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Uterine Prolapse Uterine Prolapse

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  #1  
Unread 05-07-2009, 07:29 PM
Uterine Prolapse

I'm new here. About a month ago, after a bout of intense coughing thanks to a virus, I realized that something was prolapsing. My dr said it was a mild bladder prolapse, but really, it didn't seem mild to me given that I could see it protruding out and could feel it. I decided to see a gynocologist, who said no, it was the uterus, and it was protruding about an inch. She said I could try a pessary but that comes with its own issues. The only way to really fix it would be a hysterectomy.

The good news is that I'm not really uncomfortable because of it; my only problem is that I see it and feel it and that is unnerving. I'm 46 and active. Of course I want to stay active. It seems inevitable that it will get worse. One problem complicating the issue is a chronic cough that I get frequently (usually after a viral infection) that is contributing. I've been coughing about six weeks with this last infection, and I coughed from June to Oct last year. I've tried all sorts of asthma/allergy medications and nothing helps. The gyn told me to get a new dr. I know every time I cough, I'm putting pressure on the thing.

I didn't really get much information from the gynocologist. Unfortunately, right after she stepped into my room, a nurse opened the door and told her that they would be ready for her in surgery in five minutes, so I didn't really have time for questions.

So now I'm wondering what I should do.

For the most part, I'm a get things out of the way ASAP so that I don't have to worry about them kind of girl. I'm a teacher, and although I do work in the summer, my work load is decreased and I can afford to take more time off -- so timing wise, now is not so bad. However, I've been through a lot this year, especially this spring with a death in the family, and you know, don't really need another thing to deal with. And as I said, I'm not that uncomfortable right now.

The question is do I really want to wait until I am uncomfortable. I know none of you can answer that for me.
Maybe the real question is if it is inevitable that things will get uncomfortable?

Maybe you can tell me what a hysterectomy is like. It seems as if there are a number of ways to do it such that recovery must vary enormously. Is there a typical type of hysterectomy that is done with a prolapsed uterus? What is the recovery like? How long would I be out of work?

Sorry, lots of meandering thoughts and questions.

Thanks for all your help.
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  #2  
Unread 05-07-2009, 07:51 PM
Re: Uterine Prolapse

Hi All good questions! I was in a similar situation seven years ago. In my case, out of the blue, I had a severe prolapse - suddenly I could see parts of me that were not meant to be seen without a speculum.

I was in a bit of a bind... I was already booked on a two week trip to Japan with my son about eight weeks after I was diagnosed. I could not cancel it, and my DR told me she would not approve of my going. She said that my uterus was in danger of turning itself inside out (it can happen) if I lifted luggage or otherwise strained myself. So, we booked a hysterectomy so that I would be six weeks post op by the time I needed to travel.

Really the only method of doing a hysterectomy that makes any sense in the case of severe prolapse is a vaginal hysterectomy (TVH), which is what I had. After all, to do anything abdominally, whether laparascopically or through open incision, would first involve pushing the uterus back up through the vagina. Why do that when it's already conveniently trying to make its exit on its own?

I was 45 at the time of my surgery. I was also perimenopausal. I opted to have my ovaries removed at the same time (again, vaginally) to avoid the need for future surgery to remove them should there be problems, which my DR told me in her practice happens about 30% of the time. Looking back it was a good decision for me but not one I'd recommend if your ovaries are healthy. Yes, it helped me avoid another surgery to remove the ovaries, but I've had four other surgeries since the hysterectomy anyway!

Did your DR mention any sort of repairs that may be done along with the hysterectomy? My bladder and rectum were also prolapsing (cystocele and rectocele), so I had what are called A&P (anterior and posterior) repairs at the same time to minimize the likelihood of future prolapses. So far things have been OK.

If you are not currently uncomfortable, you do have time to do your homework and make your decision. I did not have the luxury of time; however, I would have reached the same decision if I had. I also had started getting yeast infections, which is a common side effect of uterine prolapse. I also had some bladder incontinence, which was from the cystocele.

If I had it to do over and hadn't had the time constraint that I did, I might wish that I could go back several years prior to the prolapse and start on a low dose of estrogen, some vaginal estrogen and a plan of regular kegel exercises to strengthen my pelvic floor. If I'd done that (ie had a crystal ball), I might not have had to have the surgery. Unfortunately, hindsight is 20/20 but you have to base your decision on where you are NOW and what you know NOW. Best wishes with whatever you decide to do!


-Linda
  #3  
Unread 05-08-2009, 08:57 AM
Re: Uterine Prolapse

Thanks Linda for your reply.

I think I need a whole lot more information before I can decide anything. My exam yesterday was maybe 10 min. long -- not enough time. I'm planning to either make another appointment with this dr or make an appointment with the gyn I used for an endometrial ablation a few years ago (she was very good).

You asked if any other work would be required. I don't know. The gyn mentioned the possibility but did not give me any specifics. How do they know? Can they tell from the vaginal exam or do they need an ultrasound or another imaging test? Do they figure that out once I am in surgery?

How long did it take you to recover? How long were you out of work?

Is there any way to predict how quickly things will progress? I kind of think it has worsened in the month that I've been aware of it. Based on the description -- the thing protrudes about an inch, the gyn said -- how severe of a prolapse is that? I know it could be worse, but that doesn't sound good to me.

Ok, that's enough questions for now. I have papers to grade and students to torture.

Jeanne
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  #4  
Unread 05-08-2009, 11:45 AM
Re: Uterine Prolapse

My story is very similar to surferbabe. Like you I am a get it done kind of gal and at 49 I wasn't ready to suddenly quit being active. My prolapse also happened quickly and out of the blue. I got out a mirror and looked and thought "hmmm there's things there I've never seen before!" I opted to go for a TVH and my bladder was prolapsing as well. Because of that I had the anterior and posterior work done at the same time. I just had my 4 week post op appointment today. I won't lie to you, the first couple of weeks were tough, but I am glad to have had it done and am looking forward to getting on with my life. I still have another 2 weeks yet until I'm "released" from my surgeon. I went to a uro/gynecologist and have been really pleased. There are no easy answers but it's great that you've found this site. I didn't find it until I was a couple of days post op so I missed out on all the great information that might have helped me make my decision. All in all though, I would still have had it done.


My bladder and rectum were also prolapsing (cystocele and rectocele), so I had what are called A&P (anterior and posterior) repairs at the same time to minimize the likelihood of future prolapses. So far things have been OK.
  #5  
Unread 05-08-2009, 10:25 PM
Re: Uterine Prolapse

Hi mercyme:

I also had a vaginal hysterectomy (TVH) for prolapse. Unfortunately, your chronic cough is a contributor to the prolapse. I was able to get a consult with a urogynecologist, who did the surgery in a procedure which lasted about 45 minutes. I was released from the hospital the next morning, and returned to work 6 weeks later.

I hope you are able to find the right answers soon. I am sending huge cyberhugs
  #6  
Unread 05-09-2009, 07:39 AM
Re: Uterine Prolapse

Thanks Happy1 and Twysmiling for the responses. Next week I'm going to make an appointment with the gynocologist I used for the ablation. I feel confident that she'll give me the information I need (provided, of course, that all the pregnant women she treats cooperate and don't decide to have babies during my appointment time.
Not sure what to do about the cough, but I guess I have to keep trying on that.

Is six weeks out of work the norm for the surgery? That's one factor that I feel is pushing me. I can afford six weeks out in the summer way more than six weeks during the school year.

Happy1, I hope your recovery continues to go well.
  #7  
Unread 05-12-2009, 04:30 PM
Re: Uterine Prolapse

Ok, I've seen a second gynecologist, and now I'm officially scared.

He said the uterine prolapse is stage III, which is pretty bad a 46-year-old who has not yet hit menopause. I also have a stage II rectal prolapse and a stage I bladder prolapse.

As I understand it, the hysterectomy is the easy part. The problem is that the other parts need to be repaired, and given that I am relatively young and have a pretty severe uterine prolapse, the pelvic tissue is undoubtedly weak. He feels that just doing a regular repair job would be like stitching up a threadbare shirt and that would have a very high probability of failing. So he talked about the mesh, which is much stronger, but has a 10-15 percent chance of eroding, and when that happens, it's a really bad deal.

Well, he doesn't do mesh, so he referred me to the only urogynecolgist in the area, whom I will see early next month.

Of course, I have no choice but to anxiously await this next appointment. At this point, though the surgery scares me, I think I will have it this summer. The gyn said what I thought -- the surgery is inevitable. Summer is easier for me than any other time during the year. But the part about the mesh has me nervous.

Ay yi.
  #8  
Unread 05-12-2009, 09:48 PM
Re: Uterine Prolapse

I'm 37 and have stage III uterine & bladder prolapse. Fortunately, my Dr was busy yesterday and I talked to a nurse who recommended I wait until school starts again in the fall to have surgery. I saw a nurse practitioner today who fitted me for another pessary. She also thought now was definately not a good time for surgery, with my youngest at 10 months and nursing exclusively. Everything I've read says there is a chance I won't be able to nurse after the surgery, but my doc continues to deny it. Hopefully the pessary will work well enough to buy me a few more years. It was so nice to have dry underwear and nothing hanging out today!

Have you tried a pessary, even to be more comfortable until you see the other doc next month?

My NP also prescribed estrogen cream for occasional use to replace that which I'm not producing (no periods while I'm breastfeeding, which is 2+ years at a time) and recommended vitamin D supplements along with calcium. My weight continues to drop, so ensure or protein powder, too. I weigh 81 pounds. I've already had thyroid panels done, but that was a few years ago. I eat plenty, it just doesn't stick. Any suggestions on this? For the record, I weighed 104 the day my last baby was born, albeit 2 months premature. My weight has actually been dropping a few pounds a year the last few years, but I haven't been this low since high school. 88 was my norm.

Sorry to ramble -- the kids are asleep and I have time to go on and on...
  #9  
Unread 05-12-2009, 10:55 PM
Re: Uterine Prolapse

mercyme--

I can give some information on the mesh part. I had it implanted in me for a bladder lift (as well as a TOT) in June 2005. And yes, I was one of the 10-15 % who had the horrible, nasty mesh erosion. Because of my experience, I would not let them implant polypropylene mesh in me ever again. There are other ways of shoring up the vaginal walls to help with prolapses. If you need something extra besides the tissue already there, you can have some of your own tissue from another part of your body implanted or 'grafted' there. That's called 'autologous' tissue and one doesn't 'reject' one's own body tissue as can often happen in a foreign body polypropylene mesh reaction.

You can also have another type of biological tissue graft of either cadaver, porcine, or bovine origin implanted. All 3 of those also carry less risk of erosion than does the polypropylene type. [Go to pubmed.gov for specific information. You can also do a Google Search on the web.]

I had 3 surgeries to remove the eroding mesh after my original surgery. I also had several 'in-office' procedures where the doctor 'snipped' the exposed mesh right there without benefit of any anesthesia--those were hideous beyond measure. So yes, I am definitely biased against the artificial mesh. When it does cause problems, they can be anywhere from mild to truly nightmarish and for a long time. One has to be very, very cautious when thinking of putting this in such a sensitive area, in my opinion. Some highly respected doctors are no longer using polypropylene mesh for larger vaginal slings because when it does go awry, it can cause such catastrophic problems.

*If it were me, I'd ask my surgeon how many times s/he has done any prolapse repairs and what types of 'mesh' or 'graft' s/he has used. Also, "Can you use my own tissue to help do this repair?" If not, "Can you use a porcine-based or bovine tissue-based implant instead of a polypropylene because of the erosion risk?" If they ask why, say you've read that the erosion risk is so much higher with the artificial mesh.

I hope this information helps.

........
  #10  
Unread 05-13-2009, 09:17 PM
Re: Uterine Prolapse

Thanks for the responses. Orah Deb, you've made me feel better about this by informing me of the options. I will definitely ask about these options when I see the urogynocologist.

I obviously need to see this specialist to see what my particular options are, but from what I've read, I guess my gut tells me I'd prefer to use my own tissue. I would think in my case, given that the pelvic tissue is weak, it would come from the thigh. Has anyone gone that route?

Swissrollsrock,

Gosh, sounds like you do need to gain weight. This spring I was concerned about my elderly father dropping weight. The nutritionist at the assisted living center started putting extra sugar and extra butter and heavy cream on just about anything that was appropriate. It did help. There was also something called TwoCal (sp???) I think that people could take medication with. It was something like 200 calories. You need a prescription for that.
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