We often get phone calls form scared women who, for various reasons, take a look “down there”, or feel “down there” and feel, or see ‘a bulge’.
HOLY COW!!!—what the heck is happening–my innards are dropping!
Women think that their bladder, or their bowel, is literally going to fall out of their bodies— on the floor! Pretty scary!!!!
RELAX——-NOTHING IS GOING TO FALL ON THE FLOOR!!!
Now–this is a very common problem, especially if you have had a baby come through your vagina. I know, i know – they seemed like a good idea at the time…. It is also more common as you get older. It just wants to join the party with our droopy boobs, and our jiggly arms, I think. I do see it in young women in their 30’s too; some people just have weak support ligaments, and there isn’t much they can do about this! As we age, our tissues become weaker, and more prone to this!
Many times, a woman is having other issues like she is going to the bathroom more than usual, and she feel pelvic pressure, so she feels– or looks— and sees this bulge and BING BANG BOOM–thinks that is the problem. IT MAY NOT BE!
Chances are that if you feel a bulge, things were a little droopy, and then something happened that drew your attention to it–but don’t assume that the bulge is always the CAUSE of any problems you are having.
FIRST OFF — BULGES ARE NOT USUALLY PAINFUL!
If you are having pain, then we really need to find the source for THAT! SURGERY WILL NOT CURE ALL PAIN!!
So—what are some common “bulges”
We can have several type of bulges:
One of the most common things I see is “droopy vaginal folds”. The vagina is like an accordion–it stretches to allow a baby to come through, and then snaps back—and the more babies–weelllll, the snap back is not so tight. So –sometimes one of the “pleats” in the vagina is a little loose and women see this–but the bladder and the bowel are still well supported. Usually a little reassurance is all that is needed.
PESSARIES ( see my post on pessaries–). http://www.amherstwomenshealth.com/pessary-use/
MANY MANY women use a pessary to hold things up–and can do this for many years. If, for some reason, a pessary does not work for you–some women push it out with a bowel movement, or are sexually active and the pessary is to much to take in and out themselves, then you might resort to surgery.
Other bulges are….
:Dropped bladder” CYSTOCELE ( siss toe seal). This lady has a grade THREE cystocele–it was basically sticking out of her vagina, and rubbing n her pants. The bulge is coming from the front/top end—I have a large tool laid on the bottom end so that is underneath the bladder. I also wanted to show you the clamps that we use during the surgery to peel the vagina away from the bladder.
Here, we are trying to show you how thin the tissues are in the vagina–you can literally see the scissor blades–and right underneath those scissor blades in the bladder!
The clamps are on the skin of vagina–and the bulge you see is the BLADDER—just a thin line away. THIS is why there is always a risk of getting into the bladder during this surgery–the tissues are just THAT thin!
After the bladder has been lifted up and “sewn back into place” you don’t see that bulge of the bladder anymore!
We then cut away the excess, stretched out vaginal wall, and re-sew the wall to give a “tighter seam”–so instead of balloon sleeves hanging there, you have a nice “fitted” sleeve.
Prolapse of rectum RECTOCELE (wreck toe seal) is the same kind of bulge as a cystocele, except it comes up from the bottom not the top. The repair is very similar.
This video shows a mild rectocele–one that isn’t causing any problems at all–so doesn’t need to be fixed at all. Follow the first rule of prolapse–IF IT AIN’T BROKE—DON’T FIX IT!
patient with a rectocele AND cystocele
You can have one OR the other,—
This video shows a small rectocele. Other than she noticed a bulge when she was looking ‘down there. She has no trouble with moving her bowels, and no issue with sex–so best plan is to leave it alone!
Is it causing pain? not a bit. Is she peeing in her pants?–NOPE! Is she having trouble getting her bowel movements to come out? NOPE. You see, they don’t always have to give you any grief–often they are no problem at all.
Prolapse of Uterus—UTERINE PROLAPSE. This can be different levels of prolapse—Grade 1,2, 3 and right the way to the worst form– PROCIDENTIA
Prolapse of Vagina (can happen after a hysterectomy)
This is a video showing a small rectocele. It is not causing any problems other than she saw it when she was looking down there to check what turned out to be a pimple —*yes you can get them there too)
WHAT CAN YOU DO?
NOTHING–yes –doing nothing is an option! Many women have slight bulbges in the vagina after childbirth. They are having no problems at all –they are having no problems with pee or poop and don;t notice it at all. You don;t hvae to do anything —if it ain’t broke…don’t fix it.
PESSARY—these are devices that can be placed in the vagina to hold things in place. If you have a bit of a dropped bladder then a pessary is something many women choose. I have women who only werar thier pessary when they go to play tennis or go to aerobics class–and the rest of the time they are fine. They put the pessary in themselves and remove it themselves–and get quite good at taking care of things quickly.
For RECTOCELES, the pessary needed is larger and I don;t typically recommend one if the woman is still sexually active–since the pessary you need for a rectocele is pretty big, and not as easily removed.
If the prolapse is such that it is interfering with your daily activities then you may want to consider surgery. If you are unable to get your poop to come out–it is sitting “right there” stuck in the ‘cul de sac’, then fixing your rectocele should help with this. I do want to make it clear that if you have diarrhea or constipation, then surgery does not fix what is “coming down the chute”. If you do have a rectocele, it is important that you avoid constipation by drinking plenty of fluid along with your fiber. I know, I know, everybody talks FIBER– BUT—if you were baking, and you had a really dry hard cookie dough–you don’t want to add more flour!! People forget that you need LIQUID!!!
The surgery for prolapse is typically done through the vagina—so you may need a cystocele repair, a rectocele repair, BOTH and maybe a hysterectomy also!
The surgery does mean that there will be stitches put in to the vagina (they dissolve )–and these stitches are put right where you take the brunt of sexual intercourse–so bear that in mind. A scar may form, and usually the scar is not a problem, but sometimes the scar may cause pain with intercourse–so it is literally the devil you know–or the devil you don’t know.
If you have a cystocele or a rectocele prepare, this could be done as an outpatient–but if you have a hysterectomy too, you are often kept in the hospital for 24 hours or so.
There is also sometimes a couple of stitches put in to hold the vagina up if the vagina is not well supported. This is called a SACROSPINOUS SUSPENSION–the upper part of vagina is attached to ligaments that run along side your vagina with stitches that do NOT dissolve. The hope is that this will prevent your vagina from drooping down–but in the future the is a chance that the ligaments themselves weaken and cannot hold up the stitches.