Friday Q A After A Partial Hysterectomy

Q: I have a student who's had a partial hysterectomy. As she described it, to prevent the organs from pressing on her perineum the surgeon used a mesh "ligament" to attach the top of the cervix to a ligament in her back. She says that it feels "weird" and sometimes uncomfortable when we work on deep inner bodywork, such as Agni Sara (or various preparations) or ways to access Uddiyana Bandha. She feels it most when we do breath retention on the out breath and create an inner vacuum as you elongate the torso. Have you come across this before? Is there any risk for her to work on this? Any modifications you'd suggest?

A: In fact, I have not come across this particular complaint from any yoga students who have had hysterectomies of any kind. However, I have personal experience with the presence of mesh used in abdominal surgery and its effect on yoga practice. Over 10 years ago, I developed a hernia in the groin area on my left side. Upon further evaluation by a surgeon, it was discovered I had an even bigger potential opening on my right groin area, and surgery was recommended to repair and seal off these openings. This was accomplished using the kind of mesh I suspect your student had placed during her surgery. I was told that I might expect some unusual sensations in the area of the groin creases after my surgery, but that it usually would disappear after an uncertain amount of time. And, indeed, following my hernia repair, I initially felt soreness, and eventually after that disappeared, I was left with a kind of tightness, especially on my right side, that I had not had prior to surgery. As I returned to my normal practice routine I noticed it in certain yoga poses, most notably in High Lunge when the right leg was back. This persisted for some time, certainly for months, but then gradually began to fade. And at this time, I no longer notice any unusual tugging or weird sensations in the area where the mesh is still certainly located. 

But back to the student in question. So, what is a “partial hysterectomy”? Hysterectomies, in general, are the second most common surgery performed in the US each year. A partial hysterectomy refers to a procedure where only the uterus is removed, not the cervix or the ovaries. This type of operation involves a shorter recovery time, and is commonly used in the treatment of fibroids and severe and uncontrollable vaginal bleeding. Mesh is often used to hold the cervix in place, since the structures that would normally do that are gone with the uterus, and the vagina could prolapse, or fall, toward the pelvic floor. Unfortunately, there can be complications with the use of mesh, such as mesh shrinkage, which can cause such serious complications as intense pain, scarring, vaginal shortening, and sexual dysfunction. Although this does not sound like the case here, it is worth being aware of these potential complications.

In the case presented here, I would be less concerned about a student who was only having “weird” sensations at certain times in the practice. However, if there is outright discomfort, it might be important for her to check back in with her surgeon and make sure there is nothing more worrisome going on. For instance, it is not uncommon for patients to develop scar tissue around the sites of abdominal surgeries. If that scar tissue, or “adhesions” as they are also sometimes referred to, is causing enough problems, pain or otherwise, it is sometimes recommended to do a follow-up look via endoscopy and possibly release the scarred areas, which in many cases will result in reduced or resolved pain and improved overall abdominal function. The first step is simply to have a follow-up with her doc.

If the student is mildly uncomfortable only when doing certain things, there might be some ways to approach her yoga practice to her benefit. Since we are not diagnosticians as yoga teachers, we would focus on trying to modify the practice so as to avoid stimulating pain. The most obvious thing to try is to do less Uddiyana Banda and Agni Sara, both reducing the depth of contraction of the abdominal muscles and the amount of time spent in either state. The student can then participate to the appropriate degree for her unique situation without going to the point of triggering the discomfort. This could hold true for other poses or practices that she discovers also create the undesired discomfort. Periodically, she could try the full poses or practices to see if her body has adjusted to the mesh, and take things from there. While it is entirely possible that with time, these sensations will subside, keep in mind that pain is the body’s way of telling us to look a little further. Please let us know how things proceed.

—Baxter

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After Hurricane Katrina

by Mary Ann Avallone-O’Gorman

Natural Disaster by Leonardo da Vinci

Yoga Sutra 1.1 “Now, after having done prior preparation through life and other practices, the study and practice of Yoga begins.” —translation from Jnaneshvara

February 2016 marks my ten-year anniversary of studying and practicing yoga. I first came to the mat after Hurricane Katrina.

I live in Katrina-land, on the Mississippi Gulf Coast, in the shadow of New Orleans, and after the storm, I was ankle deep in mud and devastation. A piece of my porch railing served as a horizontal ladder in my front hall, thrown there by the storm surge that roiled through my house overturning refrigerator and piano, and floating a table loaded with pottery twenty feet down a hall, around a corner, and finally coming rest on top of a fallen mantle with pottery still intact. My life was bayou sludge, dead animals, rotten food, destroyed photographs. I spent months preparing my gutted house for rebuilding and also making the now four-hour drive into New Orleans (90 minutes before Katrina) to work on my destroyed rental property there, where, alone on the desolate city street, I warded off the rumor of armed vandals with the talisman of my large pickup loaded with a generator and shovels.

My marriage had been crumbling before Katrina, and the weaknesses of that structure grew, as if the storm surge had poured its polluted waters into all the fracture lines.

For months my life was hard physical labor. I was forty-seven and in good shape, but my body wasn’t made for lifting wet mattresses, pushing wheel barrows of soaked drywall, or single-handedly pulling down a tilting carport rotted out by the water. I was pretending I had super powers, which included functioning without self-care. I had a makeshift kitchen where I could cook healthy meals, but mostly I lived on rotisserie chicken, take-out, and wine. Lots of wine to help me sleep in the shell of the house within the shell of a marriage.

One afternoon six months after the storm, I drove by the local yoga studio and noticed it was open, so I stopped in. I don’t know why. I’ve always been, and still am, skeptical about any organization of any kind. But I went in and the owner, Eileen, was at the desk. I immediately put up as many walls as I could and looked to see how she was ‘other” from me: tattooed, smiling, warm, friendly. I was none of these. We talked a little, and she noticed my black lab had taken over the driver seat of my car. We shared a good laugh about the large dog in the front seat of my Honda Civic. So I decided to try yoga basics and went back that night.

My whole life I had been an active person. I’ve been a distance swimmer, a weight lifter, and a long walker. I gave up running in my late twenties when my knees just said no, but I took up aerobics when it was the trend. I felt I had a grip on my body. 

I had a grip on my body.

My first yoga class was gentle yoga basics. Our first practice was three-part or dirgha breath. I could not breathe. As the class progressed, the grip I had on my body became more evident. No muscle cooperated, and I blamed the instructor and the ridiculousness of yoga.

As sutra 1.1, says, “through life and other practices” I had prepared myself for yoga. I had trained myself to resist anything my body thought was intelligent. I clung to a completed marriage, I carried glass shower doors over my head for the length of a city block, I loaded a generator and dehumidifiers and thirty pounds of extension cords in a pick-up before sunrise and drove 100 miles to unload it all and spray chemicals on exposed studs to prevent mold. I would not wear a mask. I drank wine for dinner and ate sugar for breakfast. I began the study and practice of yoga with a set of experiences that prepared me for that first class in ways that no one could predict.

I sighed and eye-rolled through the most basic of poses, thinking all along this class was a mistake. Then Eileen instructed us through Savasana. The studio had no windows and as I reclined on my mat, I felt safe for the first time in months. My home’s second story was intact and I lived there, but my first floor—on good days a dramatic space full of water views on three sides—was a windblown, door-less, windowless, wall-less space. The dogs delighted in walking through the studs, but I felt exposed to the elements, the hurricanes that came after Katrina, the cold northeast winter winds, the surviving raccoons, possums, snakes. Here on my mat in Savasana, I was cocooned. Eileen talked us through the pose, and I soon felt the breathlessness that precedes sobbing.

Then I was sobbing. In February 2006, for the first time since August 29, 2005, I was crying. I had smothered the sobs with heavy lifting, heavy drinking, crazy eating, crazy hours, anger, and more anger. And now the sobs could not stop. I tried to stifle them, and left quickly after class. In my car, I sobbed more and had trouble driving the few miles home, staying in second gear because I could not cry and shift. For once, feeling took precedence.

I walked through the dark wind tunnel of the first floor of the house and went upstairs to my bedroom where my then-husband was reading the New York Times on the computer. I sat on the floor and leaned against the bedframe and sobbed until I was retching. He sat in the light of the computer screen and said, “Maybe yoga isn’t for you.”

That’s when I knew so many things, the most important being that yoga was for me. The prior preparation I had done “through life and other practices” had led me to the mat, despite my skepticism. My successful attempts at strong-arming through all adversity—through natural disasters and relationship disasters—painted me into a corner. The only way out was to soften into ease and grace.

As I come up on my ten-year anniversary, I come to my practice every day with new preparation, new practices. I say to my students, “You bring your whole life to the mat. Your wisdom. Your strength. Your failures. Your attitude about all these things. Use what serves you. Observe what does not. Place it gently to the side. That act, in itself, is a yogic practice. Recognize all the traits you bring to all that you do. Allow your yoga practice to be exactly that: a practice of and for your whole life.” But I am talking to myself. Happy anniversary to me, and to all yoga practitioners who come to the mat for a day, week, year, a lifetime. 

Namaste.

Mary Ann Avallone-O’Gorman (E-RYT, MA, MFA) now lives in a home out of the flood zone with a new black lab and various cats. She owns and is the sole teacher at Studio 2.46 (Practice with Strength and Grace) in her yard as well as at the wonderful River Rock Yoga in Ocean Springs, Mississippi, and at two domestic violence shelters on the Gulf Coast. She practices and studies Ayurveda, and writes her heart out on a regular basis. Her chapbook of poetry Life in This House is available through Amazon.

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