Do I need surgery? Cystocele/rectocele, 22 y/o no kids :(

Ive suffered from chronic constipation my entire life, (cant even pass without bearing down, & lately splinting) .. - it feels like there's a "pillow" at the front of my vagina on the top near the opening, along with my urethra being fallen down ... I have good insurance, anthem blue cross ppo through my dads job. What kind of procedure does that require & will it make me tighter? Its to the point where my love life is effected greatly & i feel broken, depressed all the time. Please help.

Doctor Answers 7

Chronic constipation causing vaginal laxity and prolapse: what should I do?

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The only thing I would add to the answers already given is that you should also seek consultation with gastroenterology.   The purpose of this is to handle the constipation.  The surgical repair of your vagina may be straightforward but the problem will reoccur if you don't handle what caused it to begin with.  Pelvic organ prolapse in a young woman who has not had children is not a common issue.  I would hesitate to proceed with surgical repair until you have a better handle on what caused the issue to begin with.  Hopefully its as simple as diet and exercise and fiber intake that can be modified with some discipline.

If you don't fix your constipation, your surgery won't heal very well

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Chronic straining can cause loosening of your pelvic organs similar to childbirth. You need an examination by an expert in pelvic reconstruction to assess for the status of your vaginal supports. These can be fixed and the vagina can be tightened if necessary. However, the bad news is that if the problem that caused the damage isn't fixed, the results won't last.

Cystocele and Rectocele with no kids

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I am sorry to hear of your difficulties but there are certainly great treatment options available to you. It is possible to have prolapse without prior pregnancies or deliveries although very rare at your age. Your first priority is to treat the constipation, under the management of a physician with the goal of having a daily formed BM without needing to strain or splint. It is not unreasonable to have a consult with a urogynecologist for a pelvic exam to see if there is something anatomically that also needs to be addressed. Management may include behavioral changes and pelvic floor physical therapy. The sooner you seek treatment, the less strain you will be placing on your pelvic floor muscles and support over time. Best of luck. 

Cystocoele Options

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Hello. Thank you for submitting your question and for doing so with so much detail. I recommend you have an exam with a gynecologist. The pelvic exam can determine whether you have a cystocoele and what degree if one is present. Then based on your symptoms and severity you can discuss having an anterior repair which is a surgery to correct a cystocoele. This would typically be covered by insurance. This procedure is not likely going to make you tighter. The other option is Thermiva if the cystocoele is not to severe. Thermiva can resolve a mild cystocoele and make the entire vagina tighter. This is not covered by insurance. 

Best Wishes

Dr Poucher


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This is regular OBGYN stuff--ask your doctor for his/her opinion before making things too complicated. You are at risk for overly aggressive care from cosmetic specialists in my opinion. Function may be normal if constipation  and a large hard lump of stool pushing up on vagina were not present. There are lots of times I examine a woman and there is a huge lump of stool taking up a large portion of the vaginal space pushed from below in the rectum. Treat the cause and the anatomy may return to normal. My opinion based on 40 years of practice.

Treat your function before you fix your anatomy-please

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What is obvious is a woman that is 22 and has never had children should not have anatomic problems unless there are other issues that need to be evaluated and managed.  Your history is classic for hypertonic pelvic floor dysfunction causing chronic constipation and obstructed defecation.  When you can't relax your muscles to pass stool you must push and strain for long periods of time and this is just like the pushing that occurs when you have a vaginal delivery.  This is why you have anatomic problems.  Any surgery that is done to correct these anatomic problems will not correct your functional problems therefore your anatomic problems will very likely return shortly after surgery.  Please be carefully evaluated by a trained pelvic floor specialist prior to making decisions to have surgery.  My website discusses this problem and provides you with articles that I have written on this subject.  

Charles Butrick, MD
Overland Park OB-GYN

22 years old cystocele/rectocele/ rejuvenation

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Dear FML_666

Thanks for sharing your story. From the content of your letter it appears you may need both rejuvenation and reconstruction.  The only way you will know is to be assessed by a surgeon who is well versed in both reconstruction and vaginal rejuvenation.   Rejuvenation is really a cosmetic/function type problem and reconstruction is just an anatomical problem.  

What is vaginal rejuvenation?  Vaginal rejuvenation really means the internal tightening of the vagina and tightening of the vaginal opening usually to enhance friction for intercourse.   In experienced hands this surgery is approximately 85-90% successful as defined by the patient ( i.e. she is satisfied with the enhancement of friction during the act of intercourse 12 months after surgery).   There are only 4 papers written on this topic and my partner, Dr Moore and I are co-authors of two of these papers.    This surgery is usually accomplished by performing posterior vaginal wall surgery ( known as a posterior repair and coupling this with a levator muscle plication) + a vaginal opening repair known as a perineoplasty.   This requires experience, expertise, and good knowledge of  the pelvic floor.      Patients who have had spinal trauma i.e. lower back injury, chronic straining due to "constipation' and or lifting heavy things, multiple childbirths may need more than just tightening procedure they actually need vaginal reconstruction.

What is vaginal reconstruction?  Vaginal reconstruction is what most urogynecologist have been trained to reconstruct the vagina to give the support back and this does NOT focus on tightening the vagina. Reconstruction is for the restoration of the anatomy and also to fix things like urine and fecal leakage or retention.  The urogyencologist has extensive training and is the most experienced of all surgeons in operating on the relaxed vagina.  The second most experienced surgeon for vaginal reconstruction would be the gynecologist.  The urogyn  is trained by first spending  4 years in a residency in obstetrics and gynecologic surgery and instead of going out to practice they then tspend 3 more years of subspecialty training in vaginal reconstruction or the rebuilding of the vagina (when it falls down aka vaginal prolapse - see the next few paragraph for an explanation).  Vaginal Prolapse is the general term for a woman who has one or many areas each area of the vagina or uterus which has fallen. 

Each area  has its own descriptive name" Uterine prolapse - the uterus is falling down into the hollow of the vagina and towards the opening of the vagina in severe conditions the uterus can actually fall  out of the vaginal opening and it hangs between a womans legs.  Cystocele - the deeper portion of the ceiling of the vagina gives way and the bladder which is being supported fall downward into the hollow of the vaginal canal. Often these patients will suffer from frequency and urgency of urination as well as vagina pressure.  If the condition is very severe the patient will have difficulty emptying her bladder. Urethrocele - the ceiling of the vagina near the opening of the vagina gives way and the urethra sags.  Often these patients will suffer from cough urine leakage ( aka stress urinary incontinence) Rectocele - the floor of the vagina gives way and the rectum pushes upward into the vaginal canal producing a bulge pushing towards or out of the the opening of the vagina.  Often patients will complain of difficulty emptying their rectum of stool and then this becomes a catch 22 situation where the harder you strain to get your stool to evacuate the worse the rectocele can get and the larger the rectocele gets the more difficult it is to evacuate.  Urethrocele means there is a lack of support of the urethra and often (but not always) these patients will leak with coughing  and sneezing. Urogynecologist have been trained to treat the anatomy of the vagina to support each of these structure as well as consider the function of urination and defecation as they perform surgery.   However most urogynecologist have not been trained in the concept of cosmetic vaginal surgery or  vaginal rejuvenation .

You certainly would benefit from a thorough evaluation by a urogynecologist or a pelvic floor surgeon/gynecologist.  But you would probably want to choose someone who is also trained or has expertise in vaginal rejuvenation.   Remember Vaginal rejuvenation means to tighten the vagina so its enhances intercourse for the woman.  So I caution you to choose a surgeon wisely............choose a surgeon who can accomplish both of your needs: 1) restoring friction during intercourse and   2)  decreasing the pressure  inside of the vagina ( which maybe best accomplished by restoring the supportive anatomy of the vagina and NOT JUST TIGHTENING the vaginal opening.  Choose a surgeon who is specialized in urogynecology or vaginal floor reconstruction and cosmetic vaginal surgery.  Please see both sections of my website to get a full understanding and the different between cosmetic vaginal surgery and vaginal reconstruction.  Remember your choice of surgeon should be based upon: experience, expertise, reputation and results and do not solely focus on location, convenience and cost.

John R Miklos MD

Urogynecologist  & Cosmetic Vaginal Surgeon

Atlanta ~ Beverly Hills ~ Dubai

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.