FOR WHOM SURGERY?

We’ve raised many questions and even stumbled upon a few essential answers over the course of the past two years that Whole Woman™ has been live on the Web. A body of knowledge has developed around this approach to pelvic organ prolapse and a set of principles laid down that most of us could probably agree on. There is little doubt that the symptoms of stage three prolapse of the bowel and bladder differs significantly from woman to woman, given that the same organs, muscles, vessels and bones are involved in all.

What makes the difference then between the woman who happily chooses palliative measures over surgery and seems to live well in spite of her chronic condition, and the woman who is an emotional wreck and just can’t seem to get beyond the hope that some doctor or therapist “out there” is going to make it all go away?

No short answers to that question for sure, but clearly there is a certain percentage of women for whom surgery, despite the inherent risks, is simply the best choice. And really, it is entirely possible that surgery became the primary method of treatment that it is today because of women themselves demanding that doctors “Do something!”

Yet, how do we make sure that the woman who might readily learn from the history of the surgical approach to prolapse, and therefore understand the value in responding to these conditions with posture and lifestyle change, is provided this information? She’s certainly not going to find it at her doctor’s office, nor on a newsstand, or even here unless she has Web access. Pelvic organ prolapse is the most prevalent women’s health condition on the planet, yet remains virtually unknown outside the field of gynecology. If ever there was need for a grass roots effort it is in this area of women’s health.

Comments

I had to shop around for my prolapse since I also have Scoliosis 70 degree curve and Fibromyalgia. I finally found one that believed I would do fine with a pessary.Yet I have had to take it out twice because it turned inside and hurt me. I go in Tue. for more consultation.I have been doing the exercises and using a Tampon to hold my bladder in place. Any thoughts on this? Peace, Linda

Hi Linda,

If you are only needing to use a pessary to help keep your bladder in place, why not try the sea sponge? It's a really good natural alternative to the pessary. PLUS, it won't turn itself inside out or put pressure on the rectum. I have been having much success with it to manage the heaviness of my primary cystocele. Also, having a diet rich in veggies and fruits, whole grains and less meat and milk product consumption is also really important to keep the colon "light" as Christine states in her book and here. I have found that to be as important, if not more important as the posture!! You can purchase the sea sponges on line at www.pandorapads.com. Be wishes! April

Without knowing more about your history (i.e hysterectomy?) it's difficult to answer. Please feel free to email me (christine@wholewoman.com) and we can discuss it further.

Hi, this is my first time on. What a fabulous site. I am 45 yrs. old and past thoughts of any more kids. I have a severe uterine and rectal prolapse brought about by a year long bout of IBS. Although I have given birth to 2 children, my GYN said my pelvic floor was fine after both. The uterine prolapse only shows when straining to have a BM. which becomes problematic, because, my rectum hangs out of my butt almost 2 1/2 inches and then cuts off supply to my bladder. The rectocle, is so severe that my vagina has absolutely zero tone, which is why the minute I sit to use the toilet, my uterus starts its slow descent. Who ever gave the advise about standing or squating to urinate, had it right on. It has become the only way I can clear my bladder before it becomes closed off.
So to surgery or not. I have never heard of cutting off the cervix, however, I am going to be having a hysterectomy,saving my cervix, and ovaries w/reconstruction of my vagina. and then "hoisting" of my pelvic floor. now I realize this is not an option for women still considering children, however, I have been reading some of the women are older and it may be an option for them. Also, I haven't read about vaginal reconstuction to fix the rectocele, at least it would fix some of the problem.

So when to have surgery, my benchmarks were: fecal incontinence, not haveing sex more than 4 times in 1 year, feeling like an untouchable, not wanting to go out socially anymore. (oh yeah, did I mention I was married...very patient guy)

Anyway, I realize I have only just begun to read this space and do not proclaim to have any answers for anyone else, my problems tend to be unique. You don't even want to know what they want me to do to fix my rectum! At least w/ that the Dr. is willing to admit it might not fix the problem. Thanx for listening mary mary

Hi Marymary

So glad you have found us. Sounds like your body is a bit of a burden at the moment and I am not surprised that you are having a close look at surgical options. It may be that you will go that way, but maybe you won't. Only time will tell. You seem to be pretty open one way other, which is a great way to be when their are major decisions to be made.

I can only ask you to consider that once you have gone the surgical route there is no going back, should the results not leave you better off than you are now, for an extended period of time. The results of surgery have to be worth what you will put your body through, and it sounds to me as if many women will need multiple surgeries over the following years to maintain the results, each time compromising their bodies a bit more, and sometimes eventually left seriously debilitated.

On the other hand, I feel it is worth trying Wholewoman posture for a period of several months; exercising as Christine suggests; modifying your diet significantly; adapting your clothes so they do not put pressure on your abdomen and generally caring for yourself well. I would also strongly suggest that you get Christine's book which contains the full story on the different surgeries available at time of writing, and includes documented risk factors and documented complications, all referenced from highly respectable mainstream medical journals. This is the stuff that doctors don't tell you (often I think they don't think we will understand all the complicated medical terminology). It is all there, so you can weigh up for yourself what risks you want to take, and the price you may have to pay, which seems to be pretty unpredicatble. Ask the women who have had surgery who post on this site!

Once you have done that you will be in a much better position to decide what you want to do about your surgery decision. And above all, remember that you are going to be the one who has to live in your body, not the doctor. It is a really personal choice.

Hugs to you and your very patient man. He sounds like a gem, and you know what? Your pelvic organs are not you. He loves you for all of you, even the bits that are not where they used to be. ;-)

Cheers

Louise

Surgery is the best option, I had a rectocele repair 3 weeks ago and am fine, what is all the fuss about? Why suffer for years, here in the Uk we just have the surgery and get on with life - simple!

Dear Neety41

It is good to hear that there you are expressing on this site your satisfaction with your recent surgery. It does give another point of view. Recovery from surgery is not always as quick as you say. You are very fortunate. No wonder you are crowing.

Your posts have been very brief and general. You say that you can't see what all the fuss is about. If you would like to know what the fuss is about I would suggest that you read Christine's book, Saving the Wholewoman, where she describes all sorts of surgeries. It is brilliantly referenced from highly respected, peer-reviewed scientific journals. It is not bullshit.

Many procedures do have high success rates initially, which you have experienced. However, when things do eventually go wrong, which they seem to do, whether weeks or several years later, the problems can be life changing, can be irreversible and very debilitating.

I do not know the initial success rate for the procedure you had. Hypothetically, say it is 80%. That means that there is a 1 in 5 chance of inital failure. If you are the unlucky one, and suffer nerve damage, pain with sex, difficulty with defaecation or a return of symptoms you will need further surgery to sew up your insides a bit more, and compromise natural design further. You can't just go back to the way you were. *That* is what all the fuss is about! I am surprised your gynaecologist didn't point out to you the full story on these repair jobs. But then, they often don't tell unless you ask. The vagueness of my gynaecologist was the signal that he really didn't want to answer me, and as it turns out, there is no research on the long term success rates. That's why they don't tell! Because they don't know.

80% chance of short term success wasn't good enough odds for me. Nor is 90%. Perhaps you are just more of a risk taker than I am.

It would be interesting to hear how you came to decide on having the rectocele surgery. I really hope that you will call back later and let us know how you are going, and if you need to return for further surgery.

Have you been following any of Christine's advice about posture, diet etc? There are many women who contribute to the Forums who have had surgery, often several times, who have come to realise that the best way to avoid further surgery is to manage their own bodies better.

Hope to hear from you again.

Cheers

Louise

Hi;
I am interested to know what type of surgery you had. There appears to be all kinds and after much research I am very reluctant to have surgery due to the risks. You may be one of the success stories. I hope you continue to have great success, and would also like to hear how you do in the future. Would you be inclined to let us know a few more details? Thanks...

Just to say I'm from the UK, and I saw a top gynaecologist in the summer and he told me 'not to let anyone touch me with a knife' rather than 'go for it and get on with your life!'. I don't know whether your situation is a lot worse but it would be great to have a little more information from you?

I don't want to kind of 'gang up' on you and your comments as this site does state that it's not anti surgery. I'm sure that in some cases surgery can work out really well or it would be illegal, certainly in the UK where we don't pay for our medical treatment. But at the same time you've made alot of sweeping statements. I genuinely hope that things go great for you (with no 'you'll see' undertones!) but do keep us posted, and give us a bit more background if you get the time.

Best wishes :0)

I am a staff nurse myself and have had some experience of gynaecology, I even worked on that particular ward so the consultant i saw was very open with me, I asked about the risk of painful sex and he said there was no reason to have any problems after a rectocele repair. I work in Urology and do know the risks of most surgery, there are some operations I would not recommend but at the moment I am very happy not to have my bowel hanging out of my vagina!!! However, I am having a bartholins cyst removed next week too, my consultant doesn't do marsupialization as they do in the US as this would mean i would no doubt be going back and to when it comes back over and over, so he is removing it as this is the best option. Maybe I am being cynical but do you not feel that because patients pay for treatment in the US that maybe it's in the doctors interest to ensure that these patients keep coming back for various treatments instead of just dealing with the problem once and for all? I also had a hysterectomy 3 years ago (I already had the prolapse before that, so that's not why i have it) after having several other procedures (to try to avoid the hyst), I eventually decided to sort the problem and don't regret it for a minute, I am just of the view that for me, surgery is a small price to pay for getting back to normality, I have a career and a life to lead and don't want my gynae problems getting in the way!!

Hi Neety41.

Could you explain the meaning of marsupialisation please?

Cheers

Louise

Hi Neety41

I am due to have rectocele repair and possibly cystoele (can't spell) in december. I have opted for surgery as I cannot cope with the appearance and the inability to pass a bowel motion without using my fingers -yuk.

Naturally I have concerns as to whether I am taking an un-neccesary risk but you seem happy with your surgery. Have you experienced any negative side effects?

elaineh

Hello Elaineh, Neety41

I was looking through posts on exercises that are good for rectoceles and came across your posts about surgery. I would love to know how you are feeling a few years down the line and whether your problems/symptoms have been alleviated.

Also, Christine posted some exercise tips for rectoceles, but I seem not to be able to find them or they have been removed. If anyone can help or point me in the right direction I would be most grateful.

I do find the plies and relevee are good for my bottom, would love to do more though. Kegels seem to make me notice the rectocele more so have been shelved for now!

- Davina

Funny you should mention the kegals thing Davina, sometimes I feel like they make things worse for me too. I wondered if it was just due to lack of lubricatuon and it was making things rub even more. I'm not doing then fanatically any more but they are still my supermarket queue exercise.

Sally

This is for davina, only just spotted your request. Christine gave me this exercise when I first posted on here years ago, I've copied and pasted it. I've found it very helpful:

Get down on all fours and, while keeping your neck stretched toward the top of your head (in other words, don't look up) and your shoulders centered, raise one leg up behind you keeping the bend in that knee. Now begin lifting your foot toward the ceiling...you want the sole of your foot to reach toward the ceiling. You won't be able to stretch your leg all the way straight (at least I can't), but do a series of controlled leg lifts this way, really feeling the muscles work in the area of the buttocks, rectum, and rear pelvic floor. Begin with a few and then work up to 40-50 twice a day.

Hope you've spotted this and that it works for you, Judith

This is largely a cultural issue, and the general belief system being developed at WholeWoman is a paradigm shift that will take some years to complete. Nurses are the largest working population of hysterectomized women, which comes as no surprise as they are embedded in the medical culture. The literature speaks for itself, Neety, and it is a fact that you have not been fixed, but rather have traded one set of symptoms for another. In any event, I would certainly read our tips section about non-straining on the loo and I, too, wish for you the very best outcome.

what? none of my present problems are in any way connected to a hysterectomy!!! How can a prolapse that was already there (no doubt due to large babies and tearing badly 23 years ago) be a symptom of my having had a hyst? How can a bartholins cyst have appeared because of a hyst? Incidentally, the hysterectomy was my decision as i don't believe in messing about with coils etc to alleviate my heavy periods!

Well, Neety, your questions speak to the heart of the concepts we are working with here. I guess the most efficient way to address them would be to first consider the gynecologic perspective on the matter. The following set of “principles” was established in the 1930s by the famous British gynecologist, Victor Bonney, and remains the “gold standard” of operative treatment for prolapse. Whether in Europe, Australia or the States, gynecology recognizes that without suspending organs to the bony pelvis and narrowing the vaginal outlet prolapse will return – and will usually be a more severe and difficult condition to address. It has been widely known amongst surgeons for over a century that hysterectomy-only exacerbates collapse of the vagina. And not only in this society must women return again and again to the operating suite.

• “In considering surgery for the correction of uterovaginal and other pelvic organ prolapse, the gynecologic surgeon is well advised to think of the surgical principles rather than just about a particular operative technique. For example, the surgeon should remember that the uterus is not the cause of uterovaginal prolapse. Uterine prolapse is the result but not the cause. Performing a hysterectomy will not solve the problem of prolapse."

• “The surgeon should repair all relaxations, even though they are minor.”

• “The cul-de-sac should be closed and enteroceles repaired in all cases.”

• “A posterior colpoperineorrhaphy (rectocele repair) should be performed in all cases.”

• “The urethrovesical (bladder neck) angle should be supported separately to correct or prevent genuine stress urinary incontinence.”

• “It is especially important to do a Burch suprapubic colpourethropexy (bladder neck suspension) when a sacral colpopexy (vaginal vault suspension) is performed.”

• “It is also important to do an anterior colporrhaphy (cystocele repair) when the vaginal vault is suspended to the sacrospinous ligament.”

What these principles convey is that without this level of “cure” the organs will continue to escape through the vagina. The practice of gynecology has over 100 years of data reinforcing these concepts. You are experiencing this already. Although you imply the rectocele was present before your hysterectomy, may we assume that because you did not seek treatment for your symptoms at the time of surgery or last year or the year before, it has become progressively worse?

I understand the improvement in comfort you are presently experiencing by having had the vaginal bulge reduced. However, the literature is very clear that bowel symptoms (constipation, needing to splint, etc.) are far less likely to be aided through this surgery. In addition, the bulging will often return to a different position higher or lower on the back vaginal wall.

Most importantly, the shape of your vagina has been radically altered and the chance for collapse of the front wall dramatically increased. A brief look at the anatomy will help define why this is so.

The front vaginal wall is shorter than the back vaginal wall because of the way the cervix is attached. The length of the front vaginal wall + the length of the cervix = the length of the back vaginal wall.

By amputating your cervix and narrowing your back vaginal wall, the shape of your vagina has been altered from an angular, virtual (virtual in that it is normally flattened and closed) space to a straightened, open tube unable to protect itself from intraabdominal pressure. This is why “vaginal wind” is such a problem for post-surgery women. The odds are very high that your bladder will come further down now because it has lost its supportive architecture and may even be fused (by way of the supravaginal septum that was once connected to your cervix) to your upper back vaginal wall where it is tugged on a bit with each bowel movement. Loops of bowel have already moved in to fill the space once occupied by your uterus and are now pressing on your bladder and vaginal vault. Both stress and urge incontinence are expected. Such is the reality of “simple” hysterectomy and the reason for the principles of the “gold standard” of treatment.

In my blog post “End of the Surgical Age” I address the problems with the “gold standard.”

Christine

Hi Christine, It would sure be a lot easier to understand all of the descriptive interior if somehow you could add pictures of sideways and front! For most of us that are not medically smart, a picture says a thousand words! I am going today for a pessary, and I will keep you posted on that! I do remember one thing you said in your book, to make sure before I leave the office, that I can pee! I'll be sure of that!
Hope you can figure out a picture album for us gals! Nancy

This may seem like a mad question but can anyone tell me what a rectocele feels like? I definately have one and know what it looks like (as described on this forum) Had it for years and it never bothered me. Suddenly I have Discomfort, redness, rawness in the area of my clitoral hood and urethra. The gynae says it's my prolaspe but to me it's too 'external' and at the front, not the back where the rectocele sits. Any advice would be greatly apprciated.
Sally

How about replacing kegels by pulling up strongly into the posture and breathing quietly through your nose and into your lower belly? This will be much more helpful I have no doubt. I often stand in “3rd position” when I have to stand in one place for a lengthy period of time, discreetly changing to opposite feet when I get tired. Honestly, I can stand for hours like this and it actually feels good. The key is to keep pulling up through the back of your neck and the rest will follow once your body has the hang of it. Kegeling automatically tenses your abs and messes with natural breathing.

Davina, I don’t have any rectocele-specific exercise. The pelvic interior moves as one unit, while fascia-covered organs slide past each other to perform their individual functions. There are several different exercises on the dvd that are good and an infinite number of additional ones to create once you internalize these concepts. The posture, firebreathing, are nauli are very helpful, and discontinuing all straining against the toilet seat an absolute must.