The Diagnosis

Does this perhaps sound a bit familiar? You’ve borne a few babies, middle age is firmly entrenched, and once every month or so you find yourself in the aisle of the grocery story that is filled, incomprehensibly, with adult diapers. How did you get here? The problem started out mildly enough, but now, come to think of it, you deal with it every day. You had to cut way back on your Diet Coke intake (sigh), and remember that time you had to run to the gate at the airport to make your flight. Disaster.

Well, this is me. I’ve birthed only two babies, but in that random roll of the genetic dice, I must have weak muscle tone and it has resulted in what is known as vaginal prolapse. Basically, the organs of my lower abdomen (uterus and bladder) are no longer supported as they were in my youth by the strong, muscular walls of the vagina, and it is all just falling down. (Did you know that the vagina was a muscle? I didn’t.) My case is pretty mild. I’ve heard of women who occasionally have to push the whole mess back up inside them. Hard to believe, but true. Were it not for the peeing problem, I probably wouldn’t even notice it. But I like to run, and I lead a pretty active life in general, so stress incontinence—the leaking of urine when you run, jump, or even cough, sneeze or laugh pretty hard—is, believe me, very noticeable. If you’ve ever seen a women who needs to cross her legs when she sneezes—a tell tale sign—they’ve got it, too. Turns out that the percentage of women who have some form of uterine prolapse is surprisingly high—about 15%. After living with it for a few years, I finally mentioned it to my primary care physician. He sent me right off to a place that specializes bladder and pelvic health at my local women’s hospital.

So I find myself in the mid-stages of a treatment strategy that may some day lead to a “fix.” As I progress through this multi-step process, I thought it might be helpful to relate my experience since I was not able to find much out there in the way of first persona narrative on this subject. So here we go…

Step one is an accurate diagnosis. It is absolutely necessary to find a specialist on this condition, and they are out there. On my first visit, the region down there was examined by the doctor (a woman, thankfully) and her nurse assistant. I was on the examining table in the traditional heels up position, while they called out to each other a bunch of measurements. I have no idea what they are measuring, but there must have been some points of reference down there, and they went through a long list of numbers. The net diagnosis—my prolapse was very mild. Then they told me to cough hard and they checked to see if there was any leakage. Nothing much happened and I started to sense that doctor thought I had exaggerated the problem. Then things got really interesting.

They took a catheter of a size normally used for an infant, inserted it to my urethra, and then filled my bladder with about 12 ounces of liquid. Not painful at all, thankfully. Then the coughing was repeated, and sure enough, leakage everywhere. It was quite a little gusher. So I guess I passed the test. For sure I had a problem that they were ready to deal with.

(A quick tangential note. The worst part of being catheterized is the feeling you have after it’s all over. It feels like a bladder infection; like you have to go the bathroom all the time but nothing will come out. Yuk. But the feeling passed within 30 minutes.)

After getting dressed again, the doctor explained my options. I found it a bit hard to follow, probably because her visual reference was a lame drawing she made on a paper towel she yanked out of the dispenser. Without any three-dimensional reference, I couldn’t really even tell which way was up. I mean, for God’s sake, she is a highly paid specialist, can’t she afford to get one of those cool little take apart models most other doctors have? But it slowly emerged that I had two surgical options. The most aggressive approach was basically to give me a hysterectomy (Yikes, I’m only 46). We’re talking months of recovery. This is major surgery. Option two is for her to permanently sew into me a little mesh sling to hold up the neck of my bladder. I kid you not.

But there was one other little option that I could try first. Physical therapy. No surgery, but sort of a personal trainer for my vagina. YES, OF COURSE. I’ve never had a personal trainer, let alone one paid for by my health insurance. Sounded like a great idea to me.

Every women knows what Kegel exercises are, but few women do them regularly, and even fewer do them right. They tell me that only 10% of women can do a proper Kegel. After six sessions of PT, I am now a Kegel expert. Not only can I activate all the different muscles of my lower female anatomy individually, I can even hold each of them for about 20 seconds while walking up and down the stairs. I’ve had them electrically stimulated to fire off on their own, supposedly building the muscles cells. But even after all this work, it became clear that the only way I was going to muscle my way out of this problem was to commit to a 200-Kegel-a-day regimen for the foreseeable future. Realistically, I knew this was never going to happen

So I’ve opted for the surgery – just the little sling-a-ma-dingy. It is scheduled for next week. It is an outpatient procedure and they tell me I’ll be in and out of the surgery in about an hour, and in the hospital for less than 6 hours. Admittedly, I am more excited to finally be done with this issue than I am apprehensive about the surgery. So look for my post next week and I’ll tell you how it all goes. Fingers crossed.