WOMENS-HEALTH Messages for February, 1999: AGAIN, Could someone please ..

AGAIN, Could someone please ..

From: Elizabeth (anonymous@obgyn.net)
Tue, 2 Feb 1999 11:01:23 -0600 (CST)

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(Could anyone please provide answers to the paragraphs starting with "**".? Thanks. I've been trying very hard to get some details on this)

>Now, you are asking the right question. At the heart of it is how well
>an individual makes a substance called collagen. This is the basic
>"stuff" of the connective tissue of the body. A person's ability to
>make good connective tissue falls on a Bell-shaped curve, like height.

** Is there anyway to determine what level of collagen is produced in a person? My reason for this question is that it seems my body heals quickly (had a 4th degree episiotomy and a 1st degree) no complications. I'm wondering if a lot of the damage I suffered was basically due to the very rough first delivery, and, although I may be predisposed to some degree of prolapse, had the delivery been a c-section would I have prolapsed as much as I have at this point. Does this make sense? I want to know what factors make a patient a good candidate for surgery (hysterocolposacropexy, preserving the uterus)...successful surgery that is. Success to me by the way would be getting things back in order w/out having problems w/my other "celes" until at least the end of menopause (approx 20-25 years from now) and that IF I do happen to prolapse again, that it would be to a much lesser degree. By the way - noone in my family suffers from prolapse, that's why I'm wondering if the majority of the damage was due to long labor and if I the damage was corrected, it would 'stay'.

Quality of life is a bit important to me - I've got a 4 month old and a 2.5 year old and I'd like to do things w/them like hike, play basketball or baseball etc.

>That's not all of it however. Women have to have estrogen to make good
>connective tissue. Remember, menopause is simply the end of a 10-15
>year process of steadily lessening estrogen levels.

**how can you tell if your level of estrogen is lowering (besides menopause that is). I got pregnant quite easily, even at age 34. > >And that is STILL not all. Childbirth also injuries the nerves of the
>pelvic floor. If you disrupt the innervation (nerve connections) to a
>muscle, the muscle atrophies, or wastes away. If a portion of a
>muscle's innervation is disrupted, then a portion of the muscle weakens.
>
** That makes great sense. I do recall that I couldn't feel certain things after the birth of my first child..thought it was normal. After awhile, feeling did return (and the urogyn even checked by pricking softly w/a pin). I didn't suffer any loss of feeling or pain after the delivery of the second child, other than the fact that the second delivery/pregnancy just brought things down. Both children were over 9 pounds, both induced/born before 40 weeks.

>The result of all this is the stringy and elastic bits that fight
>gravity in a woman's pelvis weaken over time, and that weakening
>continues as long as gravity is present.

**Question: I've noticed when I lie down that the prolapses no longer slide back way down as they did when I noticed them at 3 weeks after delivery..does this mean things are getting worse or that the tissue is tightening a bit and the organs won't give as much (either in or out)?

>This is true to a certain extent, but you are entering that phase of
>your life when your natural levels of estrogen are beginning to decline,
>and estrogen replacement does not even approach the quantity of estrogen
>you have enjoyed up till now. You run a large risk of subsequent
>surgery. For most of my patients, this is unacceptable, though there
>are exceptions.

**May I ask why surgery is so unacceptable? If I have it next year, I'm sure I won't have to ask this..but is it due to the possibility that things could get worse? I've got the three main prolapses but so far, no incontinence..only mild irritiation w/the rectocele, and I wear a pessary for peace of mind to not see the cervix. Could surgery create problems to those things that although prolapsed, still function? (knock on wood).

(by the way, I am only 35 and 4 months postpartum)

>This can be done, but since the uterus is frequently >already touching the sacrum in its normal position, this >can lead to a high rate of failure, and postoperative pain, >particularly with intercourse.
>
**I'm not sure I follow you here..isn't the normal position of the uterus over the bladder..not towards the sacral bone? And, I believe I had a tilted uterus to begin with although noone really mentioned it until after my deliveries. By the way, this seems to be one of the common factors of women who prolapse.

>The round ligaments have very little support function in the normal
>course of events. The operation that you mention can be performed, but
>its "life expectancy" is unacceptably low for most patients, and so is
>generally reserved for women who plan further child bearing.

** I think I got that confused w/the other ligaments..the supporting ones are the ones I meant to refer too. Same question, but w/the other ligaments..what if those are shortened and scar tissue builds to strengthen the connection?

Thank you so much for all your information, I really appreciate it and hope you don't mind if I continue to pick your mind ;-).

-- Elizabeth

--
Elizabeth

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