Grade III cystocele, Grade II rectocele and Grade II uterine descent

Women's health
1

I have finally received a report concerning the problems I have been experiencing with prolapse, and it seems I have a grade III cystocele, a grade II rectocele and a grade II uterine descent. Although I have tried vaginal pessaries, both the ring ones and shelf pessary ones, they don't seem to work for very long. Either they are too uncomfortable and have to be removed, or they actually fall out. The doctor has indicated that he feels they are pretty much at the upper limit on what size pessary can be safely inserted through the introitus without causing trauma. 

At the moment I don't have a pessary fitted as the last one fell out after a few days and I thought it might be wiser to give it a rest for a week or so before returning to the clinic to discuss other options. The option obviously will be surgery, but I am unsure what questions I need to ask to ensure I get a full picture of what will be involved. Will the surgeon actual repair all problems at once, for example. What actually is involved at the time of the surgery. And of course, what is the recovery likely to be. And what do i need to do or not do to ensure a complete and full recovery.

Having been following various discussion threads over the last weeks and months, it appears that many people have serious problems with recovering from these repairs. I live alone and it might be difficult for me to care for myself following such surgery.

Any advice, help, etc would be most welcome. Especially on what sort of questions I should ask the surgeon at my next visit. I want to be as fully informed as possible.

To be honest, I would still rather keep to the pessary route, but from the report from the doctor, it appears he feels that there is little more that can be done conservatively and I would need to go for the option of prolapse surgery.

Many thanks in advance for your help and guidance.

 

2

Hello Jacqueline.

I can only speak from my experience as these surgeries clearly affect women in different ways. Women like myself who have posted on this website have suffered following the surgery but there are probably many women who sailed through with no problems so they wouldn't have come to a forum like this.

I am almost 7 weeks post op for rectocele , enterocele and sacropinious fixation. I did not have cystocele. For me I only suffered from the sacropinious fixation but only 1/10 women get really bad buttock pain and sciatica from it. At first I regretted having the surgery because I never suffered symptoms from it. However I was told that my prolapse was so bad that it had to be done. My womb was protruding outside my body but it really wasn't an issue to me. Therefore I regretted it for 4 weeks when in pain, but now the pain has gone and I'm glad I had it done (so far).

Whether I suffer repeat prolapse again I'm not sure. There is a 30 % chance. I can't comment on cystocele and the mesh etc. I did have stress incontinence but I was told having the sacro fixation might cure this.

So.... all in all, at the moment I'm more positive about it so not regretting it.

I am a single woman of 51. You will need someone to come in and do lifting , cooking etc for you. My mum came in 3 times a day for about 3 weeks. To be honest though , that was because the sacro fix meant I couldn't stand up for more than about 40 seconds without being in do much pain that I had to lie down. I'm not sure if there is any home help available in UK, which is where I am. Perhaps you have friends or family that could do shifts as helpers? If you have the surgery you must let people know before you do how major it is. I think medics ( especially male ones)play it down. My surgeon definitely did.

These aren't surgeries that you can think you can bet. In other words, I am a very positive, active woman. I go to the gym , Pilates , run etc. So I'm generally fit and healthy and I assumed that although I was told the initial post op recovery re pain could be 6 weeks, I assumed for me it would be less. My level of fitness made no difference. I have found it so frustrating to be at home and doing nothing and a few times I probably overdid things, which made me worse. So... you must be a patient patient! It really was true what I was told: at 6 weeks I suddenly felt so much better ( although I did develop an abscess but it went with antibiotics).

As stated, we can only talk from our own experiences. But I would say that if you have symptoms then it's probably worth having done if you can sort some after care and support.

Best of luck -Caz 🌈

3

Morning J

Whatever you decide, your pelvic floor will still need strengthening. Please look at pelvic floor exercises to maintain the prolapses where they are and to stop them getting worse. 

Pessary use can be successful, but its about getting the right size. If they keep falling out, do pelvic floor exercises to keep them in place.

Please do all you can in the self-care area, this means pelvic floor exercise, maintain a healthy body weight, and improving your posture. There is no quick fix to your situation, but self-care will help to make sure whatever route you take will more likely to be successful, and that includes surgery. 1 in 5 prolapse surgery fails, so if you opt for that, make sure you give your body the best chance of a strong repair.

If you do not change what you do, you will prolapse again. This is a stark warning I know, but you can turn this around and make friends with your body and manage your prolapse, and more importantly stop the prolapses getting worse or other organs prolapsing..

Good luck on your journey - Stephanie

4

Hi Stephanie,

Sorry to interrupt this thread, hoping you can advice, not been on the forum much recently.

I am now about 16 months post op from A&P repairs and doing really well this time, although still very restricted in how much I can safely do.

I am now swimming about 16 lengths in a 25 metre pool in about half an hour. Have switched from front crawl to breaststroke for last few weeks and can feel the lower pelvic floor tighten up and find that my bladder much stronger and stream much healthier like it should be.

My concern is that about 24 hours later I feel quite achy ( not like I would if it were prolapsing) but hoping it's just the pelvic muscles because they have been worked. Perineum still nips a bit but not as much as it use to.

Question is - do you think it is just the muscles being worked or am have I maybe just reached the maximum that I can safely do?

Appreciate your input,

Many thanks,

Phyl

X

5

Morning Phyl

Great to hear you keeping strong and working on YOU. This is so important for all the ladies here - the buzz word - self care. I think it sounds as though you are strengthening up, but I really cant advise as I am not a Physio. I would say that a mix of the both would be best, but I've just asked Tasha Mulligan at Habit - shes wroitten a great blog about the benefits of swimming and I have asked her if any stroke is preferable for best results, she's in the US and they will be celebrating today, so I'll be back soonest!

Back soonest

Stephanie

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Thank you Stephanie, appreciate you getting back so quick. I had been doing a mix of both strokes for a number of months but I'm not so strong doing front crawl and can't pace myself so usually go too quick and need recovery time between lengths so don't do as many.

So Want to build up number of lengths and I can do so much more as I can pace myself ( or go slower ) doing breaststroke.

Would like to think that if I can get those lower pelvic muscles strong enough can maybe avoid further surgery in the future.

Thank again ,

Phyl x

7

Hi Jacqueline. If you go to the top of this page, click on Genitourinary Prolapse and on that page look for 'pinned posts'. There's lots of info there especially the one from Emis Moderator 'Useful Resources'. The South Tees NHS one is good but all the the others have plenty of advice and well worth reading. In my own experience, I live alone, am 74 and I managed ok with a bit of help. My daughter popped in and brought shopping, including some 'Ready Meals' to heat in the microwave. she also did some laundry until I was able to do it myself. I have a lady who comes in once a week for a couple of hours to clean for me, essential as this is a 'no no' for several weeks. I was told that I do not qualify for after care help from the local council as I have a daughter close by but if you have no one you might get some help. (They don't seem to realise that our families have to work and may not be able to come and work for us too)! I think you will find most of the answers you need if you look at the 'pinned posts' but make notes every time you think of something you need to ask and take the notes with you to any appointments. I'm now 2 months post op and recovering slowly. I was told 3-4 months for recovery and I believe it now I'm about half way through. It's not something which can be rushed, we have to be 'patient patients' to get full advantage of this surgery. Good luck, keep posting and others will come on and listen or talk to you. Pollyanna UK

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Hi Pollyanna,

How are you doing, hope all is going well for you.

Take care,

Phyl x

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Hi Phyl. I'm ok but it IS a slow recovery for me at any rate. I'm wondering if it's because of my age, 74 now and the 3rd prolapse op. He did the sacrospinous fixation for vag vault prolapse plus a second rectocele repair in a slightly different place, to the left side of vag this time! I'm having a bit of a problem with bladder now, need to keep peeing! Can't hold on for long as stitches are still inside and showing no signs of disappearing yet. Maybe it's the swelling pressing on the bladder? I also get very tired still and have to rest with feet up in the afternoon. Trying not to overdo things but I have my bungalow to run with some help from a lady I know who does home help work. I read your other post and it seems you're not 100% yet but improving I hope? Good thing I'm retired, I would def not be going back to work yet if at all. My consultant said it would 3-4 months recovery time so I'll just relax a bit longer and hope for more positive results later on. I just look at the garden now, did what I could before I was admitted to hosp thank goodness. I've not seen Matron on line lately, is she still cruising or otherwise engaged?

You take care also Phyl. X  

10

It's good to hear you are getting there even if it is slowly pollyanna, I think that after each prolapse repair our pelvic floor although fixed is left a bit weaker each time, and recovery will take longer with age.

It 's great that they can still fix us up a bit anyway.

Last time I heard from Matron she was going for exploratory surgery herself, but was hoping that she would be recovered enough in time for her cruise. Anyway not heard from her since so hoping all is well and she gets to go on her cruise I'm sure it's this month sometime.

I was so grateful having Matron on this site during my 2nd recovery it's was so good to have her reassurance when needed and keeping in touch with other ladies also helped me to be more aware to take it easy during my recovery.

Take care pollyanna, and don't be tempted to do to much too soon.

Phyl x

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Main thing I want to check is hopefully you are under a Urogynaecologist? Nothing you do now is going to improve those prolapses. Probably they will still keep getting worse. There's a big chance the surgery for you could be very successful. As lots are. The worse the prolapses get the more extensive the surgery will need to be. Opt for surgery.

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Hello Phyl

I was told Pilates was good and it works on the core and abdomen in a gentle way. I went before my surgery and will go back in 2 weeks, which will be 9 weeks. Were you told swimming is ok and how soon after surgery did you start to swim ? I'd quite like to do that if it's been recommended. It seems different medics give different advice. My doctor told me at 6 weeks that I could go back to full gym classes. I haven't though as I'm really not sure sits ups etc would be good. I'm petrified of the stitches ripping. I'm even scared to lift shopping. Today I did several trips with bags from my car to my flat. Even a bag with milk, orange juice and some meat I angry whether that was too much. Quite a few people say don't lift more than 1/2 kettle of water, which I didn't for 4 weeks , but that's impossible to stick to. Same with not getting wet towels out the washing machine. I hate this!! 🙄

So... any advice about swimming would be great.

Caz 😇

13

Hi caz,

I was attending physio before my first repair hoping to avoid surgery ( no chance), so I continued to see her after my initial recovery. I was told then swimming was best and my husband step mum who was a health visitor also said swimming was good. As I progressed and pelvic floor strengthened I was told I could return to gym but no weights only uphill walk on treadmill, the cross trainer and cycles but moderate.

I did restart outdoor cycling but only for short time on flat paths, and gad a cross trainer at home, but swimming really helped.

My repair failed for various other reasons: some of stitches came out when pack was taken out at start, about 2 year in I was spring cleaning out a cobourd that hadn't been done since repair and lifted things that were too heavy while around same time my work started putting me on my feet for full shifts and I was doing 4 to 5 days in the run up to Xmas .

Thus time I have learned to be very protective of my repair: I made sure they took the pack out carefully, I was told swimming is best from around 6 weeks or after discharge stops (I restarted around 7/8 weeks), and only restarted cycling a few weeks ago ( but cycling you have to be very careful of any down pressure, gears , wind, any gradient, so gave stopped again), treadmill was causing too much stretching this time as perineum gets nippy so can't do that.

So at the moment only really swimming. At 16onths post op I still can't carry heavy shopping, can cope with very light things in a back pack but can't carry milk, potatoes, cans for any distance. OK with Laundry but have to watch wet loads not too much. Family health visitor said will always have to watch and never let anything heavy beyond what I know I can cope with.

It's just not worth taking a chance, I miss being able to help fully with young grandchildren, I don't dare lift any of them and Iis being able to fully participate in my garden.

One of the ladies on this forum had a timetable of do's and don't's and pretty much agreed with swimming from 6 weeks, no more gardening or lifting toddlers for life and only low impact work.

Anyway think much of the advise is guidelines only and everyone may find things different depending on age and extent of repair.

I'm very much aware of the wright issues this time but struggling with length of time on my feet which was fine last repair until I was pug on feet at work and now struggle even thus time at home to cover daily chores. So frustrating.

Maybe just didn't give enough time for recovery this time before returning to work.

Anyway god luck with swimming if you go ahead wife that start with just a little and see how it goes.

Tale care,

Phyl x

14

Thanks so much for replying Phyl and for the advice. I'm definitely going to do swimming. I haven't for a few years as I trapped a nerve in my neck, but I need to get my flabby stomach back to near what it was before the op. At gym I only ever did classes - like 'leg,bums and tums' , I think I'll have to stop those for good or just go the exercises that seem ok. I guess everything is so subjective. We are told not to lift 'heavy' things, but that means different things to different people! I just fo t know what is and isn't acceptable. Even lifting a 2 pint bottle of milk from the fridge makes me worried. This sure makes one anxious!

I'm sorry it is difficult for you at work. Luckily my job won't cause any problems as it's mainly desk work. I was only signed off for 6 weeks by my doctor so am now using up some of my holiday leave.

I hope it works for you this time Phyl. Thanks again for the very helpful advice.

Caz 😇

15

I might try the pilaties that you were talking about, can do anything that does not cause down pressure, the consultant said if I cause down pressure it will fail again and as Stephanie said on this forum if you go back to what you were doing before it will fail again so maybe I need to try alternative things too.

X

16

Hi Caz & Jacqueline,

I would agree with Phyl, you have to be really careful. Full gym classes at 6 weeks?! Madness! I was told 12 weeks before you should return to a physical job or consider any type of more strenuous exercise, even then I would be very cautious.

I don't swim but I did do yoga & Pilates for a while, I explained to the instructor that I needed to be careful & she advised how much I could do. I know it's frustrating when you can see things at home that need doing but it's not worth the risk.

I'm 53 & am having a second prolapse op later this year so I've got it all to look forwards to again - not 🙁. I returned to an easy part-time sit-down job after 4 weeks but after 3 years of thinking (worrying!) I have made an appointment to see my urogynaecologist to get it fixed. It's not going to get better on its own & I hope that being (slightly) younger healing will be quicker but I might be wrong about that.

Jacqueline - I thought about pesseries but was told as I have bladder & bowel (rectoenterocele) prolapse the pessery would be quite large & sex would be "impossible" - surgery, sadly seems the only option.

This forum has been a big help.

X

17

Thank you for your helpful advice. It's most helpful. I've decided not to go back to the gym. 😥 I will just stick to Pilates and yoga. I have done a few leg outs and arm stretches at home using baked bean cans but nothing above or below shoulder level. I think I'll stop these too until I've seen the physio in 2 weeks. You would think with scientific and medical technology that they could fix us ladies in a way that does not require further surgery. So many women on here have reported their surgery failing. There must be a better way!

18

I couldn't agree with you more.

I keep reminding myself that although we keep hearing that 30% fail that means 70% are successful. I intend being one of the 70%!

Let us know how you get on with the physio. X

19

I totally agree Phyl. Matron has helped so many of us and now hopefully we can help others. I still go to the pinned posts for assistance and advice. I do hope she's ok! I'm being so lazy I can't believe I'm still me! lol  You take care too Phyl. X

20

I love your attitude - the NHS is starting to talk about 'self care' and we have to take responsibility for our bodies and help ourselves! It's forums like this that give us knowledge and insight that we just dont seem to get from some Doctors and medical professionals. We are stronger together! S