Prolapse-Long and a little tmi

[minimatron]

Actually I dont know how to start this off!!!

I have a history of uti's...ever since I can remember and the earliest memory I have had was pre primary school, so I was pretty young. Prior to being pg with dd, I basically got a uti every month, leading up to AF or after AF. I have had one kidney infection in my late teens and test showed nothing wrong.

So here I am. After the birth of dd last year I had my 6 week check up and asked the gp to have a look at my vagina, coz to me it didnt look "right". Ok just a warning coz I am going to go into a bit of detail...one of the walls of my vagina was hanging down a bit, not like the normal looking 'hole' (sorry cant think of a better term) it used to be. Basically he said that I have weak pelvic floor muscles and I need to exercise them. I am and have been...obviously not good enough though. Oh and sometimes I pee myself if I sneeze.

So now I am pregnant again and as some of you may know I have had some vaginal bleeds which happen every time I strain to go for a poo. I have tried all sorts of things...metamucil (makes me windy and stomach pain), prunes, dried fruit, I have high fibre cereal for breakfast and drink water...the list goes on about my efforts for moving my bowels, but thats another topic!!!!

So what I did when I tried to go to the toilet yesterday was apply some pressure by placing my hand over my vagina while trying to poo. I did this because when I strain, even just push slightly, I feel like my vagina and all my insides are going to fall out...actually exactly like I felt when pushing dd out. When I did this it felt buldgey. So out came the hand mirror and I have noticed my vagina is starting to buldge out. Its really disgusting to look at and am actually embarressed to show dh, although he wont mind!

So I suppose my questions are....

Has anyone had this before?

Is there a chance of completely prolapsing while pregnant and the uterus sticking out?

Whats a girl to do? Any advice would be good.

Oh and has anyone had a vaginal repair????

The midwife has put in a referral to physio, but who knows how long that will take.

I am off to Brisbane tomorrow til Sunday night so if i dont reply, you know where I am. Thanks in advance

Melissa

[MrsFabuloso]

Hi Mel,

I haven't got any experience with prolapse or anything, but I just wanted to say I have pretty weak pelvic floor muscles too. I must admit to being really lazy with my exercises so I have noone to blame but me! I also pee a little when I sneeze or cough unexpectedly. Not nice. Though I think it's got some to do with such close together pg's too.
As for a prolapse, I would go straight to your gp, or ask to be referred to a gyno if you think that would be better. I wouldn't muck around with it especially with bubs on the way soon. A physio can help with strengthening the muscles, but I think if you do have a bit of prolapse, you really need to know. And maybe when you need to #2's and strain, you might need to support yourself like you did yesterday, it might help with the bleeding and discomfort??
Good luck hun. I hope you can get it sorted soon.

[belfie]

Hey Melissa,

Bingo! I've had what you're talking about. My first experience of this was at 21.5 weeks pregnant (my current PG), and it was mistaken for prolapsed cord or amniotic sac - resulting in me being rushed to hospital & plenty of stress/panic all round (when we were told that bubby probably wouldn't make it)!

My experience was pretty similar to what you're describing - something was bulging out of my vagina. It didn't hurt, but it wasn't exactly comfortable to walk around either. Because they thought it was potentially something much more serious, I wasn't allowed to move/sit up at all for about 3-4 hours, during which time it slowly retreated. Oh and yes, it followed an episode of straining (with the worst constipation of my entire life). The first few days afterwards, I felt my pelvic floor muscles had totally weakened, if I squatted I felt my vagina would just fall out (I'm sure it couldn't, but that's how it felt!). I couldn't remotely sneeze/cough etc without a bit of wee, whereas previously things had been ok (and yes, I had also been doing my pelvic floor exercises too!).

Since then I've had it twice more (but not as badly). My obs has been remarkably unconcerned about it (his comment being that it won't hurt baby). I, on the other hand, have found it quite stressful, concerned about it happening at work, and how birth might impact this. In my most recent conversation (right after the 2 re-occurrences) I pushed this questioning. He provided the following information:

• He can put a "ring" in there which will help support the vagina walls (and just whip it out before birth). Advantage: non-surgical intervention.
• He asked if we were planning for a second child (said yes, think so!), to which he said that they've found once you've had prolapse with one birth (as is a typical issue resulting after birth - not during PG like me!), then you may be likely to continue to have issues, as the following PG will also "stress" the area.
• He didn't think there was need to do any EXTRA pelvic floor exercises - they think (could be wrong!) that sometimes it can just become weakened (for whatever reason - birth, slight inherent weakness or sumthin').

Personally I don't believe there's nothing can be done (surely that's rubbish!) - but I don't currently have the time & resources to look into it further (I finish work in just over a week, so will be re-investigating this then!). In terms of minimising risk, I take metamucil and do EVERYTHING I can to avoid straining (lean forward, read book & relax etc), but I also think I'll look into a physio who might be able to help me work to improve my pelvic floor. After it happens, I usually lie down with legs up & it seems to help it "go back in" so to speak. Given I'm already seeing an obs, I dont think I need a gyno at this stage, but I guess that would be another option, and sounds like a good idea for you (another opinion can't hurt!).

I think it's a PITA, and you have my sympathy , as it's not something you can even complain to the neighbours about!!!! Good luck with it, and let me know if you find out anything useful (I'm happy to do the same) - us prolapsers gotta stick together!
Oh and just double checking your questions:

Is there a chance of completely prolapsing while pregnant and the uterus sticking out?

The indication I got is that this wouldn't happen (and as baby gets bigger, it actually holds everything in), so saying, I've had them check that my cervix is closed a few times. I also find that examinations are quite painful now where they never used to be (not sure if I'm more tense, or if things are "different", or it's just due to PG).

Oh and has anyone had a vaginal repair????

I've read that something can be done surgically, they put a "net" thing in, but I'm assuming (always dangerous!) that my obs didn't mention this, as it's not something I'd want to do during PG.

Hope this helps!
Belfie

[minimatron]

Thats fantastic Belfie- remembered you posting about it a while back, but couldnt quite remember who you wwere. Thank you, youve put my mind at ease.
I will be supporting myselfva bit more on the toilet...it actually feels better. thanks Kel
I wish I could take metamucil daily but it so bad for me and everyone else around me!!! I have been talking coloxyl with senna for the past 4 nights and still not a great deal happening there. Think I will reinvest in some prune juice too, although too much of that is bad for my wind...such a fine line.

And I got a call today and have been given a physio appointment for next Friday. It sounds as though theu will do an internal to feel the muscles I am using. I will also go and see my gp just for a check up.

Thanks so much

[belfie]

Hey Melissa,

Yeah that was me a while back! and I'm glad i could put your mind at ease.

Re metamucil, understandable. My obs also recommended fibresure and benefibre. I can't take them for other reasons, but he said they were less "wind-producing"... if that helps!

Cheers,
Belfie

[Epacris]

Hi Melissa my Belly Buddy (and hi to you too Belfie and you too Kel),

I've been meaning to reply to this thread for aaaaages. Actually I've been meaning to write up this story as a thread of its own for aaaaaaages (but it's been a very busy week).

This is my pelvic floor story so far...

I am lucky enough to have an Uncle who is a top back surgeon and likes to ask people, "so how's your back" as a standard greeting. At a family gathering, when DS was about 10 or so months old, I made an off-the-cuff reply "Oh yeah, a bit of dull lower back pain, but doesn't everyone have that?". I actually really did think that everyone has lower back pain, I certainly didn't think that it was anything unusual or anything to worry about, just something that you have to live with when you have little ones to lift all the time.

Well anyway, DU checked me out and said everything was structurally fine so there was nothing that he could do (as a back surgeon) to help me. He said that my problems were all muscular, that I had no core strength and that I was using all my propping-up muscles for lifting, which they are not designed for, hence the pain. He gave me a referral to a physio who he works with.

So, I go to see this physio. He whips out a little ultrasound machine and goes straight to my pelvic floor muscles to check them out. He says, "yep, they're stuffed and you're well down a path of compensation" (where other muscles try to take over the roll of the pelvic floor, but don't really do a very good job because they're not designed for it). He said, "I'm surprised you're not incontinent and you're well on the way to a prolapse". Well I was amazed to say the least. I had absolutely no idea that a little bit of back pain could indicate that! And all this as a result of carrying a baby inside for 9 months, and perhaps a genetic disposition for a weak pelvic floor.

He asked me if I was doing pelvic floor exercises and I embarrassedly said, "well I know I should be but no". He said, "no don't be embarrassed, that's actually good that you're not doing them because once your pelvic floor gets this weak, what you think is a pelvic floor exercise probably actually isn't, you're just exercising all the other muscles that have already taken over and you're not strengthening your pelvic floor at all".

So, he uses his little ultrasound machine to exactly design an exercise program for my pelvic floor muscles. He argues (passionately) that ultrasound is the only way you can treat weak pelvic floors, because you have to actually see what the muscles are doing, you can't describe to someone what to do and they can't describe back to you what they are doing, you have to see it. I was amazed at how subtle the difference between a proper pelvic floor exercise and a useless pelvic floor exercise (because I wasn't actually exercising my pelvic floor at all, just all the other compensatory muscles) was. There was no way I would have been able to tell the difference if there hadn't been an ultrasound machine there actually looking at the muscles and what they were doing and a physio coaching me. It was also really important to coordinate my breathing with my pelvic floor exercises, something else I never knew.

After my first visit the physio instructed me to do 50 to 80 sets of no more than three, one second each (one breath each), pelvic floor exercises a day. He showed me on the machine how when I did more than three in a row, or held for more than one second/breath, my pelvic floor got so week that it couldn't work at all and all the other muscles took over. I couldn't feel this at all, the only way that I knew that this was happening was, as I said, I was being shown on the ultrasound.

So I went back to see him about 6 times, sometimes the appointments were a week apart, sometimes they were more than three weeks. Each time the exercises would be different depending on where my pelvic floor was at. My back pain went after my first appointment. After my last appointment my physio said that my pelvic floor was working well and that I shouldn't have to do exercises anymore because it would work automatically. I was 9 weeks pregnant at the time and he said it would be well worth coming back for a check-up after bubs is born.

It was such a revelation to me the whole pelvic floor exercise experience. My DU was at pains to point out that this approach, using ultrasound to exactly design a pelvic floor exercise program, is not exactly widely accepted. He also said that the number of women my physio has saved from surgery, when it was seen as the only option by their ob/gyns, is astonishing and really speaks for itself.

Well anyway, last week it just ached down there and it feels like something is bulging. I could be a varicose vein or is could be my insides falling out??? Then this week I've been a bit sick with a shocking cough and when I cough sometimes I get a little bit of wee leaking. Yucko!!!! Needless to say I've made an appointment to see my lovely physio, I couldn't get in till Tuesday 2nd September. I'll keep you posted...

[minimatron]

HEy Rachel,
thanks for your story. I went to my physio appointment yesterday and while she didnt have a machine, she did an internal and got me to do my exercises. According to her I am using the correct muscles, however they do become tired quickly, so I have exercises to do. The other thing is this horrific constipation I am experiencing this pregnancy. Besides increasing water intake and exercise, she showed me the correct way to sit (squat) on the toilet and which muscles I should be using. The other thing she did mention is that because of the constipation and my weak vaginal wall, it could be causing a pocket where the anal wall and the vaginal wall meets (iykwim), hence the buldging when I try and poo!!! So I also have to support my perineum while going to the toilet. I also have a gentetic predisposition to this....my mum and Aunty have both had prolapses!!

So I have to go back for a review in 6 weeks and hopefully they have strengthened and hopefully I can get this stupid constipation under control. Good luck Rach and belfie

[BellyBelly]

Kristen is an osteo at the BellyBelly Pregnancy Centre who did her masters in the pelvic floor. Maybe come and see her? https://www.bellybelly.com.au/kristen-manallack

[Deevine]

Minimatron - one thing to try for constipation is an acidophilus supplement like Inner Health Plus. This is fine during pregnancy, and can actually benefit the baby. Works wonders for constipation. The same brand does a product called IBS Support. That particular strain of Lactobacillus is specific for bowel health and constipation. I've used that product (not specifically during preg.) and its worked wonders for constipation where nothing else helps.

I can't use metameucil (psyllium husks), makes my bowel worse. And no amount of prune juice, dried fruit or All Bran will help me! Luckily for me, I haven't really had much problem so far... except, its interesting what you say about straining and bleeding. I've had bleeding pretty much every week since 8 weeks, and find it mainly happens after a no.2. Not necessarily straining, and not coming from the bowel. I'm paranoid about my pelvic floor muscles, and find that I leak a little after peeing, not when i cough or sneeze though. I found out today that I have a UTI, so hopefully the antibiotics will fix that, and maybe the leaking?!

Good luck for the rest of your pregnancy.

Dee

[minimatron]

Thanks Dee- I will start doing the Inner Health Plus again- did it for my last pregnancy. It is funny that you seem to have the same thing, vaginal bleed after straining. I dont know whats going on there, but things have seemed to have settled down. I have been drinking copius amounts of water and together with yucky prune juice and my new stools I have had some good ones lately! I hate the fact that if I have metamucil or too much prune juice or dried fruit, then I get very windy and pain in my tummy.

Thanks for all your words