Dear Dr. Northrup,
I am 55 years old and have a cystocele (herniated bladder), rectocele (herniated rectum), and a prolapsed uterus (descended uterus). I’ve been scheduled for vaginal hysterectomy. Is this the best option for me? -G.M.
Prolapse of the pelvic organs is a common condition for which women seek treatment. The condition is far more common in Caucasian women, particularly red heads. The reason for this is that the collagen connective tissue in these light-skinned women is much thinner than in Black and Asian women. Prolapse can occur even in women who’ve never had children, though it’s often blamed on child-bearing. This area remains controversial. The truth is that most women who’ve had vaginal births do not develop prolapse.
Many women have cystoceles and rectoceles (herniations of the bowel and bladder walls into the vaginal area). Sometimes this is caused by uterine prolapse and sometimes it’s not. Many women go through life with a small amount of uterine, bladder, and/or rectal prolapse and don’t have problems at all. In others, the uterus actually prolapses right out of the vaginal opening, creating pain and discomfort.
You didn’t mention whether or not you were having symptoms or if they were bothersome. In mild cases of prolapse, surgery can be avoided with a device known as a pessary. There are many different types. And the good news is that many healthcare providers are now learning the art of fitting them. You can then learn to insert and remove it yourself.
Vaginal hysterectomy with cystocele and rectocele repair is another option, but it’s often not necessary to remove the uterus when repairing a cystocele or rectocele. The only reason for the hysterectomy is if you have urinary incontinence in addition to the prolapse.
For those women with uterine prolapse who would like to preserve their uterus (particularly those who aren’t yet finished with childbearing), there are some very good procedures to repair prolapsed organs without removing the uterus. To find one, contact the American Society of Gynecologic Surgeons.
I also highly recommend that you incorporate some pelvic exercises into your daily routine so that your pelvic floor muscles will be toned and resilient before and after the surgery. This will speed your recovery. Kegel exercises are good as long as they are done properly. The main thing is to learn where your PC muscle (pubococcygeus muscle of the pelvic floor) is and the focus on strengthening it regularly. There are many physical therapists who specialize in pelvic floor function. I have also recommended the use of weighted cones for this for many years, though a physical therapist trained in this area would be the most ideal situation. I also like the jade egg exercises created by Dr. Saida Desilets very much. I use them regularly. (To learn more, visither Web site.) – C.N.
Learn More — Additional Resources
- Saving the Whole Woman: Natural Alternatives to Surgery for Pelvic Organ Prolapse and Urinary Incontinence, by Christine Kent
- The Wisdom of Menopause, by Christiane Northrup, M.D., Chapter 8, “Creating Pelvic Health and Power”
- Women’s Bodies, Women’s Wisdom, by Christiane Northrup, M.D., Chapter 9