Pregnancy, childbirth and strenuous exercise all place tremendous strain on a woman’s body. Over the years, these stresses can weaken the natural support structure of the pelvis, causing the pelvic organs to shift from their natural position.
In fact, according to The National Institutes of Health (NIH), nearly one in four women in the U.S. suffers from some form of pelvic-floor disorder. Among the most common is pelvic organ prolapse or POP - a condition in which pelvic tissues are unable to support the uterus, rectum, bowel, urinary tract and bladder, so that those organs slide, bulge or push against each other.
Even though POP is treatable, many women choose to suffer in silence as a result of their embarrassment and anxieties about the implications of the condition. Becoming more informed will help women to alleviate those fears and take a proactive approach to prolapse prevention and treatment.
What Causes POP?
The most common causes of prolapse are childbirth, aging and menopause, all natural events in a woman’s life cycle. POP can also be caused by diseases or conditions such as obesity, large fibroid tumours and spinal-cord injuries. Genetic predisposition can play a role, and pelvic surgery such as hysterectomy may also contribute. Even chronic coughing or heavy lifting can cause prolapse.
What Symptoms May I Encounter?
Many women will not notice any symptoms of prolapse. For those who do, lower backache or sensations of pulling and stretching in the pelvis and groin area can accompany the early stages of the condition. Once prolapse is more advanced, the most common and bothersome symptom is the bulging of the uterus into the vagina. It may not be sore, but it is uncomfortable. There may be a feeling of pressure, as though the vagina were falling out. Some women feel the frequent and/or urgent need to urinate as well, or experience constipation or other difficulties with the bowel. Vaginal spotting or bleeding may occur, and sex can become painful.
In severe prolapse, the pelvic organs can actually bulge outside of the vagina. The exposed tissue can become irritated, raw and infected. Severe prolapse can also cause urinary incontinence.
What Treatment Options are Available for Women Today?
Treatment depends on the extent of the prolapse and other variables, including a woman’s age, her plans for bearing children, and whether or not she’s previously undergone therapy for prolapse repair. Prolapse most commonly affects older women who have had children. If their condition is severe, pelvic reconstructive surgery is the best treatment option to restore quality of life. Younger women who are planning to have children may want to delay surgery, as childbirth will sometimes cause the prolapse to recur.
Non-surgical treatments include exercises to strengthen the pelvic floor and pessaries (small plastic or silicone devices) that are inserted in the vagina to support the pelvic organs. While these alternatives don’t cure prolapse, they may reduce the symptoms and the need for immediate surgery. Likewise, medications such as estrogen therapy or hormonal replacement therapies will not cure or reverse prolapse, but they may reduce existing symptoms.
Surgical prolapse repair is designed to reposition and then secure the pelvic organs. It is a minimally-invasive operation done through either the vagina or the rectum, depending on the type of prolapse. Typically, surgeons use a synthetic (plastic) material or mesh to reinforce the organs and to help maintain their position in the pelvic cavity. This procedure has proven success in correcting prolapse.
In some cases, however, the synthetic mesh fails to secure the prolapsed organs or causes complications such as inflammation or erosion of surrounding tissues. The mesh can also become exposed in the vagina. The FDA has received approximately 1,000 reports to date of such complications, linked specifically to the use of synthetic material in prolapse repair. In light of this evidence, some surgeons may recommend a natural biologic material that communicates with the body, signalling the patient’s own surrounding tissue to remodel and repair itself. The scaffold, a biologic repair graft, provides support and strength while the body heals itself, then gradually remodels into the host tissue, reducing the chance of tissue erosion or vaginal exposure.
What Can I do to Help Prevent Pelvic Organ Prolapse?
There are several steps women can take to keep their pelvic floor muscles strong and their pelvic organs in position:
• Eat high-fiber foods to prevent constipation and reduce straining
• Cut down on caffeine, which, as a diuretic, causes frequent urination
• Maintain a healthy weight
• Do pelvic-floor (kegel) exercises every day to tighten and strengthen pelvic muscles
• Avoid activities that stress pelvic muscles, such as heavy lifting, jumping or standing too long
Manish Patel, M.D. specializes in Female Reconstructive Surgery and practices in Charlotte, North Carolina.