I Had Surgery

Let's talk about why.

Please note: this newsletter was originally sent April 11th, 2024.

A few months ago, I mentioned in a newsletter that I had been to the urogynecologist where I was diagnosed with pelvic organ prolapse.

So many of you were grateful I was willing to talk about it and wanted to know more. So here’s my official update!

Since the birth of my second baby, I’ve been troubleshooting mild stress incontinence. I’ve done ALL THE THINGS for fixing it: seen several different pelvic floor PT’s, done my PT religiously, used an Elvie, and completed several online PT programs for rehabbing my pelvic floor.

And for a long time, it was okay. Nothing ever fixed my symptoms completely - which was frustrating - but my symptoms were very mild which meant most days my pelvic floor worked well enough.

But over the last 2 years, my stress incontinence has gradually increased from this-is-a-problem-every-once-in-awhile to this-is-a-problem-most-of-the-time.

Was it simply genitourinary syndrome of menopause that could be fixed with more pelvic floor strengthening? Or something else?

My pelvic floor PT - who I’ve seen on and off over the last 8 or so years - did an internal exam and felt like there were new issues going on and that I needed to see a urogynecologist.

And sure enough, the urogynecologist diagnosed me with several types of pelvic organ prolapse, but it’s the “Cystocele” that’s causing the stress incontinence.

A Cystocele occurs when the front wall of the vagina has weakened, allowing the bladder to drop from its normal position. And because of the prolapse, when my pelvic floor contracts it actually pushes a small amount of urine out of the bladder, rather than helping to hold it in.

Well that explains everything.

One in three women who have given birth vaginally will develop some kind of pelvic organ prolapse (there are 5 types) and given that I’ve had four vaginal deliveries, I shouldn’t be surprised at this development.

Aging and menopause also increase the risk for pelvic organ prolapse, as do genetics. So if your mom experienced POP, you’re more likely to develop it as well.

And lucky me, I can check all those “higher risk” boxes.

Thankfully, the only type of prolapse that is causing any symptoms is my bladder, so that’s the one I decided to treat.

I opted to try a pessary before considering any invasive options. And while I’m sure pessaries have helped countless women, my experience was a disaster.

It turns out that people with prolapse of the back wall of the vagina (called a Rectocele) often can't to use a pessary to lift the bladder back into place because the rectocele causes the pessary to flip. This is exactly what happened with me. Long story short, a pessary wasn't going to work with my anatomy.

After researching the remaining options for treating my bladder prolapse, I decided to schedule surgery for a Mid-urethral Sling, which lifts the bladder back into place and provides the support it needs.

But first, I had to have a Urodynamics test done to prove to my insurance the surgery was necessary. The test was bizarre and occasionally uncomfortable but I did get to see the inside of my bladder on a TV screen which was pretty cool.

With the test out of the way, I was able to schedule the 30-minute surgery, which I had a few days ago. I was in and out of the same day surgery center in about 3.5 hours and am home taking it easy for the rest of this week.

I have 3 small incisions (one in the vaginal wall and two just above my pubic bone) and some vaginal bleeding and bruising. Thankfully, the pain has been very manageable with Advil and Tylenol. And if I'm lying down, I have no pain at all.

I suspect the hardest part of this whole thing will be the activity restrictions. For the next few weeks, I’m not allowed to do much at all, including light housework. And then after that, no exercise until I get the okay from my urogynecologist, around 6-weeks post-op.

That said, I’m very excited to eventually resume with my life, leak free. The ever-worsening stress incontinence meant having to modify more and more and I could see how without treatment, I would be forced to slow down quite a bit. And I didn’t like what that would mean for my quality of life now and 20 years from now.

I’ll be sure to follow up in a few months, after I’ve put my bladder sling to the test. In the meantime, feel free to comment with your questions. I’m happy to answer what I can.

xo, Rebecca