Breaking the Silence about Pelvic Prolapse
Though half of women who’ve delivered a child and half of women over 50 experience pelvic organ prolapse, it remains something rarely discussed except with a woman’s closest girlfriend or physician.
Why the embarrassment? Pelvic prolapse refers to a condition where the uterus, vagina, bladder and rectum shift positions in a woman’s body and move downward, resulting in some uncomfortable and awkward symptoms such as heaviness or aching in the pelvis, or the leaking of urine or stool. Luckily, there is help for women experiencing this situation.
Blame It On Gravity Gravity pulls things down as we age: breasts, jaw lines and even the pelvic organs. Every woman experiences some degree of slippage, but some are more susceptible, especially those who’ve had multiple children or a single delivery that involved extensive straining. Other experiences also can lead to prolapse, including chronic constipation, chronic cough or jobs that involve heavy lifting, says Wes Hilger, M.D., a urogynecologist with Sutter Independent Physicians. “Anything that repeatedly puts pressure on the abdominal organs can strain the ligaments and connective tissue,” he says.
Signs of Prolapse Many women have some degree of prolapse with no symptoms. Others will feel pressure in their pelvic area or have constipation or pain during bowel movements.
In extreme cases, women may actually feel their uterus or bladder bulging toward the outside of the body through the vaginal opening. Many also leak urine or stool. After having a bowel movement, they feel the rectum isn’t completely emptied.
Even intimacy can be hampered as sensation in the vagina changes. Emotionally, many women feel embarrassment or shame about their symptoms – uncomfortable even telling their spouse or doctor.
Treatment Options Dr. Hilger says the first step in treatment is to stop blaming yourself.
“You might think, ‘If only I’d done my Kegel exercises more diligently!’ and Kegels do strengthen the muscles of the pelvic floor , which can relieve certain symptoms. But serious prolapse usually involves connective tissues such as ligaments, which won’t respond to exercise,” he says. Once a woman understands what is happening with her body, she may be able accept the symptoms and live with prolapse without surgery. “A woman who feels a bulge or has difficulty urinating might fear a cancerous tumor. She is often relieved to find out it’s prolapse,” Dr. Hilger says.
Maintaining a healthy weight and avoiding heavy lifting may help reduce symptoms by reducing pressure on the organs. For others, a pessary may be needed. This device, inserted into the vagina, helps support the organs mechanically. It can be left in place, removed only for intercourse or occasional cleaning. A pessary also works well for active women with prolapse
If a pessary is not an option, women may be candidates for surgery to lift the organs and tighten connective tissues. Depending on the woman’s anatomy and degree of prolapse, surgeries can be done laparoscopically, vaginally or through an abdominal incision.
Surgeries have a high success rate, although Dr. Hilger “can’t give a lifetime guarantee” of success. “Women will continue to age, and gravity will continue its pull. But a successful surgery will restore women to comfort and functionality,” he says. Other Causes Women should keep in mind that other reasons could be causing symptoms, including urgency (the sudden need to urinate) and stress incontinence (leaking urine when sneezing, coughing or laughing). Not all of these symptoms are related to organ prolapse, but a good medical evaluation will help sort that out.
“Organs may not have slipped, but the urethra alone may be damaged or weakened, and it can be restored with new treatments,” Dr. Hilger says. Bottom line: If you have urinary or bowel symptoms, or feel pressure in the pelvis, have it evaluated. “Ask questions and don’t be embarrassed,” Dr. Hilger says. “This is a fairly common problem, it’s not life threatening, and there are treatments. That is good news.”