The Most Basic Advice

If any doctor or specialist diagnoses you with any one prolapse (bladder, rectal, vaginal), it is critical that you not allow a single prolapse repair. First find an ob/gyn who is experienced in evaluating and treating pelvic prolapse (which views the entire condition of the pelvic organs).

If the single prolapse is due to a weakened pelvic floor condition or another pelvic issue, other organs may be impacted and the surgery may lead to the next prolapse. A trained ob/gyn will decide in which order the prolapse(s) needs to be repaired. Having a single repair and then learning of the pelvic prolapse can cause complications.

It's your body. Take charge and get a second opinion from a board certified ob/gyn who has adopted viewing any organ prolapse as potentially pelvic prolapse.


Not so fast...

Of course when the rectal prolapse suddenly appeared again, I panicked. These are body parts falling to the outside. Very disturbing. Because of the holiday, Brian placed an emergency call to Dr. DeLeo. That's when we learned the doctor does not do emergency call backs. I spoke to her office the next day and secured an appointment for July 6.

Dr. DeLeo confirmed the presence of a "slight" rectal prolapse. She asked me to have a "second opinion" with a colo-rectal specialist. I left her office wondering why she asked me to have a second opinion. Isn't that something the patient requests? She didn't say, "I'd like you to see a specialist because I'm not sure what is going on." Seeing a male colo-rectal person was not an option for me.

I returned home and hit the internet searching bladder and rectal prolapse. That was the first time I ran into the term "pelvic prolapse" or "pelvic floor disorder". They were articles about the big picture. The bladder, vagina, and rectum are all connected in terms of issues. When the bladder prolapses, it bulges into the vagina. The vagina can also prolapse causing pressure on the other two organs. A rectal prolapse can cause pressure on the vaginal wall. One of the main causes of pelvic prolapse is weakening of the pelvic floor muscles which can be due to age, childbirth, frequent lifting, and (while not specifically stated) I would imagine long-term sexual abuse.

I extensively researched the best way to evaluate pelvic prolapse. The NIH highly recommended a specific type of MRI. I printed out their recommendations and requested an appointment with Dr. DeLeo right away. I cancelled the appointment with the colo-rectal surgeon because I wanted the "big picture" approach. If that surgeon confirmed the rectal prolapse, he would have recommended a rectocele without taking the condition of my entire pelvic region into consideration.

My thinking at that point was Dr. DeLeo had performed the cystocele well. The explanation given for the immediate rectal prolapse was that one prolapse usually leads to another. "Nothing to worry about. I can fix that." While she was board certified, I realized she was certified in General Surgery but held herself out to be experienced with ob/gyn issues. Because she had been recommended for the colonoscopy my assumption was she knew that area of the body well. I didn't mind working with her.

In the meantime, I was concerned about additional time away from my clients. I didn't have an ob/gyn because my PCP since 2004, Dr. Bogdan, had been doing my annual Pap smear and checkups. I called her office to find out if she could get me in to see a female ob/gyn because I was in a mid-pelvic crisis and wasn't positive I was with the right doctor. Each ob/gyn I called either wasn't accepting new patients or had a wait until January. It was July. The prolapse was too uncomfortable for me to wait that long. I also assumed Dr. DeLeo was sending reports to Dr. Bogdan so she could monitor what was happening with me.

Returning to Dr. DeLeo's office with research in hand, she ordered an MRI for me. During my next meeting with her, she reviewed the MRI results with me. I had a rather large cyst on my left ovary, likely a "chocolate cyst" also called an endometrioma. She indicated she would have to remove the cyst before she performed the rectocele. Both procedures were scheduled.

Lesson: Even if your PCP performs your annual ob/gyn checkup, make sure you are on record with an ob/gyn in case of an emergency.


But she's the doctor...she knows

As Dr. DeLeo told me I had no evidence of a rectal prolapse but clearly had a bladder prolapse, I was speechless. I was pretty darn sure I knew which orifice was my rectum. The definition of the prolapse was that the bladder pushed into the vaginal wall causing pressure to occur in the vagina. I had no problems with urination. Since my body has always been weird, I figured maybe the bladder had caused pressure over to my rectum? I didn't ask those questions. I didn't speak of the photo out of embarrassment.

"Why would my bladder have fallen out?" The doctor assured me it was common in women over 50, especially women who had lots of babies. When I informed her I had never given birth, she was silent. She said she would be unable to repair the bladder the next day when she did the colonoscopy but scheduled a date for the cystocele, an outpatient procedure.

Walking out the doctor's office with Brian, I sarcastically noted that my bladder must have prolapsed on the walkway into the office. Surprisingly, since that visit, I no longer noticed the rectal prolapse but did have increased frequency of urination. Whatever happened, she must have been right. The colonoscopy went well, or so she said. For some reason I didn't get photos of my colon like Brian had after his. I didn't think much about it at the time.

With the cystocele already scheduled for June 29. I returned to my full work schedule not thinking much about the surgery. The cystocele went well. I had very little pain. I was discharged with a catheter that would be removed a few days later. My thinking was that she did an excellent job with minimal pain. The catheter was removed in Dr. DeLeo's office during the afternoon of July 3. The morning of July 4, the rectal prolapse returned.


New health issue reveals itself

It is not easy to identify a rectal prolapse. Especially when we don't know such things exist. Most people want nothing to do with discussions about this area of the body. What happened to me should be mandatory education for women before it happens. What is supposed to remain tucked up inside the body, begins to fall out. What should never see the light of day, becomes quite prominent as well as physically and emotionally uncomfortable.

Some of my symptoms that had been dismissed for months were feeling like I had to go or still had to go when nothing was there. I'd had lower back time for many months but chalked that up to sitting most of my working day. I also had a pinpoint pain on the left side of my body that wasn't quite forward in my consciousness. I had begun to pee more frequently, although I thought it was my body adapting to my therapy schedule. Each hour in between clients. I was six months into menopause so was having no vaginal symptoms. Nothing in my mind put anything together.

Once I spotted blood, I became more aware of what was going on with that orifice, especially after elimination. One day, a week before my colonoscopy, I had been waiting for what seemed about 20 minutes because I didn't feel as if I were finished. I reached back to check (understanding I don't recall ever really exploring my anus) to find about a golfball sized "balloon". It felt rubbery and had no excrement on it whatsoever. In a panic, I quickly cleaned up and ran to the computer.

Initially I searched the symptoms and body part...rectum, balloon, outside. That's when I first learned of rectal prolapse. I had the symptoms. At the stage it becomes visible (on the outside of the body), is the final stage. Some women choose to live with the prolapse that undergo surgery. Once mine came out, it sometimes retracted on its own. Sometimes I had to push it back inside on my own (ewww). Sometimes I could feel it outside the body while I was in session and had to completely ignore it to focus on my clients.

I had called Dr. DeLeo the day I discovered the prolapse. I wasn't sure if the colonoscopy needed to be delayed or what other doctor I would need to see. She gave me an appointment the day before the colonoscopy. While I often had cautioned my clients not to self diagnose from the internet, I had found images of a prolapsed rectum on the internet. Being the inventive person I am, I placed my camera on a stepstool and stood over it while the prolapse was fully exposed and took a picture. It was identical to the internet photo. I did not think to bring the photo with me on the day of my appointment. In fact the whole topic was totally embarrassing. The fact that I took the photo still surprises me. I'm glad I did it though.

When I saw Dr. DeLeo, she asked why I thought I had a rectal prolapse. She claimed she found no evidence of one while in a Pap smear position. She had me stand up and probed my orifices. She proclaimed me to have a bladder prolapse.

A scary symptom

In May 2007, I noticed I was spotting blood from my rectum. I knew that couldn't be a good thing. After visiting my primary care physician (PCP), I was advised to schedule a colonoscopy. I was 54 when the spotting occurred. At 50, I had been referred to the only female doctor in my area who performed that procedure. Because of abuse issues, I was not willing to have a screening test. The doctor, Joanna DeLeo, agreed it would be okay to wait until a time when my PCP or a specialist felt it was necessary.

I let my current doctor know I was already set up as a patient for the procedure. My PCP asked me to call her office with the doctor's name and date of the colonoscopy, which I did. The meeting to discuss the procedure in the Dr. DeLeo's office went well. I felt comfortable with her demeanor and believed I was in good hands because I had initially been referred to her by my previous PCP (also a female). Because of an abusive past in the hands of males, I tended to avoid male doctors. I had checked to make sure Dr. DeLeo was an still an approved provider and in my insurance network.

And so the colonoscopy was scheduled for June 1, 2007, at an outpatient surgery center in Lebanon, nearly an hour's drive from Harrisburg. Several years earlier, the doctor performed her procedures at a local hospital. She told me the local hospital was not treating her patients in the manner they deserved to be treated, so she found a place where her patients received the best care: Lebanon Outpatient Surgery Center. I didn't question her response. (It was not until after I placed myself in a specialist's care that we learned she no longer had hospital privileges in any local hospital and only had outpatient privileges in Lebanon. Yet she was still an approved surgeon!)

What happened before June 1 set the tragic series of events into motion. If I'd only known.