I am hoping someone has had experience with this. Basically, this is going to be long so bear with me. Evidently, I fractured my tailbone at some point in my life. It could have been from an accident when I was 12, high forcep delivery of my daughter in 1984 or the vaginal hysterectomy in 2000.
Anyway, I have had spinal issues since 2000 and had to have two cervical fusions; one in 2004 and another in 2006. So, I have been ignoring the "sit pain" for some time. I also have lumbar issues. But those issues are not as bad as my neck.
Just last year I was diagnosed with a cystocle and rectocle and according to my Urogyn I was graded out as a 1...no surgery warranted. So, he recommended pelvic floor PT. My muscles should be cupped and they are not...they are pulling apart. He also told me that the cystocle and rectocele should NOT cause pain...just pressure. And it was his recommendation to get the nerves calmed down in the lumbar area. So, I did this by having a facet Rhizotomy and a couple of other injections.
More recently I showed my spinal pain management doctor exactly where I was hurting and he told me it was the coccyx. He gave me a coccyx injection and it helped tremendously. However, I can REALLY feel those pelvic floor muscles now and the pressure is tremendous especially in the rectal area.
Finally, I have started pelvic floor PT. My Urogyn DID say that if the PT causes severe pain, to stop and he would do the repairs even though they are minor.
My concern is how do they do this? I would imagine they would have to somehow connect the ligaments back to the coccyx or sacrum...exactly where I hurt now!!! The PT gal thinks that because everything is tight with knots and spasms in the vaginal walls that eventually she can work these out and the pulling might stop in the coccyx.
Kathi, I didn't even know I had rectal / bladder prolapse and I was third degree. My new dr found this when I went in for my most recent pap and pelvic exam. What I mainly experienced was the rectal pressure. During my cycle it hurt to even sit down. I kind of had to rock from front to back as I eased down and sometimes the pressure was painful enough to take tylenol. As far as bladder prolapse, I had no issues with it other than it felt like my bladder was going to fall out when I urinated. I did have both repaired during my tvh. Dr cut through the vaginal wall and tacked both back up and into place. My recovery time seemed normal by standards on this site. And I didn't have any extra "issues" that came about because of the repair. One concern was that my uterus was so large it was actually pinching off my bladder and that once repaired I would be incontinent. Fortunately this was not the case. Again, after reading about the discomforts with bm's after the surgeries, mine were probably normal. I did stay on stool softeners for a while because I didn't want to have to over-push which could have messed things up. I did find that when I had to "go" I needed to right then for awhile. Dr said probably because the pressure was off the rectum so the sensations were just different. At my six week post-op dr said she couldn't have been more pleased with the results.
I don't know if this helps at all, just maybe a perspective that wasn't quite scary or negative?
Hi Kathi I had very severe prolapses which necessitated my TVH five years ago. I had anterior and posterior repairs done for the cystocele and rectocele. They didn't involve tying anything to my coccyx - which, incidentally, I also was concerned about because I, too, broke mine when I was much younger (riding in the back of a pickup truck through a field full of holes at an alarming speed ). I didn't have any additional trouble after the repairs because of it, but I did need to sit on a donut pillow for longer than most, I think -- at least six weeks, longer if I was going to sit on a hard surface for more than a couple of minutes.
The A&P repairs I had just involved shoring up the front and back walls of the vagina so things couldn't push them in as easily. Once the weight of the uterus was removed, that plus a little shortening of the ligaments holding up the bladder was all that was needed. You might want to ask your DR exactly what type of repairs would be done, and whether or not they'd involve your sacrum/coccyx. Let him know what your concerns are.
I haven't scheduled surgery yet. My Urogyn wants me to try the pelvic floor PT first. And I haven't even TRULY started on that yet. My first appointment was the other day and it was mainly going over my history and then a simple exam.
My hysterectomy was done vaginally by the way in 2000. So, over time things have definitely changed.
I, too, am having rectal pressure...very bad. But my prolapses are supposedly minor. So, I think some of this is due to the coccygeal nerve and/or sacral nerves (S1 has facet arthritis).
For now, I am trying to keep everything moving...every day. But sitting is awful. I was told NOT to use a donut pillow and that I could use a coccyx pillow. Both even with the coccyx pillow it seems to just pull those muscles apart.
If it isn't one thing it is something else! I thank you very much for your responses. Oh, I do have an appointment with my regular ob/gyn on Monday so I will ask him more about it.
Kathi, usually with vaginal repairs everything is tacked up to the sacrospinous ligaments. Your PT may be on to something because spams and knots in the pelvic floor muscles can cause a lot of pain. My PT performed myofascial relaxation and that had really helped me after the first and second repairs. It's certainly worth a try before having another surgery.
wow, a familiar name and face! I'm back with more prolapse issues, haven't been to dr.yet, husband is having rt knee replacement in September so must wait until he's back on his feet. just wondering if a pessary would work at this point,as I've already had surgery once.
Kathi, I fractured my tailbone a year before my hyst. Within a week of hyst I discovered a rectocele. The pressure of that really pulled on my tailbone and PT said it was pulling it into my rectum. After rectocele repair my right side was weak and my left side was stronger and that was pulling my tailbone off to the right. She was able to straighten it out with massage and that helped alot until my pelvic strentgh equalized.
I am almost 5 months after repair and my tailbone still bothers me if I sit long periods of time. There are many things they can do with the physical therapy. Just be sure and tell your therapist what you are feeling. There were exercises I refused to do as they hurt me. She was always able to find alternatives.
The myofascial relaxtion techniques or massage is what my PT is planning on FIRST. She told me to be "prepared for some pain for a couple of hours afterwards." Eeeek! But I suppose that is okay because I do take Vicodin and Klonopin for spinal/neuropathic pain. I guess I may have to "up" the Vicodin a little.
My reproductive endocrinologist was going to provide a pessary for me about a year ago. But because I have BOTH a cystocele and rectocele it was the "square" kind that would have had to be used. Oh, boy, forget that! That thing was huge...and she was trying the smallest one. Nope, way, way too painful. So, she kind of laughed and said she figured it would be "too much". Anyway, that's when I was sent to a Urogyn to have all the testing. And it was the Urogyn that Graded the prolapses as a 1. And he was also the one to tell me to go back to my spinal pain management doctor and get the "nerves calmed down". And all of that is a story in itself LOL! I am such a mess!!!
But I will say for the record, the lumbar is not as bad as my neck was. For the lumbar so far, it has been injections and meds and a facet rhizotomy which helped a great deal.
How I fractured my tailbone I really have no clue! I NEVER felt it! And in 3 cases that I can think of that may have caused that...I was on pain meds. So, maybe that is why I did NOT feel it. You are right though about PT. At least this gal is going extremely SLOW. She knows about the neuropathic pain I have and I wonder if some of it isn't pudendal and I may need blocks??? Anyway, what you said makes sense to me. I plan on asking my PT about it today. Because even though the prolapses are minor the rectal pressure has been something else! I did notice though that if I keep my bowels moving and soft, I do so much better. I tend to think (and this happened with the Barium test), that when the stool backs into that rectocele it lies against the coccyx causing such pain! Sorry to be gross. And that is another reason the Urogyn said to keep things moving EVERY DAY! So, far I have. But if you could have seen what happened during that darn Barium test you would have died! Evidently, and oh, I knew to drink a lot of water BUT I was NOT told to take stool softeners or a laxative BEFORE the test...only AFTER. To make a long story short, I ended up in the ER two days later. The Barium ended up in the rectocele and turned to concrete! And I am not kidding when I say I gave birth to a Barium Brick! Sorry again...but that was one horrible experience. So, I told my Urogyn what happened and he was in shock! And he said it wouldn't have mattered if I had drank all the water and taken all the laxatives in the world; because the Barium was in that pocket, all of that bypassed it!!! Anyway, sorry for being so graphic. But I think this very same thing happens when I take Calcium WITH Magnesium in it. So, it is fiber and water...as much as I can get down and to keep things soft and moving. And, well, being on constipating meds doesn't help.
So, now for my next question....
Right now I am currently on the Vivelle dot .025. A few months ago my new ob/gyn took me down from the .05. I noticed if I did NOT wear the patch or forgot to change it on time, my legs felt so much better. He said my requirements have changed over time. So, I use the .025 and was using Vagifem. And overall I felt pretty good.
But in order to go through PT he suggested that I use Premarin Vaginal Cream. That stuff is great! However, he wanted me to use 2 grams twice a week as a maintenance dose. What I noticed was 2 grams was way too much! I had PMS-like symptoms; crying all the time etc.
So, I wonder if the .025 PLUS the cream is just too much. I was wondering if maybe anyone here just uses the vaginal cream OR just the Vagifem? I know the Vagifem is not systemically absorbed as much as the cream. I just don't feel, now at age 50 and 7 years out from my hysterectomy if I can't just get by with the vaginal estrogen. I would LOVE to stop the patch and this is a question for my ob/gyn today. I am just trying to say that perhaps all I need is the vaginal estrogen and nothing else. When I dropped to the .025 I noticed nothing; no headaches, no leg pain...just nothing except a few minor night sweats. So, I would love to dispense with the patch altogether. Oh, and my ob/gyn said I could go to something else to combat bone loss. Does anyone have any recommendations on that as well? I know I need the Calcium with D. But he mentioned meds like Fosomax, Evista, etc.
Oops, sorry for rambling. I just have sooo many things going through my mind right now.
Kathi, I can't help on the hormone question...I am headed the other direction as Ihave taken none and did not figure out what was wrong with me fast enought. I went for bloodwork last week to get on some HRT. It will be none too soon. I am not much fun to be around. I do use the premarin cream (1/2 applicator) 2 times week but I have been forgetting. I did notice more dryness so I am going to go back to using it. It all is sooooo confusing! Good luck on you mission to find the right amount. That was a horrible experience with the test. That could not have been good for the rectocele either.
Let us know what you find out!!! (ps I cracked my tailbone on a jetski almost 2 years ago. I had to fly home from Houston to Tucson on the hard plane seats....thought I was gonna die. Then I could not sit for 2 months. It got better until the rectocele came along. I had forgotten about it all together)
Sorry I haven't posted back for a few days...I just got busy.
Pelvic floor PT is going well and I am already noticing a difference after 3 visits. My tailbone still aches a little but I can get another injection for that. And the Piriformis muscle was extremely tight; perhaps pulling for lack of a better term..the coccyx. She released that knot and that hurt! But overall...I am a little better than I was. It was very interesting when she did the EMG with electrodes on the outside muscles. The graph or machine rather, had a range of 0 to 1000 I believe. And even at rest I was ranging right around 60. I SHOULD be at 40 or lower. Then she had me Kegel a few times and it shot up...not ONCE but twice in a row which was weird. But as she said, it just goes to show the muscles aren't relaxing as they should. But by the same token, AFTER I did the Kegels it dropped to a 50. I guess she is going to show me how to get them to relax once we get everything to stop spasming.
As for the ob/gyn appt....
He said I could stop the Vivelle dot .025 and just stick with the Premarin Cream OR Vagifem. And he told me just as my Reproductive Endocrinologist said....base the dosage on HOW I FEEL...NOT numbers! There are reasons for that. Anyway, I did notice that my skin felt more taught and dry by NOT wearing the patch. But also know I have small fiber neuropathy. So, the burning sensations I was feeling probably have more to do with that. Just not sure yet. So, I will wear the patch awhile longer. Oh, and he did say if I were to dispense with the patch altogether, to use 1/2 to 1 gram of the Premarin Cream twice a week. Or, if Vagifem, twice a week as well. The problem is...2 grams of the Premarin Cream send me into PMS like symptoms. But I will work with it.
And that's pretty much where it all stands for now. I want to thank everyone again for the responses.