You have overcome the shock of being diagnosed with pelvic organ prolapse. You’ve moved past the frustration of exploring multiple non-surgical treatments in your quest to resolve frustrating, uncomfortable POP symptoms such as vaginal tissue bulge, incontinence, pressure, and pain. You’ve made the choice to move forward with POP mesh surgery after navigating several non-surgical treatment options. Surgery went well. You are now over a year past the surgical heal curve. You feel good, have an active lifestyle, but just can’t quite shake the fear of POP returning. You swear from time to time you feel vaginal pressure, or some type of pelvic pain, or your constipation seems to be a bit more frequent than acceptable, and your mind immediately navigates to “what if my POP is back?

 When you chose to have mesh surgery, your intention was to be completely free of POP, symptoms gone, hasta la vista baby. You do your best to be optimistic on days when you feel pressure but a lingering doubt nudges you. You do your best to brush it off, yet it pokes you, like a microscopic sliver. What if, what if, what if?

February will mark the seventh anniversary of my POP transvaginal mesh surgery. Hard to believe; it seems like yesterday (well, maybe not yesterday, that first week after surgery was pretty rough). Yet the days/weeks/ months/years have slipped by quickly as they typically do once you pass the mid century mark. There hasn’t been a day I’ve regretted my POP surgery. Not one. Not during the week after surgery when the heal curve was raw and intense, not at the six month mark when I was well healed but still navigating minor adjustments like sensation shift related to nerve heal curve, not at the one year, five year, and now seven year marks. But to say I haven’t at times wondered “what the heck does that sensation/symptom mean” would be a lie. I’ll bet there isn’t a woman alive who’s had POP surgery who didn’t at least once worry that pelvic organ prolapse had returned.

Over the past several months, I’ve noticed a subtle shift in health ballast, especially after a three month stretch of coughing (indoor winter dry air, allergies?). Picture me repetitively bending at the waist and crossing my legs like we frequently talk about in the APOPS forum (talk the talk, and yes ladies, I walk the walk). I am experiencing a shift in bowel movements. What has been normal movements for the longest time (well, as normal as I get, being the queen of IBS constipation), became spaghetti shaped or bumpy gravel stool. I’ve been experiencing more frequent bloating and belching concerns. The acid reflux occurs frequently enough that I nearly always have canker sores in my mouth. I started noticing more frequent urinary urge or the need to massage my bladder to start the flow. I started wondering about my repair.  While mesh was used for my cystocele and rectocele repair, the enterocele was large and that aspect of the repair was mesh free. Was I doing/not doing something to generate return of my enterocele? What if the pressure of intestines in the abdominal cavity was causing issues for other organs? I had to find out. The time had come for a return visit to my urogynecologist.

The cool thing about seeing a practitioner you have a comfortable, trusting relationship with is it doesn’t matter how long it’s been since you’ve had a consult. After playing catch up, we spent considerable time navigating questions to enable her to better understand my concerns. I had no fear that anything was wrong with the mesh that had been used for my procedure, but I was concerned at the symptoms my body was displaying. Normally heading into an exam that includes a rectal digital exam is enough to crank up my blood pressure, but I was relaxed and excited to get some answers both for my own peace of mind and to share with APOPS following.

The great good news is my mesh repaired cystocele and rectocele are absolutely fine, tissues are still where they are supposed to be and holding sound. The mesh has not eroded, bunched, or shifted. My vaginal tissue is very healthy thanks to my bio-identical hormone replacement regimen.  My PC contraction is good.  My urogyn did not feel an enterocele while palpating vaginally or rectally. My POP-Q results confirmed the manual vaginal and rectal exams. So the question becomes what is causing the shift in stool consistency and frequency, what is causing urinary urge, what is causing the frequent bloating and belching? Is it simply stress related? That wouldn’t be a stretch; I’ve been putting in long hours on the POP front for the past six years and have danced with stress IBS for decades. Is it diet? Although in general I watch what I eat pretty closely, I have to admit to a Dove dark chocolate or gin binge upon occasion.

The next step is a colonoscopy and cystoscopy, possibly upper and lower GI images as well. Let’s get a look inside the organs that are behind the symptoms.  Screening will indicate if there are any concerns that need to be addressed or perhaps that it’s time to completely clean up the diet (ok, I freely admit, I’ll give up the Dove dark when someone pries them from my cold, dead, fingers). This article will be the first of a multi-part series. Post colonoscopy and cystoscopy, I’ll share the details we discover. Even though my symptoms are most likely stress induced, I feel this is a great learning opportunity to explore the inner workings of organs that have mesh on the outside. The more we understand about how POP procedures impact the colon, bladder, uterus, and intestines, the better we’ll be able to move the needle forward.

Let this next journey begin.  Need to know is powerful driver.