Prolapse / Cystocele / Rectocele
The archives make it pretty clear that Kegel exercises help incontinence. But can they help minor uterine prolapse?
Two years after the non-traumatic vaginal delivery of my first child, I'm preparing to try to conceive my second. While charting my ovulation I've been checking my cervical position, and I've discovered it's hanging a LOT lower than it used to! Sometimes it's within an inch of my vaginal opening. Yikes.
I knew things were drooping down there -- I think I also have a mild bladder prolapse -- but my healthcare providers always said things were within the range of normal, although once one of them described my vaginal walls as ''flabby.'' I always accepted their dismissals of my concerns, but now that I've actually begun to examine myself, so to speak, I've diagnosed myself with a ''first degree'' uterine prolapse, meaning the cervix is in the lower third of the vagina.
Besides having trouble using tampons successfully and an occasional annoying ache after intercourse, I don't have any troublesome symptoms, so it isn't (yet) a medical problem requiring surgery or pessary. But it's psychologically challenging to feel like my insides are falling out. Plus I'd like to prevent further problems, especially as I'm hoping to get pregnant again soon!
I know I should have been doing my Kegels all along, but it's just hard to stay motivated. I was hoping some success stories, especially any involving improvement of a mild prolapse, would help inspire me! Any advice is welcome. Flabby
Have you been diagnosed with uterine prolapse? Placement of the cervix varies throughout your cycle and can certainly change after giving birth. Kegels tone the vaginal muscle walls, so they're not going to do much for you if you have an honest-to-god prolapse situation, which it does not sound like you have. meg
I'll be curious to see your responses because I've been dealing with this since the birth of my twins about a year ago. I too don't have any incontinence, but my walls actually fall outside me regularly. I know, gross, and frustrating when you're trying to keep up with toddlers. But because of no medical issues I've been kind of brushed off by docs. I've been told to do Kegels by my OB and got a little more advice from my internist... she recommended a book by Peggy Brill that focuses on increasing core strength. From what I can tell increasing these core muscles is a lot more helpful to my situation than the Kegels. By core muscles I mean the upper inner abdominals (my lay term for them). It's observation only, but when I'm sagging and still have a long walk home it's by sucking my tummy into my ribs that gets things right. I believe some yoga works these muscles. Maybe you can ask about improving core strength and your MD will have something to say. Unfortunately when I asked for a referral to a physical therapist I was told I had to wait until 15 months after my kids' births to address the issue. But maybe you could see a physical therapist if you're able on your insurance. sagging too
Our 5 year old suffered 2 rectal prolapses during a bout of bad stomach flu. Since then we've seen a specialist & been told that there is a retention problem which might have caused the prolapse. She is on a daily dose of Miralax for the indefinite future. No-one seems to knows what or why this has happened. Tests have ruled out celiac disease, but are there other things going on? She is a healthy child with a normal growth curve & has a pretty good diet, except when eating school lunches. Any advice on what this could be, any diet tips, long-term prognosis? anon
Our son went through 3 episodes of rectal prolapsse over a two year period when he was 4 or 5. Needless to say, we were quite disturbed. We tried to have him use a stool under his feet when he sat at the toilet and discouraged him from staying there too long. He was also tested to rule out CF. The doctor's advice was to wait and watch, and that's what we did. It hasn't happened in over 3 years, so I hope it won't happen again. h.
My son had a couple of rectal prolapses when he was 7 or 8. We just advised him not to push so hard, and have not had any problems since. If he's feeling constipated, he's supposed to drink a glass of water and have a couple of prunes, then try again later. eh
It's looking like I'll need surgery to fix a combination of uterine prolapse/rectocele/cystocele. Kegels aren't going to fix it,sadly. I don't want more kids, so I'm fine with a hysterectomy. Does anyone have recommendations for a good surgeon to do this? Preferably in Berkeley, but could go to SF if needed. I'm also interested in hearing from people who have had this kind of repair--what was the recovery like? Were you able to resume full lifting (e.g., 35 pound kids) after you recovered? Could you go jogging? (I miss jogging...) How long before you could drive or work? Just wondering what I'm getting myself into. anon
Unfortunately my surgeon no longer practices in this area, but I can comment on recovery which you also asked about. I had some vaginal prolapse, but the most severe symptoms (incontinence) were correctable with bladder sling surgery, and it was such a blessing. I suffered years too long -- I couldn't even walk a few blocks without peeing, much less jog. The recovery was easy, just a few days of discomfort and then some time for complete healing. I also have rectocele, but I've managed so far without surgery. Biofeedback techniques have improved a lot since my surgery, but I'm convinced that some of us need surgical repair and shouldn't suffer because kegels and biofeedback aren't effective. Good luck. happy hiker
Dear anon, I could write a book, but I have one already - the binder of material that I still have from my completely successful surgery in July 2004. I worked with Dr. Eugene Kaplan from Walnut Creek, who performed the surgery at John Muir. (I was fine with doing it there, as his offices are across the street; I wanted him to be able to check on me more conveniently, frankly, vs. being closer to my family in Oakland. Them I didn't want to see till I got home!) I had a the whole enchilada: bladder work, hysterectomy for prolapse, and repair of rectocele. Had a bladder sling, repair of tear from episiotomy (if he's going in, might as well get it all cleaned up at once, was my attitude.)
I had surgery July 5 and followed post-op instructions like my life depended on it. I was not working at the time, so I didn't have to deal with when I would want to return to work, and I'm glad I didn't. For several weeks I had 2x day hot baths, naps, etc. - it was 5+ hours of surgery, so it's pretty major stuff. Hardest part was feeling constantly ''not quite right'' while I had the suprapubic cathether for 4 weeks. I had to wear it until I was peeing enough the usual way that it was not a risk to remove it. I think the micromotions of a tube hanging out of your body just makes you feel crummy. You may not need it. Like I said, follow the instructions to the letter and you'll do great - as long as you have Dr. Kaplan doing the procedure. 7 weeks post-op I was riding a bike and bodysurfing on a family vacation, feeling fantastic. No problems since, even though I'm lax about the kegels...
Dr. Kaplan is a urogynecologist, meaning he specializes in the whole set of stuff in your pelvic floor, and passionate about his work. He drew pictures and made sure I understood thoroughly what he was planning to do. When I had trouble with one of the post-op medications, I called him on a Saturday evening, and he answered his phone immediately. He was helping to repair a poor result someone else had done on another patient, as she told me while sitting in the waiting room. He's the best. T (925) 979-9969 F (925) 979-9979 W http://www.agscenter.com/ 120 La Casa Via, Suite 209 Walnut Creek, CA 94598
He was not in my PPO network at the time, so I had to pay a portion of the cost out of pocket; I would do it again in a heartbeat. It's too important not to take it to the best surgeon you can find.
Last word of advice: go read up in HysterSisters, an online support forum. I didn't find it till afterwards, but it's chock full of a ton of great information. Take a week to read as much as you can there, then get your questions together for any surgeons you want to interview. There is a specific forum called ''Hysterectomy Special Needs Pelvic Floor and Bladder Issues'' that is related to the associated surgeries - which in my opinion were more involved, from a recovery standpoint, than the hysterectomy. I had to USE the bladder and rectum again right away; the uterus I didn't miss at all!
good luck! . - Nancy
wondering if anyone has taken this class and found it to be helpful in recovering from post partum issues:
What does the tone of the pelvic floor have to do with our sense of well-being, back pain, bladder control, trauma, and our feeling of support from the ground? Find out through a few short presentations and a series of quiet, easy movement lessons coupled with awareness. You will take home ways to sense and improve function in your pelvic floor and leave with an easier, more complete experience of your whole self. Carol LaDue is a Guild Certified Feldenkrais Practitioner
I took this class a few years ago. It was very helpful. You do exercises in class (very easy and mild) that strengthen the pelvic floor muscles. You also get a binder of these exercises and more, and info on pelvic floor care to take with you. Unfortunately I couldn't make it to the 2nd class due to getting sick but the 1st class was great...time and money well spent. It's still useful to me 2 years later. Good luck leaky no more
7 months after the VBAC birth of healthy 9.5-pounder, I (late 30s) am still dealing with vaginal prolapse - a moderate-to- severe cystocele. Essentially my vaginal wall is so thin that depending on time of day and activity (evenings, standing/lifting/coughing are bad, shoulder stands good for obvious gravity reasons) my bladder bulges into the vaginal area from inside. That bulge often reaches the opening, getting squeezed and rubbed there.
Thankfully I have had no tears or incontinence issues, but that golfball-size bulge feels heavy, very uncomfortable, in the way, and keeps me from moving the way I would like to (and have to, with 2 kids, a PT job, groceries etc.)...
My midwives had advised Kegels, but that didn't lead to further improvements after month 3 postpartum. (I still keep doing them and think I'm doing them right.) My new OB said Kegels won't help much in my case, and prescribed estrogen cream to strengthen the dry, thin tissues (I'm still breastfeeding and plan to keep doing that for a while, but it keeps those tissues weak). She also suggested occasionally wearing one (or two) tampons to press things back. Tried it once, felt uncomfortable in a different way, and had bleeding afterwards. Hm. The cream seems ok, a bit messy, but will only have longer-term effects. The OB advised against surgery at this point, since it can be unsuccessful LT and/or can damage the bladder.
My questions: 1) Anyone else out there who had a similar degree of cystocele, without incontinence, in their late 30s? What helped you? Did you fully recover, and how long did it take? 2) Is there any softer, reusable device I could use instead of rigid dry tampons? Or things to make plain (or even ''super'') Kegels more effective - anyone have experience with the various ''original'' Kegelmasters etc.?
What you need is a device called a pessary. If your doctor can't fit you for one, ask for a referral to someone who can. Also, if the cream is too messy, ask your doctor for a prescription for an Estring - small silicone ring that you wear in your vagina all the time that secretes a small amount of estrogen. I used it while nursing my last two kids, and it was much less messy than the creams. Once you have finished having kids, I would consider having the surgery. It can make a world of difference. more common than you think
Need recommendations for a GYN surgeon for rectocele, cystocele repair in the Berkeley/Oakland area.
I just had the rectoscele and cycstoscele surgery done last month, and highly recommend any of the doctors at Sutter East Bay/OB Gyn Fertility, 2850 Telegraph Ave. My doctor was Dr. Arzou Ahsan and she was terrific. This surgery is becoming very common and all of the doctors there do the procedure. Any questions you could call me 510-334-8750 Sandy
I am 4 mos. post partum with a rectocele from the delivery. Has anyone had success healing without surgery? I have gotten mixed advice from the doctors, but one specialist said to give it time and it would improve. Has anyone had this get much better? Did the end of brestfeeding help? Any advice to speed healing?
Still healing at 4 mos.
I also had a rectocele as well a cystocele and noticed it at about 4mo. postpartum of baby #2. I did stop nursing b/c I was told that estrogen would help re-tone the muscles down there. It's hard to say if it made a difference. It seems that the healing is a very slow process. I am 1 yr. postpartum now and it's hard to say if it got better or I just got used to things being in a bit of a different place. I think it has gotten a bit better, but after days of heavy lifting or pushing I can feel things a bit out of whack. I did some physical therapy, learned exercises to re-tone the area and electric stimulation to re-teach the muscle what to do. It was hard to keep up the routine on a daily basis with working full time and having 2 kids. The physical therapist seemed to think it would get noticible better If I could dedicate that kind of time. Meanwhile I try not to think about it and hope to have more time for exercising in the future. Also anti- depressants really helped me b/c I was pretty bummed about it. anon.
I have a rectocele follwing a vaginal birth with a second degree tear 3.5 months ago. I have gotten mixed messages from the doctors, but a specialist said it would improve within the year. Has anyone recovered from a rectocele without surgery? How long did it take and how full was your recovery?
I have a rectocele I never repaired, and it's 20 years later. It definitely improved in the first year, but it does remain with me. The condition varies so it's hard to give advice, but obviously, in my case, I've lived with it. It's embarrassing to discuss, but the greatest problem is with bowel movements, and I've really improved my diet (lots of veggies and fiber!) to contend with the problem. I've read that rectocele repairs may not last, and surgeons are therefore less likely to repair. That said, I am actually considering having my condition repaired after all these years..... I'd hang in there to monitor the healing and evaluate surgery later. Good luck to you. anon
I think I may have prolapse. I am 36 and 3 months post-partum after baby #2. I am really bummed and feel like I'm falling apart. Has anyone else experienced this? What did you do? thank you. anonymous please
Hi there. I saw your post about a suspected prolapse and thought I'd share my experience. After the somewhat traumatic (induction and then forceps) delivery of my first child I experienced what I will call a 'protusion'. To be blunt, there was a fairly large (golf ball) fleshy thing sticking out of my vagina, about three months post-partum. It was, to put it midly, unnerving. I saw my OB who diagnosed a 'rectocele', which is basically a vaginal hernia wherein a rip or tear forms in the vaginal wall, allowing the rectal passage to poke through. Charming. After about 7 months post partum it got better and eventually didn't really stick out all that much. As the muscle tone improves it tends to draw the hernia back in, or so they say. Whatever. Anyway, it didn't really bother me all that much. Then I got pregnant again (whoops) at 8 months post partum (again I say whoops) and by the end of that pregnancy it was sticking out again and would ache if I walked a lot. Mind you, everything ached, so there you go. After the delivery of my second child the whole thing basically fell apart and now I have a cystocele (which is where the vagina wall tears on the OTHER side, allowing the bladder and urethra to poke through) and a uterine prolapse (basically the connective tissue at the top of your vagina stops holding the uterus in place, and it descends). Interestingly, although possibly only for me, the rectocele mostly went away, possibly overwhelmed by the competition for room in my poor front- bottom, as we say in England. Anyhoo, here's the upshot. All of this can be fixed surgically, and it's important to go to a specialist in pelvic floor reconstruction, as the negative outcomes of bad surgery are vaginal strictures (basically they sew you too tightly and it's painful to have sex etc) or incontinence of one sort or another (bummer). The good news is that there is an excellent doctor at UCSF, called Sharon Knight, who you can go see. There are several other centres for pelvic floor reconstruction around the country. The bad news is that it takes many weeks to recover and during that time you can't pick up anything heavier than a bag of flour. As I have a two and a half year old and a fifteen month old I have decided to wait a few years and then get everything fixed at once. In the meantime I just kind of suck it up. Some days it's worse than others, and I can't run or do impact exercise any more. Oh well, like I have either time or inclination... So that's my experience. In many cases they fix themselves, and certainly mine seemed to be on the way there before the second baby. IMHO it's pretty early for you to get super worried about it right now, and in fact, they won't do an evaluation for prolapse surgery until ONE YEAR post partum as they consider the vagina to be in trauma until that time (no shit). I sympathize with the sensation of everything falling apart -- I find myself chastened and somewhat embarrassed by my crappy vagina, but hey, at least it's relatively private. Feel free to email me if you have any other questions or if you discover some excellent way to fix it, especially if it involces lying still in a quiet room eating chocolate! Abbi
Post partum prolapse can really feel overwhelming, especially in the midst of taking care of your baby. I am an acupuncturist who specializes in fertility and pregnancy care and I have treated this many times and everyone seems to feel overwhelmed in the way that you described. In chinese medicine, post partum is a period of two years. I say this because I don't want you to feel like you are falling apart because your body can repair itself. Birthing a little one is a big deal and in our country I am not sure we give it enough credit as we hurry off back to work after a few months. Anyway, this is definitely something that you could be treated in a holistic manner with acupuncture and chinese herbs with good success. I guess the first step is to know your symptoms to make certain of the diagnosis. I am more than happy to help you with more specific advice if you need. Maureen Raytis, L.Ac.
So I think I have a 'dropped cervix' also known as a Uterine Prolapse. I won't know for sure until I see a gyno in a couple of weeks. I did look up the condition and I have one of the symptoms: urgent urge to pee at a moments notice. I also looked at myself and well, things don\x92t look right.. like the entrance into my vagina is blocked!! Needless to say when I saw that, I panicked. And the only reason I even looked was that I felt some irritation. I\x92m wondering if things got worse since I got sick with a nasty cough almost three weeks ago. I\x92ve had very violent coughing fits and they do pressure that lower region. By the way, I did give birth vaginally 15-months ago. The two gynecologists that saw me afterwards never mentioned anything. Can your cervix drop afterwards?? I admit I haven\x92t done keigel (?) exercises and I\x92m still nursing my son. Any way, can any of you out there who may be dealing with this issue give me some insight, how are you resolving it? Did you get a pessary, can you describe how it works. Has anyone opted for surgery? Thanks! anon
It sounds like you have a cystocele, which is a prolapsed bladder. The bladder drops onto the vaginal wall and is visible when looking at your vagina in a mirror. It often occurs during pregnancy with the pressure on the bladder from an enlarging uterus, and during delivery from bearing down. Symptoms include urinary urgency and frequency. Kegel exercises can help lift a minor cystocele and tighten the muscles, but a more significant cystocele often requires surgery (done vaginally). Whether or not you opt for surgery depends on the severity of your symptoms and whether you want more children (it does not affect your ability to get pregnant, but you might want to delay surgery until after you are done having children because it can drop again with subsequent pregnancies). Good luck! -Been there!
To the woman who may have the dropped cervix, I too had a baby 15 months ago and since then have had symptoms such as stinging when I soap my vulva in the shower ( as it feels like the urethra opening has been stretched), pee still coming out after I pull up my pants & think I am finished, and right after giving birth a lot of pain. But I spoke to my midwife and she said do kegals and so I've been doing 5 to 10 a day on & off and now I feel that most of these problems have just about dissapeared(over 15 months). It just seems to me that healing is a long process. I hope that helps. A
My mother (early 60s) was recently diagnosed with a dropped bladder or cystocele prolapse. Has anyone had experience with this and tried kegels, a pessary, or surgery? Any words of advice would be very helpful. Thank you! anonymous
I had bladder sling surgery for this condition 7 years ago, and it was 100% successful. I was in my late 40s, and my condition was so bad that I needed a thick pad at all times, and even the thickest pad was not enough when I exercised. I lived like that for a decade, had had many embarrassing accidents, and I became a new woman after the surgery ; ) The surgery requires an overnight stay in the hospital with a catheter, and another day or two at home with the catheter. I recovered quickly. You need to find a urologist or a gynecologist who is trained in the procedure and has experience with it. I\x92m afraid I can\x92t recommend my surgeon, because he's no longer practicing in this area. Good luck!
Living a normal life again!
I had uterine prolapse after the birth of my first son, at the ripe old age of 31. After the birth of my second son, I tried all kinds of non-surgical options, including kegels which are useless and have no effect on the tendons and ligaments holding the uterus in place. It could also be the bladder pressing out in your mother's case. In any case, kegels can't help. Any doctor who tells you so you can be sure knows nothing about the condition. I did go to an osteopath who has demonstrated success with restimulating the ligaments and tendons to do their job - alas, didn't work for me. I turned to surgery and am thrilled with the results. I had the uterus and cervix removed, kept my ovaries. Also I understand they did some lifting and tucking of the whole area, including bladder. Its a major surgery. Prolapse is something that's quite common in older women and hereditary. My mother had a hysterectomy about 20 years ago at about 40 or so to repair a prolapse she had lived with for about 10 years, unthinkable. If you're an active person you simply cannot live with a prolapse. Now, here's the bad news, my mother thinks she may need another surgery now that she's older things are sagging again. Good luck. Sharon
My mother had surgery almost a year ago for a prolapsed bladder. I don't know the name of the procedure she had (she is not one to ask many questions of her doctors) but the procedure put some sort of internal sling under the bladder to lift and support it. The surgery was done vaginally. She had a very slow recovery, spent many months still not able to hold her urine and was in much discomfort. She felt that the doctor minimized the time for recovery and discomfort. Now almost a year later, they tell her her bladder is still low. She hasn't said she completely regrets the surgery (she suffered from years of yeast infections because of the prolapse) but she swears to never have another surgery. Everyone's experience is probably different, but I would suggest your mother asking a lot of questions (mine didn't) and really thinking long and hard about having surgery. anon
She should make an appointment with a uro-gynecologist for an examination and discussion of all her options. I've seen a few in Oakland, and I enthusiastically suggest Ed Blumenstock, M.D.
A cystocele patient
I'm a little late in posting this, I think - for the person looking for advice on cystocele prolapse, here's my two cents. Get a thorough workup by a uro-gynecologist. I had surgery for stress incontinence, prolapsed uterus and some other stuff in July. My recovery was right on target - about 7-8 weeks and I was operating at pretty close to 100%. If it had been only the cystocele repair, 5 weeks would have been plenty. (I'm 46.) My consultation and surgery was with Dr. Eugene Kaplan in Walnut Creek, 925 979 9969. He is extremely knowledgeable, very gentle, very aware of related issues, and all-around great. My surgery included a vaginal hysterectomy, bladder sling, and rectal muscle repair - about 4.5 hours total. I'm sure it would have been far shorter if it were only the cystocele. I'd be happy to talk to you about the experience if you would like. I'm very relieved that I had the work done, feel a million percent better with all pelvic functions, and really recommend my doctor highly. Hope that helps. Nancy
I am 13 days postpartum with our 3rd baby and just last night discovered my cervix hanging down into my vagina! I am 32, this is our 3rd baby in 4 years (all home births), I am fit and healthy, swam and did yoga (and kegals) throughout pregnancy, and I am worried and scared! My 3rd baby came barreling out of me in no time, apparently dragging my cervix/uterus down with him. My midwive pushed it back up in place after the birth and checked me again a few days ago (I was fine), then . . . last night I made my discovery. Of course, I have spoken with my midwives who aren't yet officially calling it prolapsed (b/c it's so soon after birth) but of course it's a strong possibility. Who has gone through this? I am pretty terrified of using one of those devices to hold it up, or having surgery - - or, even a hysterectomy. I'm taking Sepia (homeopathy). We may want another child in 3 or 4 years. I looked in the archives and found nothing . . . what have others done in this situation? Is there anything I can do now to increase my chances that it will go back to normal? Any specialists? Any advice appreciated. Thanks.
Fifteen years ago, I had my first and only pregnancy. Fibroids that were already present grew enormously, one to about grapefruit size. After the birth, my uterus descended into my vagina. The first thing that helped was to put in my diaphragm (I cut out the middle and just used the ring.) Later I went to a chiropractor in Santa Cruz who was recommended for such problems, who may have helped but I really don't know. One thing I remember doing was lying down with the legs of the bed raised on blocks, so that gravity would help the uterus move back in position. I guess I did that a few times a day for an hour. It's hard to remember, and of course I had a baby, so I couldn't have had time to do much of anything. My fibroids shrunk down post-partum, but I have always had problems with stress incontinence. My uterus is ''tilted'' according to my nurse practitioner. I wear a pessary, which is extremely helpful, and I find that abdominal exercises are as good as Kegels, if not better. I have not needed to have surgery, but I wear a pad everyday, just in case.
Holding up just fine
Hi, having suffered a fair bit of damage during my second child's birth, I am thinking of having surgery to repair a cystocele and rectocele. Has anyone been through this, and can you recommend a good doctor? Were you glad you had the surgery? Thanks
I gave birth to two very large babies with the same consequences. After the second delivery, I suffered from incontinence for 12 years, not realizing how simple the repair can be. Dr. Peter Schneider (a urologist) performed a 'bladder sling' procedure, and I've been cured ever since! His no. is 848-1727. He does not repair rectocele - this is a gynecologist's domain. I cope with the problem with diet and manage well enough. My gynecologist, Richard Rudd, 841 5510, routinely does these surgeries, and I've heard he's an excellent surgeon, but obviously I can't attest to that. anon
I was also diagnosed with a cystocele, rectocele and prolapsed uterus. When my first gynecologist was nonresponsive to my complaint, I fired her. My new gynecologist referred me to physical therapy and it has really made a difference for me. Of course, the degree of benefit you'll derive depends on how severe your symptoms are. Many gynecologists do not refer patients like us for PT, perhaps because they are unaware. If yours is similarly unaware, get her/him to refer you to Physiotherapy Associates and ask for the therapist who specializes in ''women's health''. Not all therapists are educated in this specialty, and the one with this organization only works in their Oakland and Walnut Creek locations. I urge you to try it. I highly recommend it. Been there and back
Has anyone dealt with a prolapsed bladder or uterus? I am looking for alternatives to surgery for dealing with this problem. Do exercises really work? Is this a condition which comes and goes? km
My doctor recently noticed the same thing happening to me. She referred me to a physical therapist who specializes in this sort of thing -- ''pelvic floor rehab''. The plan is that I'll do that, as well as lots and lots of Kegels for the next three months and then we'll re-evaluate the situation. Maybe exercise can be effective enough to make surgery unnecessary. Good luck to you (and to me!)