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Dr. K.
Dr. K., Board Certified MD
Category: Medical
Satisfied Customers: 4836
Experience:  Board certified with experience in primary care.
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Youve recently answered a couple of my questions and I was

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You've recently answered a couple of my questions and I was very happy with your help, and I've only just noticed you're an Ob Gyn specialist so hope you can help me. It's about a cystocele / prolapse. (This is not an urgent question)
I have 3 children: first birth was via a caesarian section (breach) 7.5 years ago, and the other two were VBAC at home 4 and 2.5 years ago. A few weeks after the first VBAC I noticed something had "moved down" and after consulting my midwife it turned out to be a mild vaginal prolapse. This birth was rather difficult as it took nearly 2 hours of pushing due to severe tiredness (after going into labour for 7 nights, the pains would suddently stop half way through the night, and only once the midwife pushed and "straightened" my baby's head he was born that day). I also tore quite badly (right labia and deep inside the vagina) and had to go to hospital to be sutured. I saw a physio for a while and due to her help and excercises it didn't get too bad and I could "live with it" (although being very aware everything inside felt out of place). But I was planning another pregnancy so decided not to do anything more about it at the time. However afer my last baby 2.5 years ago (also home birth but quick and easy water birth, altogether 1.5 hours from start to finish), things have got much worse. I saw my GP and then the physio again but my vagina seems very "stretched" and when I do the excercises the muscles barely twitch. I also have trouble putting a tampon in as there is a "mass" (cystocele? - that was the term the GP used) in the way. My husband says none of it bothers him, but it bothers me. In addition, I have to use the toilet very frequently as I know that if my bladder gets too full or I sneeze I won't be able to stop the leak. It has affected my life a lot, wherever I go I look for a toilet and at night I get up several times too. I have tried the excercises, including a "gadget" from the physio with an indicator, and also purchased Aquaflex but I cannot actually fit it properly. In short, my problems are incontinence, the "mass" in the entrance to my vagina, and a very stretched "gaping" (an awful word to describe it - sorry) vagina. Also after being sutured I was told I could later on have reconstructive surgery as the labia was quite "shattered". What are I my options? FYI - I am not planning to have any more children.
Hello. I will be online later tonight and can answer any more questions but I did want to respond to you. It sounds as if you are already using physical therapy with no relief. I suspect this is all a result of childbirth trauma. You say that it does not bother you but does bother your husband. In what way does it bother you?

I would not recommend incontinence surgery for this minor issue, it may cause you more problems. But consider a vaginal hysterectomy, repair of the cystocoele and a perineoplasty. This would give you the cosmetic result you want. Seek out a urogynecologist if you can.

Let me know if you have more questions and thanks for coming back.
Customer: replied 5 years ago.

Thank you for your reply.

When I say it bothers me, I am very aware of the "blockage" at the entrance to my vagina, and also any pressure on the abdominal area causes discomfort and feeling I need the toilet (despite having just been) and actually leaking sometimes. And the feeling the inside is very big and stretched.

Can you just briefly describe the procedures (incl. incontinence surgery) please. And did you mean to have all the procedures together or just one?

Hi. I would avoid incontinence surgery if you can. Its not appropriate for occasional leakage and the side effects, in my opinion are not worth it.

You would have a vaginal hysterectomy with removal of the uterus. The ovaries of course would not be removed.

Then the surgeon would remove the extra tissue that is over the bladder and stitch it up so that the bladder is higher and you do not have a bulge in the front.

Finally the surgeon would open up the area of the old episiotomy and basically re do it so that the opening looks more normal.

This can be done as an outpatient or as an overnight stay and the recovery is not that bad.

Hope this helps!
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