Six months postpartum - rectocele advice please!


So today a bittersweet milestone - I'm six months pp which means that my beautiful baby is an absolute joy in every way possible. It also means I'm at the point where my pt told me if I wasn't healed I'd be referred to a urogyneacologist for a proper diagnosis.
Although I've told the pt I'm not doing kegels and she knows I'm following ww, I'm still seeing her every six weeks or so to keep 'in the system' - although I wonder now how much value this may be.

My question is, how valuable do you think a diagnosis at this stage actually is? Those of you who read my early posts know I was told by every doctor, obstetrician and pt that there was 'no prolapse' but reading accounts on here so many new mums come to the site with a 'grade'.

Also, where I have seen many improvements in the last two/three months and now have less tailbone pain, less of the falling out feeling when transitioning from sitting to standing, less bulgy days and less problems with confusing bowel urges (from several times a day to several times a week) there are some questions I am pondering.

1 - the pressure in my vagina and perineum during bowel movements is distressing and I often wonder if that is a 'normal' rectocele or a sign that my episiotomy was not properly repaired?

2- Would an examination by a urogyneacologist At the six month stage be too early postpartum?

3 - is this vaginal bulgy feeling with gas and bowel movements just a fact of life now? With all my other symptoms improving, this is one area that still distresses me and that I've seen no change in since four weeks pp.

It's still confusing to me because I can 'see' my cystocele or Urethracele at the front but don't 'see' a rectocele, only know it's there due to the symptoms.

Apologies for the ramble. It's been an up and down couple of days as I approach this milestone. Tomorrow I'm starting a diet plan for a month to see if it helps. I have so much to be thankful for and am learning to live in the now and enjoy the good days as fully as I can but I still have a long way to go with this recovery - both physically and emotionally.

Miss D, I hesitated for a long time before writing here, hoping someone who was not such a scold as me, would offer up some suggestions. I think there are some major pieces of the WW message that you have not gotten yet.

Gynecologists and urogynecologists are surgeons. Surgery is what they do. Why on earth would you take your prolapse to a surgeon? Christine has many many times, throughout her work, called for urogynecology to be disbanded. And yet you are here asking, is 6 months PP too early to go? How about never, Miss D?

I can see that you are being influenced by your PT. You are more of a "dabbler" than I thought, if you are even still going to one. Trying to stay in a "system" that has nothing to offer.

I don't think a day goes by on this forum, that someone (often myself) points out how subjective and confusing and unhelpful a formal diagnosis can be. The only reason to get one, in my personal opinion, is if you are afraid you have something serious, not just a lousy prolapse. I've been here 5 years, never talked to a doctor about my prolapse, never will. Of course we can't tell women what to do about their doctors. But Christine has often pointed out that the women who cannot separate from their doctors are the women who have less success with the WW work.

So it's time to get off the fence, Miss D! - Surviving

for your response.
Believe me, I have questioned the value of each and every pt appointment since her first assessment and I am not at all surprised that you have cause to doubt my commitment to ww. Neither do I doubt the failings of 'The system' I'm currently being processed in and perhaps my questions about formal diagnosis have more to do with a deeper lingering need for vindication and yet why I need this from an establishment that has so far and so wholly let me down is telling I suppose...
Perhaps it's the wider resistance from those closest to me to accept the condition for what it truly is. Without a formal label, it does not exist - or at least to them....I don't know...a huge part of me wants an opportunity to vent my frustrations at someone higher up the chain.... Perhaps there is 10% of me still at the dabbling stage - mentally at least.... what does a diagnosis matter after all? I know it's real and that should be enough.

It is often human nature to be hesitant to invest time and effort into anything we do - we are so tugged in different directions.
You are not alone in that.
I have found that the WW work is worth this investment, so I encourage you to give it some time and commitment.

It is hard sometimes to go it alone against mainstream beliefs and remedies, and family or those closest to us can be the most resistant and difficult, however I now am learning just do it as I believe in it for me and if no - one else is supportive of me so be it.

I have just posted about my decision not to dye my hair anymore and the reaction of others is going to be most interesting, however I am going about my life as usual, not pointing it out or justifying it, and Whole Woman has given me the confidence to please myself more and more.

Wishing you all the best,

Aussie Soul Sister

For taking your time to respond.
A bit of a low day prompted my post I think and you are right about the 'encouragement' from those closest to us to seek fifth, sixth and seventh 'expert' opinions being the hardest to weather....a lack of understanding starts to wear one down...
I truly am investing in this however and have made so many changes to my way of living to my benefit. It's the nagging desire to know exactly what is damaged and to what degree that sometimes drives me a bit bonkers although I do realise that it isn't all that important.
I commend you on your decision to stop colouring your hair. Grey is in don't you know? A sexy little pixie crop in silver tones could be just the thing!

We are the only ones who can do this work for ourselves. If, despite your efforts to enlighten them, those close to you are still not supporting you in a way that helps you, then let them get off the train, and you stay on it. Until you really open up your total self to this work, and give it 100%, you will not reap all the benefits. And if you keep talking about your prolapse, complaining, worrying, those around you are going to respond accordingly, with their own opinions that may or may not be grounded in common sense or true knowledge. That's just the way it is. Don't blame the others, they are simply reacting to your own self-doubt. - Surviving

...there is nothing particularly unusual about where you are right now in this process. As we know, the emotional response to prolapse for so many of us really is akin to the grieving process with very clear, well established stages, the last being acceptance. But it's not a linear process- you can certainly accept one minute and then find yourself doubting again in the next. Just be kind and patient with yourself and most importantly, stay the course- the WW course.

I can promise you that by 6 months pp I certainly hadn't reached the acceptance that even though I hadn't come across WW at that time(this was over 10 years ago) I'm not entirely sure if I had that I too wouldn't have still done the whole urogyn, PT, pessary, etc path. (I hate to admit that, but there it is)

But Miss D, what I wish more than anything is that I could sit with you, reassure you that a formal diagnosis just doesn't change a darn thing, and ask you to not spend one more second of your time and energy on prolapse related dead ends that shift even a moment of your focus from that precious baby. This is a big ask I know. You don't know me, we've never met and likely never will. But in a way I am you- just a decade further down the road, (I had a significant pp rectocele). I adore my 10 year old. Absolutely adore her. But my heart aches for all the PT appointments, Urogyn appointments, the drive time, the fear and anxiety that took my focus off my beautiful (and last) baby. What I wouldn't give to do that time over, not just so that I could immediately implement WW practices and ensure the best possible outcome for my pp prolapse, but also to get back that time with my baby. I can't though and so must live with that and forgive myself. But you have the opportunity to cancel those PT appointments, to not schedule that urogyn appointment and instead, head to the floor, on hands and knees, relaxed belly, and play with your beautiful 6 month old precious baby- all the while knowing that you are doing the very best thing for your prolapse and your body.

A couple of points:

Like you, its my urethracystocele (or cystocele- don't really know because this showed up 8 years after my pp rectocele - 8 years of not doing WW work- and I've never gone in to see anyone about it so no formal dx) that I can see peeking at times, not my rectocele. Another reason why that formal dx is so irrelevant is because there are times when I see it peeping (what would that be? Stage 2 or 3?) and other times, my vagina is sealed up tight and there's nothing to be seen or felt. Things just simply move around, so a number that implies they are static is absurd and decidedly not helpful. Truth be told, there are times my prolapse is a 0-1...and sometimes it's a 2-3...this doesn't change a thing in terms of what I do- it's still WW posture all the time...I just assume that my rectocele starts a little higher up along my back wall and my urethracele/cystocele starts starts lower on my front wall and closer to the vaginal outlet- thus why I can see it at times and not the rectocele- which in my case is actually more severe that the anterior prolapse. But again, none of this really changes anything so it's not something that diverts my attention from my task at hand- WW posture.

At 6 months pp, you still have a full year and a half of healing to do. You are nowhere close to being done healing so who knows what your prolapse will be like for you in another 18 months. You may not notice it at all, or it may just be a slight annoyance that you can easily manage.....only time will tell, but you are in such a great place for maximum WW work- I think those pp pelvic organs are just crying out to be rearranged in that lower belly where they belong. They just need a little help getting there.

I personally no longer even think about relying on my normal support system for prolapse support. I don't blame my friends and family (the few I've told) but they can't even begin to understand or relate. They don't see anything wrong with me, so just can't quite imagine the depth of the impact prolapse has had on my life. (this impact by the way has shifted from all bad in the beginning to so much good and a lot less bad). The women on this forum have become my prolapse support system and on those days when I'm feeling sorry for myself, I can come on here and read all their understanding and encouraging posts.

If it helps, sad as this is, in another 18 months, that urogyn and pelvic PT's will still be there if you feel you must see them. In the meantime, I'd encourage you to spend every second enjoying that precious baby, working on your WW posture and diet and coming to the forum when you need our support. We understand where you are and we are here for you.
All the best Miss D- gr8fl

For what you wrote. The guilt I feel already for devoting too much time and too much headspace to this instead of enjoying my baby time (this too will be a last baby) is a sign that it's time to get a grip and focus on my two tinies instead of what is, after all, on a good day, a mild annoyance.
You ar so right about those around us not being able to understand this unless they have experienced it. Aside from my mother, there's not much point in discussing this with anyone and I think I already knew in my heart of hearts that the diagnosis issue is not the key here.
I'm a pretty positive person but am going to need a bit more time with the acceptance as you rightly assert. I'll get there though! I'm not going to let a bulge be the boss of me!
Truly thank you for your response. It was just what I needed to hear.

im not about to get off the train! I had a smile when I read your first post having anticipated a no nonsense response and I thank you for telling it like it is. Like gr8fl says, I'm not quite at the acceptance stage yet but am already truly grateful for the holistic benefits I'm experiencing through ww and will get there in time.
My goodness! It must get waring having to do all this reassuring and reinforcing when people like me have these wobbly days!

I think your post caught me a little off guard, Miss D, you were so matter-of-fact about asking us for advice on whether it was time to schedule that urogyn appointment. Like that was the thing to do. I didn't recognize you in that post! That's what a down day can do, I totally understand, and I know you are committed to this work, but you need to quiet all those other voices so you can hear your own. Hang in there, girl !!! - Surviving

I think it helps to know that virtually no one escapes prolapse without a couple of emotional bumps and bruises. It sounds like you're doing great- those more challenging days -either physically or emotionally- are also par for the course and I believe you'll find they get fewer and further between.

Go give that sweet, dimpled baby a hug from me! :) -gr8fl

So, the new mom gets referred to a PT, who tells her that if she is not "healed" in 6 months, she will be referred to a surgeon. What kind of protocol is that? No pressure there! Alarm bells should have going off all over the place.

There are others here who have experimented with PT. Is this the norm?? - Surviving

As I understand it, the fact that you are post-partum puts you in an enviable hormonal situation, as you still have your female fertility hormones working for you and helping to stabilize (or even reverse) your prolapse symptoms. This unfortunately is not the same for women with post-menopausal prolapse who don't have the hormonal advantage you do but who are also helped greatly by the WW work in stabilizing their symptoms nevertheless. So please cheer up and understand that your body has such a wonderful chance of healing itself as you're still young and in an ideal hormonal situation.

The pt thing in the uk health service is a bit of a box ticking exercise I reckon. For mild pop you have to do six months minimum with them in most cases with pelvic issues to be referred onwards - rationale being if the kegels don't work (or you don't give up coming) within that time frame, you need further referrals. The same holds true for women whatever the stage of life when they present through the nhs so two of my mother's friends are also 'in the system' for this mandatory period until they will be seen elsewhere... I have to say she has been pretty open to ww but very much stuck in her kegel it away mentality. I think on the nhs there is a limit to what they are allowed to endorse versus what a private pt might be open to.
At best I've had eye opening discussions with her about ante and post natal care here and at worst it's been a big fat waste of time!

..but I have a feeling my urogyn was not the norm. I was referred to him by my obgyn, saw him about 6 weeks pp, at which time he told me NOT to have surgery and then referred me to a PT- with no additional plans to see him. Mind you, he didn't offer me anything but a pessary and PT, but at least he was discouraging me from surgery.

I will say, that whole PT route for 6 months to heal, then automatic referral to a surgeon does sound like quite the racket......I'd steer clear for sure!

That was also my experience where they advised no surgery and actually he said that pesseries don't work very well! Of course he didn't have any useful advice but he was a nice guy with three daughters :o(

I gave up on my PT after 3 times, I think I was a kegal dropout.

Miss D how horrid for them to give you that message of surgery after 6 months. They must love to cut.

Oh, I did get the well you could try giving up breastfeeding. Another ridiculous thing to say.

As Miss D described it, the automatic referral to the urogyn was for a "proper diagnosis", not necessarily surgery.....but what a scary and wrong message for a young mom. PT says "we can't fix you, better go to this guy who will figure out what's REALLY wrong, and what your options are." I just think that's horrifying. I can only hope the day will come when PP moms learn they can take themselves out of this track. - Surviving