My Decision To Have Prolapse Surgery - Rectocele Repair

This post is about my decision to have surgery for my prolapse, a rectocele, that I have lived with for over 8 years now.  Surgery is something I have been debating for 4 years and I did not come to this decision lightly but I know it is the right choice for me. 

16 years ago I gave birth to my first son.  I believe that was the start of my rectocele.

My goal for childbirth was to have a vaginal birth with no epidural and no tearing.  

Goal Accomplished!

I did everything I knew about to prepare for birth with the aim of avoiding episiotomy and tearing like my mom had experienced. She also dealt with incontinence and because at the time with my limited knowledge about pelvic health, I equated tearing with incontinence, I felt that because of the fact that I did not tear must mean that my pelvic floor was doing well!

Or so I thought….

I Wish I Had Known
Knowing what I know now, I would have understood that just because there was no external tearing didn’t mean my pelvic floor was ‘good’.  Knowing what I know now would have meant that I would have seen  a pelvic floor physiotherapist at 8 weeks postpartum.  Knowing what I know now would have meant that I would not have tried to run at 2 weeks postpartum.  Knowing what I know now, I would have held my pelvis differently throughout the day and in movement and I would have been more consistent and creative with my kegels.

I have learned a lot over the past 11 years running a pelvic floor wellness company and I have been able to coach thousands of women through various life stages.   I have used my own experiences in birth prep, lack of recovery, learning about pelvic floor physio, overcoming a stage 2 uterine prolapse, living with a rectocele and diastasis recti to help women prevent and overcome challenges like incontinence and prolapse. 

I will now add the experience of pelvic floor surgery to the mix. 

I Had Internal Tearing
Remember when I said ‘goal accomplished’?  Well, although I had no external tearing I did find out years later that I had internal tearing.   I didn’t even consider that there could be tearing inside.  I look back with a bit of surprise that my health care providers did not check for this…and that they did not refer me to pelvic floor physio but I appreciate that they didn’t know to look or to refer. 

It wasn’t until my second son was almost 5yrs old before I went to a pelvic floor physio and found out I had experienced internal tearing.  Right where the left over scar tissue is, is also where my rectocele is. 

What Is Happening To Me?
Around this time I was also experiencing strange symptoms that took me on a path of dealing with VERY heavy periods, high blood pressure, high cholesterol, hormone imbalance, weird rashes, a racing heart, anxiety and constipation.

I could not understand what was happening to me and why I was constipated.  I ate healthfully, I exercised, I drank water – why am I constipated? And how do I have high blood pressure and cholesterol??

Long story short, I found out 1.5 years ago that I have Hashimoto’s – an autoimmune condition that affects the thyroid.  Constipation is a major symptom and something I struggled with silently for years because I kept being told ‘it’s just stress’. 

That constipation led to the development of a uterine prolapse and a progression of my rectocele.  That was about 9 years ago now.  I was quite upset but knew what to do.  I had recently learned hypopressives and so became very diligent at that practice.  In time my uterus went back but my rectocele did not.

I Had Surgery Booked Twice
I first began thinking about surgery about 4 years ago.  I had surgery booked two times but ended up cancelling because I was still struggling with constipation and still bleeding quite heavily so I knew I needed to get those in check first. 

I got an IUD…that helped a bit…I went gluten free, dairy free, egg free and also took out caffeine…that helped a lot.  I have since taken out alcohol and that helped a lot as well.  My digestion transformed and so did my periods.

Should I Book It Again?
I was considering having my IUD taken out and then I started thinking that surgery had been a reason why I got the IUD i the first place….Did I still want surgery? 

As I was contemplating this, my periods stopped and I started experiencing dryness and some irritation/burning in my vagina and hot flashes.  I also started to become very symptomatic from my rectocele. I reflected on why I had considered surgery in the first place.

In my mind, a rectocele, especially low down like mine, means a lack of support for the bladder and uterus.  I also knew that a pessary was unlikely to work given how low my prolapse is.  I wondered if restoring the anatomy would help bolster support for what is up above and allow me to then use a pessary if needed in the future.  I also felt that having surgery before the prolapse had progressed or other organs were being affected would be beneficial.  Finally, knowing how tissues in menopause thin, I felt that having surgery before menopause may have benefit.

I Felt Ashamed
I have looked at research.  I know the risks but I still felt like it was better to have surgery sooner than later.  I asked my circle.  The surgeons were in agreement with me.  The pelvic floor physiotherapists, not so much. 

I remember ‘asking for a friend’ a few times because I was afraid of the reaction I would get from the physios.  I felt ashamed that I was even considering surgery, especially given what I do for work!  Thankfully, I was not judged. I was questioned but not judged and after hearing my line of thinking and my rationale, many supported my decision. 

A Different Physio
I recently had an assessment done by a pelvic floor physiotherapist who I know well but have never been treated by.  She has an ultrasound and is very movement focused.  She found the internal scar tissue where my rectocele is and also found that I have a partial levator ani tear on my left side. 

Huh. 

Didn’t see that one coming.. but it sheds some light on perhaps one of the reasons why I experienced prolapse.  I know that having a levator tear makes me more prone to prolapse so it helped solidify my decision to fix my rectocele in hopes that it will increase the success of a pessary should I need one down the road.

She also found that I don’t have a balanced contraction in the muscles in my pelvic floor (which I have known about and work on) and my lift is not very strong in standing.  The physio feels that it could be because of the levator tear, and/or hypertonicity in the muscles and/or from the rectocele.  She took some images and I will go back after surgery for another assessment to see what has changed, if anything. 

2020 Is Perfect Vision
There is a saying that was used not long after the pandemic started….2020 is Perfect Vision.  While this year has been challenging on so many levels, it has also been very positive for me.  I have gained clarity on so many things and I have been focused on letting go of what is no longer serving me.

I have learned a lot through my pelvic health journey and feel grateful for it but my prolapse is no longer serving me.  Living with pelvic organ prolapse is emotionally draining and it very often occupies more than its fair share of my brain.

Navigating it while also searching for an understanding of my thyroid has been exhausting.  I have always been a very low maintenance kind of person and I have been the opposite of that for quite some time now.

I have tried everything to heal my rectocele and it has not improved.  My symptoms are becoming more difficult to manage and my quality of life is suffering.  I move differently on symptomatic days.  I don’t eliminate as effectively.  I avoid sex.  I have difficulty concentrating.  I withdraw from social activities.  I am not myself.

It's time.

Informed Choice
Like a midwife who has a cesarean, or a yoga instructor who needs a hip replaced, it may be a shock that the vagina coach is having vagina surgery but I feel comfortable with my decision and know it is a very informed one. 

My mission in my business has always been to ensure all people with a vulva and a vagina know about pelvic floor physiotherapy, have tools to help themselves at home and have resources that allow them to make informed decisions about their pelvic health for life. 

I have experienced pregnancy, childbirth, hemorrhoids, urge incontinence, and prolapse.  Now I will also have experienced surgery.  I will be in a more informed position to support people through the process of making the decision to have surgery or not, preparing for surgery and recovering afterwards. 

I NO LONGER FEEL ASHAMED
I struggled with this decision for a long time but I have come to peace with it.  I no longer feel ashamed.  I know I have tried everything and I have accepted that this next option is not a sign of failure but rather an opportunity.  An opportunity to improve the function of my pelvic floor, an opportunity to use a pessary successfully if needed, an opportunity to eliminate better, an opportunity to move with freedom again, an opportunity to have spontaneous sex again, an opportunity to not be thinking about my prolapse all the time.

My body, My Choice.

Let me be clear, I know there are risks.  I know that I may have pain with sex.  I know that my elimination may not improve.  I know that my function may not improve....but what if it does?  There is the possibility that it could and I want to try.  I am done suffering and am ready to pursue this option. 

I also want to say that my lifestyle will not change.  I will continue to pay attention to my posture, release my tight muscles, do hypopressives, incorporate kegels into my workouts, build my glutes, use a squatty potty, eat to support digestion, drink a ton of water, and reduce stress.  I know surgery can increase the risk of another surgery but I also know that I am informed and disciplined and see a pelvic floor physio regularly so believe I am in the best position for a positive, sustained outcome.

I will be documenting my prep and recovery through my Instagram Stories – come follow my journey!

 

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