If you haven’t read part 1 already then I recommend that you do here. This tells you the background to my story and how I got to the stage where you now join me; legs akimbo in the gynacologists office with his fingers up my bum! (I do remember making a crass joke to the incredibly professional consultant to try and make light of the situation- the joke was something about how usually a man would have to buy me dinner first… It was the nerves you see, but I’m cringing about it now.)
I should rewind a tad, just to set the scene. I had been referred by my GP for stress incontinence and now the consultant was giving me a full examination. Naturally it was embarrassing and awkward (not helped by my bad joke) but he had to fully assess the situation, both vaginally & anally and see what was going on.
During the examination he asked me to do pelvic floor squeezes, coughs and all sorts. He told me that my urethra was mobile- this is the tube that runs from your bladder to your wee opening (see, I told you that I wasn’t a doctor!) it should be nice and secure, so that you don’t involuntarily wee. Mine was moving around and so I didn’t have full control over it. Furthermore, he discovered that I had a prolapse high up in my vagina. Apparently (I now know) there are loads of different types of prolapse in women. Common ones include:
Cystocele– this is where the bladder bulges into the vagina,
Rectocele, where the rectum bulges into the vagina
Enterocele, this one is a small intestine prolapse
Uterine Decent, where the uterus drops into the vaginal canal and there are loads more.
If you want to find out more then I’d recommend this website as a good starting place: www.nhs.uk/conditions/pelvic-organ-prolapse/
I was diagnosed as having a “Second degree rectocele” This came as a bit of a surprise as I had no idea that I had a prolapse. Everything was working as it should vaginally, my sex life was decent (well, as decent as it could be with two kids around!) and when I’d had my smear test and my coil fitted, the health professionals had never said anything to me. Therefore I’d assumed that everything was as it should be….
The consultant explained to me, that whilst the prolapse wasn’t causing me issues or pain currently, as I got older then gravity would do its business and things might change. A good friend of mine (who will remain nameless) was a nurse who years ago used to perform smear-tests regularly. I remember her telling me stories of vaginal prolapses and things falling out during routine smears!
Anyway, the long and short of it was that I didn’t want my vagina falling out when I was old, nor did I want to restrict my sex life by having to wear strange devices to keep it all in place when I’m older (you can google that!) therefore, this prolapse needed to be sorted whilst I was young and healthy.
The gynacologist confirmed that my pelvic floor muscles were good and everything else was normal. This first examination was done with an empty bladder- I was told I’d have to return to do the whole thing again with a full bladder, which I did. 4 weeks later I was back in his office, with that awful “my-bladder-is-going-to-burst” feeling that I used to get when going for pregnancy ultrasounds- it was all about the timing of the fluids! You have to drink enough to get a good ultrasound image, but if you drink too much, you’d be in agony! If the appointments were running behind it was torture- It was a game of bladder-roulette!
This second consultation confirmed the diagnoses of a mobile urethra and second degree rectocele (a prolapse where by my rectum was bulging into my vagina) furthermore the consultant mentioned that there was a possibility of an “enterocele” (a small bowel prolapse) The consultant was very patient with me and took his time explaining the various options to me. I was told that the incontinence and the prolapse were two separate issues and would be dealt with separately.
For the incontinence, a non- surgical option would be a bulking agent- in my mind this was like getting botox in the bladder! (Again, I re-iterate that I’m not a doctor!) The idea behind this is that they inject around the urethra with a bulking agent, this narrows the urethra and so reduces leakage. Whilst this sounded good- it was a relatively short-term solution and would need to be repeated every few years. I think that this option would have been more appealing to me if I was planning on having more kids in the future, but I wasn’t. I wanted a more permanent solution.
The other options which were given to me were something called “Colposuspension for stress incontinence” or a “Fascial Sling” both were fully explained to me and I was given information leaflets on both to help me make a decision.
There were plusses and minuses to both options, but in the end, I decided to go with a Fascial Sling. Historically this operation had been done using a synthetic material for the sling (sometimes referred to as mesh) You may recall a few years back that issued with surgical mesh attracted an awful lot of media attention due to mesh-related complications and awful side effects. Therefore my sling was to be created by removing a sliver of my abdomen (I’d like to think it was a sliver of muscle hiding under there, but who knows what lurked beneath my mum-tum!) and using that to create the sling.
The surgeon would then make an incision through my vagina to stitch the sling onto the inside of my pubic bone to support my urethea. All being well, this would then remain in place for ever and allow everything to be fully supported and I would we normally again (apparently the success rate for this operation was 80-90% and I was very comfortable with that)
The repair for the prolapse was more straightforward- well what I mean is that I didn’t have to make any decisions on that one. Again, the operation was fully explained to me and I was given a patient information leaflet.
The plan was that the surgeon would perform a repair to the back wall of my vagina to fix the rectocele prolapse, and if required, would perform a “iliococcygeus suspension” and repair any “enterocele” at the same time. (He’d be able to examine it all properly once I was in theatre) Although he explained all this to me thoroughly and professionally , all I was thinking was; “After this operation, I’m going to have a designer vagina!”
The next decision that I needed to make was which operation to do first- sort my incontinence out or get my designer vagina… At this stage it was expected that I would have the two surgeries a few months apart- what I didn’t know was that a worldwide pandemic was on its way to scupper my plans.
On reflection, I made a bad decision because I elected to have the prolapse surgery first. My thinking was that I had been dealing with peeing myself on the daily for the past 8 years- I could cope for another few months. I wanted the designer vagina! Furthermore, the Rectocele repai operation sounded like the more straightforward procedure, so I thought it was best to ease myself in gently.
My operation was booked (thankfully) for 30th January 2020- a few weeks later and we would have been in the throes of Covid 19.
Read Part 3 here for details of my operations and recovery.
Blog by Sally Haslewood
