Uterine prolapse, pessaries, surgery, etc

[gypsymare]

I’m looking for help and to hear personal experiences. I know there are better forums for this, but you are my people and no one else understands the complications of horse and farm ownership quite like you folks.

It happened after the birth of my first child 2 years ago… my uterus decided to try to vacate. I’m 34. I just had my second child who is 7 weeks old. It’s an odd feeling but isn’t painful, just a bulging feeling and the cervix just exits the vaginal opening. The biggest downside is not being able to wear a tampon any more. It’s usually not a huge deal but thin pads wont stand up to 4-5 hours on a horse and thicker ones are going to be visible under breeches. Then there’s the no swimming for a week every month. It’s hereditary, almost all the females in my maternal line have one but haven’t opted to do anything about it. It started to improve just as I got pregnant with #2. I was riding and doing stalls and hauling hay every day and finally getting fit again.

I’m seeing a pelvic floor physical therapist (just started) and she and my OBGYN have both suggested a pessary and the OBGYN talks about a hysterectomy like it’s the simplest thing in the world while I read the rates of secondary operations for mesh erosion and bladder prolapse are unacceptably high. My OBGYN says the pessary is not removable by the patient while the physical therapist and tons of articles say they are removable and can be removed and cleaned nightly. So I’m on the hunt for a good urologist with some experience in these things (south central and south eastern PA or Maryland if anyone knows of one!). The physical therapist says the pessary will help the exercises be more effective. The OBGYN says I nor my husband should be able to feel it. I say BULL. I want one I can take out.

My question is, have you had a prolapse and what did you do about it?
How did it affect your riding?
Do you have a pessary, what kind, do you remove it and can you feel it in there?
Can you use a tampon or menstrual cup with your pessary?
Have you had a hysterectomy and did it affect your hormones, sex life or horse riding? Any complications?
Any other solutions?
Any suggestions of a good urologist? I’m leaning towards the Lehigh Valley Hospital system if there is one to be found there.

Thanks!

[Bluey]

Not the same at all, happened past 65 and no, you can’t ride well when your innards keep trying to come out as you are using your seat to communicate with your horse.

Now, when they checked, the reason was “a large mass” that should not be in the pelvic cavity was crowding and pushing everything out.

So, surgery was indicated, the mass could have been cancerous, maybe terminal cancer, but it was not, just a handful of intestines herniated into the wrong place.
That alone could have killed me any time if they strangulated, like a horse with colic.
Surgery was, pushing those back in place, taking out what was not necessary any more, partial hysterectomy , one ovary was glued solid to the wall and the surgeon didn’t want to disturb it and maybe get into more problems there and everything else left in there was sewn back into place.

No mesh, surgeon didn’t like that at all, only as last resort and very rarely.

Recovery was great, no more problems, but am in lifetime restriction to not lifting more than 20 lbs, after begging he said a one time feed sack or bale of hay or saddle ok, just not make it a habit.
Had to promise that, or surgeon would not proceed, said if I lifted much, we may be there again, why chance it?

I think, for what you say, you need to ask more question of your Drs and be sure you are understanding exactly what the answers are, not sure you are quite there yet.

As for hormone disturbance, for total hysterectomies before menopause, they give HTR, hormone replacement pills, for a few months and then taper those off, so you don’t have to suffer thru that kind of shock to your system all at once.

[trubandloki]

The only question I can help with is this one.

@gypsymare

Have you had a hysterectomy and did it affect your hormones, sex life or horse riding? Any complications?

I had my uterus removed (large fibroid), I still have my ovaries. So no change in hormones (other than age related stuff now).
After the six weeks of no lifting all was fine. It was a laparoscopic procedure so just a few small incisions.

[sweetas]

Gypsy mare - any updates on this? I’ve been dealing with this for awhile and I’m considering my options. Thanks for any insight!

[gypsymare]

@sweetas

Gypsy mare - any updates on this? I’ve been dealing with this for awhile and I’m considering my options. Thanks for any insight!

I did an 8 week course of physical therapy that wasn’t super useful other than hearing from a professional that my OBGYN was ill informed. I met with a urogynacologist who did a VERY thorough examination and laid out my options of hysterectomy or pessary. I decided to try the pessary route and it has worked out very well for me.

The fitting consisted of trying on (in?) multiple styles and sizes and making sure they weren’t too easy to push out. I ended up getting two, but the one I primarily use is a “dish with support”. It looks like a miniature flexible Frisbee. Insertion and removal takes less than 5 seconds and it does a fabulous job of holding in a tampon since it has a bit of a lip around the edge. I can’t feel it at all once it is in. Since losing 20lbs and hitting the gym every day, I haven’t had to even wear it in-between periods. Everything still rides lower but it isn’t exiting or feeling uncomfortable. I’ve very happy with my decision.

[CindyCRNA]

@gypsymare

I did an 8 week course of physical therapy that wasn’t super useful other than hearing from a professional that my OBGYN was ill informed. I met with a urogynacologist who did a VERY thorough examination and laid out my options of hysterectomy or pessary. I decided to try the pessary route and it has worked out very well for me.

The fitting consisted of trying on (in?) multiple styles and sizes and making sure they weren’t too easy to push out. I ended up getting two, but the one I primarily use is a “dish with support”. It looks like a miniature flexible Frisbee. Insertion and removal takes less than 5 seconds and it does a fabulous job of holding in a tampon since it has a bit of a lip around the edge. I can’t feel it at all once it is in. Since losing 20lbs and hitting the gym every day, I haven’t had to even wear it in-between periods. Everything still rides lower but it isn’t exiting or feeling uncomfortable. I’ve very happy with my decision.

This is a great update!

[Bluey]

@gypsymare

I did an 8 week course of physical therapy that wasn’t super useful other than hearing from a professional that my OBGYN was ill informed. I met with a urogynacologist who did a VERY thorough examination and laid out my options of hysterectomy or pessary. I decided to try the pessary route and it has worked out very well for me.

The fitting consisted of trying on (in?) multiple styles and sizes and making sure they weren’t too easy to push out. I ended up getting two, but the one I primarily use is a “dish with support”. It looks like a miniature flexible Frisbee. Insertion and removal takes less than 5 seconds and it does a fabulous job of holding in a tampon since it has a bit of a lip around the edge. I can’t feel it at all once it is in. Since losing 20lbs and hitting the gym every day, I haven’t had to even wear it in-between periods. Everything still rides lower but it isn’t exiting or feeling uncomfortable. I’ve very happy with my decision.

You were lucky there.
My Dr was talking pessaries when the report of a large mass in there came from the radiologist and the Dr suggested to just go on with surgery and see what that was.
He felt that mass was probably cancerous and we needed to get in there right away, so “we” did.

Lucky me, it was not cancer or a mass, just some displaced intestines.
That is what was pushing everything out of place.
The 45 min surgery took a good over 2 hours, as he had a lot to get back and tack in place.

I am glad I don’t have to keep working around any other like pessaries, if they had worked at all and the other problem could have caused a blockage that, like a horse with some colics, would have then be an emergency surgery with questionable results.

Seems that your situation is stabilized as it is, that is great.

[sweetas]

Wow, my doc had me try a pessary. A no-go for me. Thing wouldn’t stay where it was supposed to. Next step could be the hysterectomy + mesh surgery. But I’ve read some horror stories! Honestly, at the moment I’m coping with padded underwear and still riding! I’m going to put off the surgery as long as possible, I think. What good news that the intestinal mass was detected and fixed! Are you still able to ride after having all of that surgery? What was the recovery like?

[Bluey]

@sweetas

Wow, my doc had me try a pessary. A no-go for me. Thing wouldn’t stay where it was supposed to. Next step could be the hysterectomy + mesh surgery. But I’ve read some horror stories! Honestly, at the moment I’m coping with padded underwear and still riding! I’m going to put off the surgery as long as possible, I think. What good news that the intestinal mass was detected and fixed! Are you still able to ride after having all of that surgery? What was the recovery like?

No problems whatsoever with anything, fine riding.
Recovery was a snap, but I heal fast and handle pain well, didn’t even need any pain pills.
Nurse was mad at me that I would not use the pain pump, thinking I was afraid of the medications.
I told her to read the metrics and see if any indicated I was in pain.
She had to agree I was fine, no need to take anything.

I had a miracle worker top surgeon that put Humpty Dumpty back together, according to the gastroenterologist, after seeing what all he had to do to get everything back where it belongs.

Today they even do better, some with robot assisted surgeries.

I don’t think they use mesh for that any more.
When I asked the surgeon was alarmed and said no, no permanent mesh for those surgeries any more, for others is ok.

If you decide for surgery, find the best surgeon you can and let them do their thing.
They do several a day, they know what they are doing.

[gypsymare]

@sweetas

Wow, my doc had me try a pessary. A no-go for me. Thing wouldn’t stay where it was supposed to. Next step could be the hysterectomy + mesh surgery. But I’ve read some horror stories! Honestly, at the moment I’m coping with padded underwear and still riding! I’m going to put off the surgery as long as possible, I think. What good news that the intestinal mass was detected and fixed! Are you still able to ride after having all of that surgery? What was the recovery like?

Just one? Multiple styles and sizes? They are all very different. I found my original OBGYN woefully lacking in experience.

[Sannois]

Just stopping in to lend support. Never heard of this before, I had no kids, but it sounds positively scary and truly uncomfortable. :eek: And here I am complaining about my cancer symptoms… true not the same but still.
Best of luck getting it squared away! (((Hugs)))

[Bluey]

TMI, but I will say, riding was harder when you had to keep watching you didn’t strain where “stuff” would come out, then after the surgery, when you knew now nothing would happen.

You had to keep “holding it in” best you could when getting on and when cantering.
Not a good place to be, something had to be done and right away.

Surgeon will test for that and when they did, the nurse was alarmed.
She stopped the test half way and to surgery I went as soon as they could get me in.

Better not wait to get help once that problem starts.

[Sannois]

@Bluey

TMI, but I will say, riding was harder when you had to keep watching you didn’t strain where “stuff” would come out, then after the surgery, when you knew now nothing would happen.

You had to keep “holding it in” best you could when getting on and when cantering.
Not a good place to be, something had to be done and right away.

Surgeon will test for that and when they did, the nurse was alarmed.
She stopped the test half way and to surgery I went as soon as they could get me in.

Better not wait to get help once that problem starts.

And I thought the rest of the posts made me Quesy :disgust: Not belittling it, it sounds so scary!

[sweetas]

Wow, Bluey! The surgeon I visited is supposed to be good, but he does use some sort of mesh, but said he had very good results. I must say when I asked him about all the bad mesh stories and law suits, he was mildly defensive (or maybe just annoyed because he is asked about it so often?) - he said what he uses/does is nothing like that stuff. I guess I want to be sure that in a few years there aren’t more lawsuits! From some of the minor research I did, there seems to be a fairly high rate of the problem returning within 2-3 years. Not having to worry about it any more sure sounds pleasant!! I’d sure like to do some gardening and other things that require squatting or bending over for long periods.

It seems like most people took about 6 months to heal - was this your experience? I think I also have a high pain tolerance, but maybe not as high as yours. They couldn’t believe it when I had my gallbladder out when I told them I didn’t want anything. BUT, I will say that I did finally take a very mild painkiller after I woke up from surgery, 1 that night and then I was done with it. So maybe I’m not as tough as you!

[Bluey]

@sweetas

Wow, Bluey! The surgeon I visited is supposed to be good, but he does use some sort of mesh, but said he had very good results. I must say when I asked him about all the bad mesh stories and law suits, he was mildly defensive (or maybe just annoyed because he is asked about it so often?) - he said what he uses/does is nothing like that stuff. I guess I want to be sure that in a few years there aren’t more lawsuits! From some of the minor research I did, there seems to be a fairly high rate of the problem returning within 2-3 years. Not having to worry about it any more sure sounds pleasant!! I’d sure like to do some gardening and other things that require squatting or bending over for long periods.

It seems like most people took about 6 months to heal - was this your experience? I think I also have a high pain tolerance, but maybe not as high as yours. They couldn’t believe it when I had my gallbladder out when I told them I didn’t want anything. BUT, I will say that I did finally take a very mild painkiller after I woke up from surgery, 1 that night and then I was done with it. So maybe I’m not as tough as you!

With such problems, each one may involve different structures, I don’t think you can say much, but “it depends” what all they do how long it takes before they turn you loose from restrictions.

I was supposed to be in the hospital five days but they let me go home in three.
Yes, that one grumpy nurse was mad about that too, “everyone” needs to stay five days! according to her.
Healing was fast, the restrictions were not lifting for so long and promising not over 50# for the rest of my life, or the surgeon would not operate, said I would be back in there again if I did.
That one is hard, I now scoot around heavier things or use a dolly or the tractor where I can.

I expect they may have better mesh products today and better ways to use them.
If in doubt, get a second opinion, your confidence with what they may do is important.

[LarkspurCO]

I had uterine prolapse – surgery in 2009 with hysterectomy, pelvic floor reconstruction including mesh urethral sling, which is all holding up just fine.

[sweetas]

Wow, that’s good news!! Makes me very hopeful indeed! I’m sure tired of tiptoeing around this problem.

[HannahsMom7]

I had a mesh put in for incontinence. I tried the pessary route and could not get it out. I also am not very flexible. but when a different doctor tried to take the last pessary out and couldn’t I refused any more trials. I am happy with the mesh.