but the luxury does make life easier.

I agree walking is very uncomfortable in this situation and the mistake of leaving the cloak room too soon an agonising one. Although not an easily foreseeable one. As nightingale suggests it would be better to stand up in posture after peeing , and then return to the toilet bowl, don’t strain but just wait a little longer when you find yourself in this frequent urination situation.

Re cold weather and rain, definitely don’t help. I'm sure you have sat next to a water fountain, similar effect. Not really a matter of mind over matter just mind being matter.

For me limiting fibre which has always made me windy and unpredictable bowel wise and also limiting my liquid intake to 4-5 cups a day have been major steps in decreasing the frequency of these extreme situations that you have described.

Cheers Fab

Just wondering, with your frequency of urination ... do you pass a lot of urine each time you go or just a little bit? I had a lot of urge symptoms a while back (you can read all about it on this thread: http://www.wholewoman.com/forum/node/4134), but the urge did not correspond to having to pass a lot of urine, and I know I was completely emptying my bladder because I happened to have a ultrasound scan at the time and I got the technician to check.

There's some good advice on that thread from Louise et al. I ended up doing bladder retraining (which is trying to hold on for longer and longer and making sure I passed a good cup or two of urine each time I went), along with avoiding constipation and keeping in posture, and the urge gradually went away. It took a good few months though. Until one day I noticed it wasn't there.

I just remembered reading your post that this was at its absolute worst when I was traveling. I had a reasonably heavy back pack which made it all feel a lot worse.

Oh and I'll just add that I also made sure I was drinking plenty of water. When I reduced the amount of water I was drinking the urge got much worse.

One more thing: you have my sympathy! It's such a horrible and debilitating feeling.

Hope this helps!

Thank you for your reply Pom Pom it is much appreciated. Yes, it is depressing to be worrying about the availability of a toilet. But once this episode has calmed down, you can plan on making arrangements again. I hate staying at home out of the fun too so I learnt to be somewhat assertive about it and arrange to meet where I know there are facilities and where I can drive to rather than the whole public transport/walk expedition. Cutting your cloth to fit type of thing. I remember a friend of mine used to organise her progress through the city according to different pubs in different suburbs. Can’t see anything wrong in organising your progress spaced by toilets visits. It can become very much a confidence thing otherwise. But I think if you can retain your regularity and keep those intra abdominal forces at bay, you can win that confidence back. I find that if I have missed a regular bowel movement then it is best to be cautious the next day about walking engagements, but if all is fine reasonable arrangements can be happily made. What you could do with is a mate, who has a similar problem, and then you can laugh about it as you both rush off to the toilet.

Cheers Fab

Dear Curious

Yes, I have seen your other posts in which you have said much the same. Of course, it is possible for us both to be right. Though you give sparse directions, I wonder whether we are talking about the same thing.

I believe you have uterine prolapse, so we have that in common. Now the uterus may bulge only into the upper part of the vagina, into the middle part, or all the way through the opening of the vagina. I have total uterine prolapse.

You like to eat fibre and consequently need to drink lots of water. I find eating fibre causes flatulence in which my bowel impacts on my uterus. I therefore limit my fibre and so do not need to drink so much water.

Because of my total uterine prolapse I have difficulty with bowel movements and urination in the aspect that each time I go to the toilet, or need to go, the rectum (perhaps even sigmoid colon) and bladder intrude upon the pelvic walls and push my uterus back further. I am not however incontinent.

This is the normal situation.

What I was talking about in the above post were those especially difficult situations where the state of things generally worsens.

How I experience these episodes, they are acute, not chronic. They do come to an end after a few days, in other cases they can continue for a week or more. You pee amounts commensurate with what you drink and as the condition continues you pee more frequently small amounts, and mostly with difficulty in that there is more there, but it is not ready to empty. I have not experienced relief on these occasions by drinking more. The frequency remains about the same, but I pee a little more water at each episode and there seems to be more water pressure in what I can’t pee. There is still no incontinence.

At the same time, your uterus is puffed like a balloon; it extends some inches further out through your vagina and is hard rather than flaccid. It is full and round not like the flat tube when inside the pelvic region as described on other threads. It is as possible to walk in this condition as with a football between your legs and a football with pulling strings attached to your pelvic muscles, as someone else on this forum described it. The whole area is very dry and straining under pressure including your groin. And of course the frequent urination begins to sting the vaginal area.

I find the episode is usually started with a failure to use your bowels or bladder with your usual regularity which is common with the time constraints, change in diet and not easily available facilities and other demands of travel. Or, at other times, it can result from staying innocently at home and suffering some reasonably mild gastric upset, or eating something disagreeable. Some people have a nervous stomach that balks at using public toilets and so on. There are any number of things that can give impetus to this initial irregularity not all a matter of diet at all. This accumulation of stool in turn seems to set off some inflammation /retention process which exaggerates the normal condition but which fortunately does eventually calm when things are back to regularity. Sometimes it is as if the halt/germ/ unfriendly food in the bowel have a poisoning effect which sets the bladder off into overdrive.

Of course if one sits, one does not need to go so frequently. One can do bladder training for as long as one wants while seated. But if you are up and walking about your home or office, or if you are out and about, this becomes rather masochistic as the seated defence against gravity no longer applies. I think anyone would find the gravitational pull and shift in weight bearing will aggravate the pain and anguish already being suffered.

So no, in the absence of any further enlightenment, I don’t hang on, and would not advise anyone to hang on in these circumstances.

Cheers Fab

I have stage 2 cystocele and rectocele and stage 1 uterus, so nowhere near what you are describing.

I definitely wouldn't 'advise' someone to do something that either felt really bad physically or just seemed like the wrong thing to do. And what you are saying about eliminating sources of irritation in your bladder totally makes sense to me.

I guess I raised it because when I first found out about bladder retraining it made no sense at all (going to the toilet less would give you less urges - what??), and for me incomplete emptying was not the whole story. But I had nothing to lose in trying it because going to the toilet was not relieving the urge! I think it was Aussielou who described it as having the urge without the urgency. And I don't know even know for sure that it was the bladder retraining that made my urge go away - I was about 8 months into WW at that stage so it could have been my organs repositioning themselves. This stuff is so complex, it does my head in sometimes!

Anyway, I hope pompom sees through to some solutions to her current woes.

Thanks for jumping in Fab.

Hi Takecare

When you think about it, the urge to pee is so that we can know when our bladder is in need of emptying. If there is not much in there, either the emptying process is unable to work very well, or there is not much urine in there.

As Pompom says, strong urine can be irritating for the bladder. I have noticed this myself recently. It is cold weather here at the moment, so I am not drinking because of thirst. I have just run out of red clover tea and am still waiting for my new order to arrive. I am missing two big mugs of water every day, which has to be made up somehow during the day by conscious effort. I have found that, particularly in the evening I don't pass much urine, and it is stronger than normal. I also have a vague stinging sensation in my vulva and possibly in my urethra, which is I think the urine irritating the urethra (postmenopause, therefore more sensitive), and possibly the vulva as well. Then I just have a big drink before retiring to bed. It doesn't make me get up more during the night to pee, but I sure am ready for a big pee the following morning! This is good because I get to flush my bladder well. I had quite serious stress and urge bladder incontinence as a child. This is the sensation I remember from wearing wet undies and getting 'nappy rash'.

If you know that your bladder is nowhere near full, then this sensation of needing to empty may indeed be the bladder being irritated by concentrated urine, or by stale urine, which may have pathogens (UTI risk!) or changed pH or some other change happening in it. It would be worthwhile drinking more during the day, up to say 3 litres (6.5 liquid US pints) of *water only* or more if you are in really hot conditions and thirsty. Don't count other drinks which *will* contain sugar, salt, caffeine or other water gobblers).

Contrary to what our bodies say about how inconvenient or undesirable it is to pee, other than at home, (and during the day only) the answer to training your bladder to behave is usually in drinking more, not less, even if it means we have to experience uncomfortable sensations (or unpalatable thoughts!) while we learn. If learning was intuitive we wouldn't need to be taught things, eh?

Note if the sensation of wanting to pee is different when your urine is clear or light yellow (or light green if you drink red clover tea) from when it is dark yellow or orange. It might be just a matter of learning to discern the different sensations. If you have been responding to the irritable signal for a long time you might not remember the full signal, so your brain makes an assumption.

The current colour of your urine will tell you if it is too concentrated. If you are not peeing much every time you pee the colour in the bowl will be very diluted. Using a little drinking glass it should be light yellow or clearer.

Here is a link about what you will need to test your urine, http://www.topendsports.com/testing/tests/urine-color.htm . This is very technically complex but it gives you an idea about sampling times etc.

Here is another site about urine. Down the bottom is a link to a urine colour chart, http://www.urinecolors.com/dehydration.php .

There are plenty of other sites as well. You might pick up other reasons while reading these sites why you may be experiencing frequent urination, eg adult onset diabetes, overweight, drugs that you might be taking, etc.

I would make sure that the reason is just because your brain needs retraining, and not any of the other factors. You can use a doctor and a pharmacist for this. Then do your own bladder (brain) training by progressively increasing the time between visits to the loo. If you need to, make it as little as 1/2 an hour for a start, then when you can do that without too much sweat and stress, extend it by 15 minutes, until you can do that comfortably, then keep extending it until you can do it for 2 hours or so. Just start somewhere managable for *you*. There are no prizes for doing it too fast. You want to your brain to experience the good feeling of succeeding at a stage before moving on. Otherwise your brain never experiences *success*, so it doesn't learn to 'look forward to it' and hold your bladder for longer so it can experience it. It is team work! Brains are impatient creatures. The more you drink, within sensible limits, the more teachable moments you will produce for your brain in 24 hours.

If you don't feel able to do this in a disciplined way, then I am sure that a physiotherapist who specialises in bladder continence will help you to be accountable to yourself. ;-)

Good luck.

Louise

Dear Louise

I am not exactly sure Louise but I think you may be talking to me, Fab, not Take care; unless you are on the wrong thread. It would not be Curiosity because she has already taken your advice and successfully.

I did spend a lot of thought and time trying to explain to Curiosity why I disagreed about the amount of water consumed and the reasons why I have inhibited that. I certainly do not share your enthusiasm for consuming 3 litres of water a day. And I wonder about your certainty on this. If you are eating one hell of a lot of fibre then it may be necessary, but I would seriously question even that. That you would not count other fluids if they contain sugar, salt and caffeine I find particularly puzzling. Solid food also is made up mainly of water.

The modern trend for sipping water as you walk to the train or pass groceries through the checkout I see more as a fashion thing or a substitution for smoking, the old Freudian oral obsession, and question its relevance to a healthy body and worry about its possible ill effects of overly irrigation.

If you still experience this stinging even after drinking more liquid as you say, then that is exactly what I found, as I explained to Curiosity. So drinking more did not change a thing in this regard either for you or me.

That I could drink copious amounts of liquid well into my sixties does not mean that I want or need to do so then or now in my late sixties.

I also tried to explain why urination was not a matter of mind when you have total uterine prolapse. Curiosity to her credit got it. I can hang on till the cows come home if I am seated or in any position for that matter when these acute ‘attacks’ do not happen if that is what is required, but it certainly does not help much if I am standing, which I mostly am, when an acute case is on.

I particularly resent being told that my brain needs retraining. I can’t give you any particular reason for that except that you seem to make out that this wonderful organ is somehow dull and lame and tricked by listening to wrong signals; that the pressure in my bladder and other pelvic organs is imagined. I sense what you are saying is just off- key, and intuitive or not, how could we learn if we do not intuit?

I guess what I’m saying could all boil down in part to the fact that grandmas don’t like being told how to suck eggs when what they want to do is throw frogs. Telling me what colour my urine should be is sucking eggs. Listing all the possible causes of frequent urination when I am talking about a specific aspect of uterine prolapse is also sucking eggs. Telling me the remedy for the acute attacks of frequent and uncomfortable urination would be throwing frogs, but instead you claim to be experiencing that very thing at the moment because the weather is cold and you have run out of red clover tea which I was under the impression (from this forum) helps moisturise the vagina and which by the way is not so very harmless to anyone taking blood-thinning tablets.

I thank Nightingale, Pompom and Curiosity for their thoughtful dialogue. And I apologise if I am acting badly. I know Louise you are very experienced and knowledgeable and you have been doing an absolutely wonderful job and you can only be admired and congratulated on your performance and inexhaustible generosity of spirit as also more recently surviving60 has provided, and I in all sincerity thank you both.

Cheers Fab

Sorry Fab, I didn't mean Takecare. I meant Pompom, who signs off "Take care." It wasn't addressed at you at all.

Fab, I am sorry if you got the idea that I am keen on drinking 3 litres a day. I was saying that if your urine is concentrated and not much, then drinking more water a day will help that.

The 3 litres was in response to a post I thought I saw by you (ahh yes, my crossed wires - different topic), saying that a certain amount of water would be too much, so I googled 'maximum water intake' and found the other stuff in the post. I couldn't find any definitive amount because there are so many different factors at play, as described. But, as we are advised in Australia to drink 2 litres a day I thought that 3 litres per day (while probably more than needed) might be necessary for somebody who doesn't drink at all, and who prefers drier, salt and sugar laden foods, and who has concentrated urine.

I have only drunk 3 litres per day while doing heavy work in hot weather out of doors in our dry climate. That was simply what I needed on that day to prevent dehydration. I wouldn't tell anyone to drink that much. I did say,

"If you know that your bladder is nowhere near full, then this sensation of needing to empty may indeed be the bladder being irritated by concentrated urine, or by stale urine, which may have pathogens (UTI risk!) or changed pH or some other change happening in it. It would be worthwhile drinking more during the day, up to say 3 litres (6.5 liquid US pints) of *water only* or more if you are in really hot conditions and thirsty. Don't count other drinks which *will* contain sugar, salt, caffeine or other water gobblers."

It was intentionally a very conditional statement about someone with concentrated urine, conditional on several accounts, with all the ifs, buts, and specific conditions. It certainly wasn't an exhortation to Pompom to drink 3 litres per day. I am sorry if you interpreted it that way. Perhaps I should have phrased it differently.

Pompom, I hope you now understand a bit better what I meant. Sorry if I alarmed you.

The different functions of all our organs are interrelated, particularly where it comes to excretion and elimination, where water has to be traded between kidneys and intestines so that the kidneys have enough water to filter out matter for excretion in urine with the intestines that can compete for that same water to fill out fibre and keep the stool soft.

We have had women who were eating a lot of fibre and couldn't drink enough water to fill out the stool. Drinking more water was not going to work, when they really needed to cut down on the fibre so that water was not being sucked up by fibre and creating unwanted bulk in the stool (at the same time robbing the kidneys of water to make urine). It is so complicated when we are talking about kidney/bladder problems and constipation in conversations about POP.

I hope that clarifies what I said, and why I said it.

Cheers

Louise

Nah, I know you can suck eggs and throw the best frogs in the world. Crossed wires. ;-)

Of course, Louised we're good.

I know you're the fastest runner, but slow down a bit girl and take time to smell the wattle.

Cheers Fab

Hi pompom, glad to hear that you are taking control of the situation. I wouldn't blame your mom if I were you. I think pretty much all of us, and all our moms, have encouraged our little kids to "go" before taking them out. Now, if she was still doing this to you past puberty, that might be another story!! - Congrats - Surviving

What I mean is that we live our lives by what we have learned, and by what we have been taught. If we want to manage POP we have to accept that it is essential to have healthy toilet habits, and have our bladder and bowel function as it was designed to, by distending and emptying periodically during the day. We also have to get over the flat tummy thing, because that is not the way our bodies were designed to be. Our bodies need that extra room in the lower belly to allow the organs to move forwards onto bony supports, and it needs the abdominal muscles to be bouncy like a foam cushion, not firm like a sheet of spring steel, so it can absorb intraabdominal forces from breathing, sneezing, running, jumping, etc.

Have a look at sheep. Maiden ewes have a body that is almost horizontal underneath. The following year, after they have reverted from having their first lamb their belly bulges slightly between bottom of ribs and udder. Their shape has changed forever.

Re-educating the brain is the hardest part. Learning to accept your female belly draped from the underside of your ribs to your pelvis, like a yacht's sail, can be really hard. Often our abs are 'locked' by our brains into being pulled in as far as we have to, in order to have a flat profile from under the breasts to pubic area. This simply pushes the pelvic organs back over the vagina. Why?

I think it is because of western society's obsession with youth, looking young, staying away from getting old and dying. If we accepted death we could accept old age. If we accept old age we value the wisdom it brings. If we value wisdom we can let go of our quest for inappropriate youth, and value our natural design, just as we are.

This is exacerbated by the fashion industry, much of which stupidly does not acknowledge that women's bellies need room to expand during movement. Lycra incorporated into woven fabrics has improved this for this generation of women but fitted waists do not allow for upper belly expansion. Skirts ride up and wrinkle on the waist. Crotches on trousers become creased from being pulled and the groin gets compressed by tight fabric, which affects blood, lymph and nerve movement. We give up trousers because we cannot find trousers, other than tracky daks, that are comfortable, particularly while sitting. We give up skirts because they pull our waists in while sitting, or ride up. What can we wear? Frocks!

Some women say that they cannot relax their belly. The brain has forgotten how to relax it. An elite athlete, eg a professional dancer or gymnast, may have a very flat belly, but they can also stretch their abs while bending backwards. They need very strong pelvic floor muscles to counteract this front muscle strength.

If your old script has told you to always go to the toilet 'just in case' your bladder will need to be re-taught to hold on for longer without giving you distressing fullness sensations. This retraining desensitises the bladder (and the brain's response to distension), making it learn to cope with distension. Your bladder can hold 350-500ml, but you probably won't be able to empty more than about 85% when you pee. That is a lot of urine. Normal is 4-7 pees a day, with up to one during the night. That's a pee every 2-3 hours. If you are peeing a lot more than that, bladder retraining is a good option. However, it is probably a good idea to see your doctor first to eliminate other reasons for frequent peeing, eg diabetes, tumours, low grade infection, etc. We need to have big pees less often because it dilutes the last 15% of residual urine and flushes out any germs in a big whoosh, several times a day. Bladder prolapse means that it is more difficult to empty the last bit of urine, so it is even more important with POP that we get plenty of dilution and 'whooshing'.

Your brain *can* adapt, if the will and the wisdom is there.

Louise

Dear Louise

Well I can’t really add much more to what I have already written above.

Although frequent urination, urgency and incomplete elimination are symptomatic of bladder prolapse the overall effect in uterine prolapse is compounded by the weight of the uterus. Holding on (bladder retraining) to the pressing bladder means allowing the uterus to remain stretched low. I’ve not considered that was a reasonable thing to do.

In the acute situation, until the bladder quietens, it presses to empty. It also presses the uterus, only now more strongly. Consuming more water means more peeing and consequently inadvertently more pushing of the uterus back and down. I keep saying that I am managing a prolapsed uterus better since I have restricted my liquid intake to 3-4 cups a day. I know this goes against received wisdom and so is hard to accept. I could understand this if we were talking about UTIs.

Where you have the uterus dragging on the bladder, I think that we have to expect a certain degree of more frequent urination and occasions of incomplete elimination as a natural part of what’s broken. And as the uterus rises (with the benefit of WW posture, exercise and compatible diet) the bladder’s pressure is less strong and the urination frequency decreases. In acute situations the reverse occurs.

Possibly, I jumped to the wrong conclusion that we were talking of great discomfort when walking because of the low position of the uterus where it can be so heavy that one instinctively wants to allow it some relief and protect it from further stretching and strain. The suggestion to hold on in that situation was to my mind unreasonable.

Cheers Fab

What Fab says certainly rings true for me. I don't understand the whole cycle of drinking extra fluids and then training yourself to hold your pee. It seems totally counter-productive in the management of prolapse. I feel the same way about the cycle of extra fiber and extra water to bulk it up. That seems tough on the system, especially with prolapse and especially as we age. Lots of different schools of thought, I realize; just my opinion..... - Surviving

I don't believe the uterus actually "presses down" on the bladder, a common reason surgeons give for the need for hysterectomy. More on this later.

But the risk I see with drinking a lot of water is forcing this fluid through the fine meshwork of the kidneys to the point of weakening or damaging them.

At the risk of having rotten tomatoes thrown my way - lol - might I suggest a tsp. of raw, local honey in a small amount of water for bladder urgency? Honey is an osmolyte, which means it helps manage body fluids and actually makes you pee less. It soothes my bladder urgency and I am hoping others will have the same results. Animals only drink when they are thirsty.

Christine

I probably should chime in here since I suggested bladder re-training to pompom. I said:

Oh and I'll just add that I also made sure I was drinking plenty of water. When I reduced the amount of water I was drinking the urge got much worse.

I certainly don't drink excessive amounts of water (probably 5-6 glasses a day, pretty much just when I'm thirsty like Surviving and Christine say), but when I had this acute urgency I tried drinking a lot less, to the point where I was not drinking even when I was thirsty. For me, this made my urgency worse. I would got to the toilet, then 5 minutes later would feel the need to go again. If I went then, nothing but a dribble would come out. This seemed entirely counter-productive to me, and the signals saying I had to go certainly weren't stemming from a full, or even close to full, bladder. Just thought I should clarify that, in case anyone thought I was recommending drinking a truckload of water every day.

Anyway, pompom, you certainly have some ideas to work with now. It will be really interesting (and informative) to hear how you go with all of this. Please report back :-)

The last time that my bladder was in overdrive and my uterus lower it just happened to coincide with a bout of flu. I took a small amount of honey (the proverbial pea size) for my sore throat each morning and night when the throat was at its rawest. I would put money on it that it was the honey which helped down below as well

Cheers Fab