Name : Michelle
Age : 41
Location in the world : Brisbane, Australia
My condition : Prolapse – Stage 2 urethrocele and stage 2 rectocele
Gaynor: Good morning “Michelle”, first of all I would like to thank you for coming forward and allowing me to ask you questions which hopefully will get you results and help educate other women in a similar situation as yourself.
Can you recall the first time you felt something was not ‘right’? How old were you?
Michelle: The first time I recall something not quite right was 3 months after my hysterectomy. (I had to have one due to a cancer scare. A day after the hysterectomy, I then had complications and had an emergency procedure to place a stent in my ureter as my kidney had blocked and perforated. I had the stent removed and was then giving the OK to start light exercise and gym work to get me back to the fitness level I required to do my sport – pole fitness). I had started to walk again and did some Pilates (3 months after my hysterectomy). I remember the first time I felt something not quite right was when as I walking around the shopping centre (it felt like my ‘g-string/thong’ had worked its way up higher into the vagina area more than what it should and felt uncomfortable). After adjusting it and still making no difference, I went home and checked with a mirror to see if everything was ok down there. This feeling started to reoccur more frequently as the next few weeks went on. I was and still am 41 years old.
Gaynor: You must have been in agony with a perforated kidney.
Michelle: The kidney pain and recovery far outweighed the recovery of the hysterectomy. I was incontinent and had back pain while I had the temporary stent in to repair my ureter. I could do absolutely nothing (even walking was difficult) in that first 7 weeks, so I was well rested and looked after with basically everything done for me in that time.
Gaynor: Did you inform your Pilates instructor that you had had previous surgery?
Michelle: When I started Pilates (at 12 weeks), I spoke to the instructor at length before the first class to what my situation was. During the class I went to once a week, she would personally show me alternate, gentler options. I only participated in some of the class.
Gaynor: Do you think that you may have ‘over exercised’ too soon after a major operation?
Michelle: I don’t believe so. When first discussing my hysterectomy with my gynaecologist he said I could go back to my normal activities and sports at 6 weeks. I questioned him with regards to pole fitness (as I was at a very high level which requires a lot of core strength and heavy lifting, and also, this sport is still struggling to be recognised) He still believed at 6 weeks I could slowly return. I doubted his advice and saw my physio (who was treating me for a shoulder injury and knew exactly what was involved in my sport) He was very adamant that I should not even consider my sport for at least 4 months, advice I strongly took as I had learnt previously with other injuries that if you don’t take the time to heal, you only go backwards and the healing process takes longer. So at 3 months I did short walks and only 1 Pilates class a week, at 4 months I had a personal trainer to do me up a very light weights recovery program. I only did 3 sessions of his program as it was after these sessions I noted the ‘heaviness’ feeling more prominent.
Gaynor: What was your initial reaction on feeling the ‘heaviness’?
Michelle: When the sensation became more frequent and more obvious over the next 2 weeks, I started to Google my symptoms as I had become very paranoid after all my complications with my hysterectomy. All symptoms pointed towards weak pelvic floor or prolapse.
Gaynor: Many women go through what you have gone through; finding information on the net about their symptoms, the danger of this is that not every site can offer accurate information. My advice is to look at website which has the medical professional’s kudos behind it. After your operation were you given any physiotherapy treatment to train you on how to do kegel exercises?
Michelle: I had no physio offered to my with regards to kegel exercises, or anything else for that matter. The gynaecologist never mentioned anything about it as well.
Gaynor: Looking back do you think that had you learnt the correct technique on how to do proper kegel training along with breathing exercises would have helped?
Michelle: As for do I think it would have helped? Looking back over the past 7 months since I discovered I had a prolapse, kegel exercises certainly would have helped to a certain degree but would have had little effect for my condition now due to all the following reasons:
• After the natural birth of my 2 daughters my pelvic floor exercises was basically non-existent.
• My current job for the past 9 years after (straight after the birth of my second child) is in our business (scrap metal recycling yard) which requires very heavy lifting.
• My sport I took up 4 years ago was pole fitness and I was at a very advanced level….taking my training to extremes (for example, holding onto the pole upside down just by clenching the insides of my thighs together and then doing between 10 – 20 sit-ups) and taking up running and step classes for cardio and weights at the gym all to improve my pole skills.
• I have now only discovered that my mother and grandmother had forms of prolapse, but have never had it addressed (and both never had a hysterectomy)
• Having a hysterectomy where nothing is now ‘holding up’ the walls of my vagina.
• I am currently waiting to see my gynaecologist on scan results for the possibility of Lavator Avulsion (where the pelvic floor muscle has partly torn away from the pubic bone)
Gaynor: This is interesting regarding your mother and grandmother being diagnosed with pelvic organ prolapse. Through my research one common denominator which keeps popping up is that women with POP (no pun intended) have had mothers and grandmothers with POP. Women, who are in this situation, please advise your daughters early enough so they can monitor their own conditions and be familiar with what is a pelvic organ prolapse so they can work on prevention of the condition.
Did you discuss this with anyone of your family?
Michelle:I discussed it with my husband thinking more that it was likely just weak pelvic floor muscles, but I booked into my family doctor the very next day just to make sure. My husband was quite causal about it thinking it was nothing more than just doing pelvic floor exercises.
Gaynor: I’m glad you could discuss it with your husband, many women hide things like this from everyone. Strangely enough most men, when their partners tell them about their symptoms are quite casual about it and put it down to pelvic floor exercises. Do you think it a good idea that men be educated on pelvic organ prolapse and pelvic floor issues?What did the initial consultation of your doctor suggest?
Michelle: My general doctor examined me and said he did not believe I had prolapse as he could not see anything, but I should see my gynaecologist for closer examination. I then went to see my gynaecologist that performed my hysterectomy, hoping it was just weak pelvic floor muscles and at the worst, a mild case of prolapse. My whole world was shattered after his examination as I sat to hear what he believed in his expert opinion I had. He proceeded to tell me that I had stage 3 cystocele, stage 3 rectocele and stage 2 vault prolapse and that I needed to have a procedure called sacropexy using mesh for vaginal vault prolapse and mesh on either side for the other 2 prolapses as soon as possible. I was still recovering mentally, emotionally and physically from my hysterectomy and the 2 surgical procedures that followed due to complications…..I sat in his office crying uncontrollably due to the shock of what he had said and the thought of more major surgery…..especially using mesh…..as my body never accepts foreign objects ectI was devastated (this was my first gynaecologist opinion of 3) I also asked about the use of a pessary, and he said very bluntly that they should only be used in elderly women that are too frail to be put through an operation like that.
Gaynor: Gosh, I can certainly understand your feelings of total bewilderment.
We are often brought up never to question a doctor’s judgement, but sometimes you have to, it’s YOUR BODY! The more questions you ask the more you can understand and the more you would be able to accept if the time came that a procedure was the last resort.
Regarding the statement he made that pessaries are ONLY used with elderly patients, hmm the Cerclage pessary is designed to support the cervix and uterus in cases of women when they are prone to miscarriage, and are fitted around 15 to 20 weeks into the pregnancy. You have lots of elderly women getting pregnant in Australia I presume! Sorry that’s me being flippant and proving a point that different pessaries are used to help various symptoms of incontinence and prolapse issues, they are used by all ages.
Maybe your doctor was trying to explain that he/she felt you would benefit from surgery rather than a pessary (where elderly patients can’t have surgery).
Michelle: I think that was the angle he was taking, was basically saying that a pessary is wasting time as ‘in his opinion’ I was in the advanced stages of prolapse and I will have to have surgery eventually.
Gaynor: There are stages of a prolapse where pessaries won’t be of any use, so in essence his judgement may have been correct.
Have you told your doctors about your concerns regarding your body not dealing with ‘foreign bodies’, do you have any evidence to convince them?
Michelle: Funny enough, when I knew I had to have surgery both myself and my husband explained to him how I have a high tendency to get infections with wounds. It wasn’t until he saw how 2 of my incisions did not heal for 2 ½ months and constantly wept (his theory was that my body was trying to reject the internal stitches) and I also had to abstain from sex for 3 months rather than the normal 6 weeks due to the slow healing of the vault wound. It was then that he said “you need to make sure that you tell surgeons that you are sensitive to foreign material and a slow healer”.
I question how much he listened to what I had said right at the beginning and also to his own words when he then suggests I have mesh. With such a high failure rate of mesh used in this type of surgery, I believe without question I would be one of them which urged me to get a second opinion.
Gaynor: Just an idea, but have you had your blood checked for any immune deficiency or other conditions which contribute to ‘slow healing process? This maybe an answer to why your body rejects and heals slowly.
So that was the first gynaecologist option of 3, what did the others say?
Michelle: During the next 2 months, because of my extremely high drive not to have the mesh surgery I then saw 2 physio’ s one who deals with strengthening pelvic floor muscles and the other who specialised in pelvic floor recovery and prolapse maintenance to avoid surgery. During this I sought out my 2nd gynaecologist opinion. He believed I only had stage 1 rectocele and stage 1 cystocele and no vault prolapse.
During this 2 month period of seeing the 2 gynaecologist, my symptoms worsened even though I was avid on pelvic floor exercises, the use of the electrode stimulator, the use of tampons as a ‘splint’, change in lifestyle habits, only doing walking and swimming as exercise and no lifting what so ever, posture etc. It was then that my physio strongly suggested I seek a 3rd opinion especially because of the vast differing diagnoses and her concern was the vault prolapse. She suggested a gynaecologist who is the top in her field that specialises in prolapse and pelvic floor conditions. It took 4 months to get in to see her but it was worth it. Her opinion was that I had stage 2 cystocele, stage 2 rectocele and she believed that there was no vault prolapse. I was then sent for a 3D/4D ultrasound, it was there I could see for myself what was happening inside me and even though I am not a medical practitioner, I can see that I am definitely at stage 2 (not in a relaxed position, but when I tense my stomach or bear down). The scan picked up as well that I am not just cystocele but I also have prolapse of the urethra. So the scan confirmed stage 2 rectocele and stage 2 cystocele and urethra which is known as Urethrocele prolapse and no vault prolapse.
Gaynor: It sounds after a lot of pain staking research and tenacity on you part that you are finally at a stage where 1. You know what is wrong 2. You have found a way on how to deal with it. 3. You finally seem to have been seen by medical professionals who are able to help you. 4. You probably know more about pelvic organ prolapse now than ever before.
Urethrocele is one of the prolapses which isn’t often spoken about, but is common with patients who present with a cystocele. The urethra tends to ‘kink’ as it has no support. If you are able to wear a ‘splint’ then this will help. Incostress is a clinically approved medical device pessary worn the same way as a tampon. The good thing about this, is that it is reusable. It’s available throughout Australia.
Gaynor: You have been forced to give up your activity of pole fitness. What advice would you give other women who practise such intense sports which do put a lot of strain on the pelvic floor.
Michelle: This is a hard question to put in the right words. The societal trend at present is to ‘be fit’ which encourages all women of all ages to go to the gym, do high intensity classes, increase cardio fitness and even the emergence and popularity of pole fitness among women (especially those who have had children and are looking at a new sport). The number of women taking on these types high intensity, heavy weights and high impact sports are increasingly on the rise. I was one of them, and absolutely loved it, and with it came the changes to my physical appearance, confidence and fitness levels. If it wasn’t however for my hysterectomy, I would still be doing intense sport as I was not aware I had prolapse, my only sign was that I had a slight incontinence issue. I realise now that if I had continued, I would have had more serious complications and the possibility of early surgery. If I knew back then what I know now, I would not have started pole fitness, weights and running, and I would have looked for alternate sports options. However, for those who are doing it and possibly know they have mild prolapse, slight urinary incontinence, or a history of prolapse in the family and they want to continue the sports they are doing, my advice would be as follows:
1. Become vigilant on correct pelvic floor exercises, that means every day.
2. Start using a form of device to help increase pelvic floor strength, especially if it is weak. But be aware that the electrical stimulation machines can over work the muscles and cause more damage.
3. See a physio to ensure you are engaging your T.A. muscle (the deeper of the 3 stomach muscles) when supporting your core. This muscle acts as a sheath against the pressure of your oblique and abdominal muscles which then in turn protect your internal organs.
4. Seek a physio therapist that specialises in pelvic floor issues or a gynaecologist/urogynaecologist who can fit you with an appropriate pessary and then use it every time when you are exercising.
5. Ensure regular bowel movements to avoid ‘extra pressure’ internally.
6. Make regular visits to a gynaecologist to keep up with the progress of your prolapse.
7. If you have children, try to encourage them into less intense sports and make them aware of what you have.
8. And lastly……Talk to others in your sport openly about what you have……if there is one thing I have learnt….most women who have incontinence issues or has prolapse rarely speak about it, and most younger women have either never heard of prolapse or understood what it is. Since I have been so open and honest about what I have, I have discovered many friends who have some form of issue with their pelvic floor or incontinence. By making them aware, they are now more preventative and cautious of what they do in their sports to avoid further damage/weakness to their existing problem.
Gaynor: Michelle, will you stay in touch and keep us up to date about your progress please. It’s been a real pleasure interviewing you and you truly are an inspiration for me to continue the work I do, and for all women who are struggling to come to terms with a life changing habit due to a medical condition. Take one day at a time, listen to your own body and build up the strength mentally and physically day by day.
Well done Michelle for having tenacity and finding out more and then for educating other women of the dangers of intense exercise. I have done the same in my Pilates classes, they must be sick of hearing about it, but I have new people in all the time as I teach mixed ability. I now no longer teach classical Pilates. The people that come to me are often injured, they want to feel better when the leave. I now teach myofascial release using foam rollers and tennis balls, educate them about breathing, as it’s directly connected to the function of PFM, mobility, stretching and functional exercises that relate to every day movement. We do nothing that resembles a crunch or curl. At first I thought they might stop coming, but they are still coming every week and my classes seem to be growing. The fitness industry needs to wake up to this problem, I think they would rather we women didn’t know about the downside of exercise, if women knew what could happen to their most intimate parts, Les Mills and all his ‘Body bollocks’ style of teaching would probably go into receivership as its mainly women that do group exercise classes! Even my co ordinator told me I should be careful of how I put the information out there, as I might make it difficult for other instructors!! The fitness industry is still relatively new and only now are we beginning to see the effects on women of training like a man!