Pelvic Organ Prolapse: You Have Options

Although it remains an awkward, rarely discussed topic, pelvic organ prolapse is incredibly common. The Women's Health Initiative study found that 50-60% of women have some degree of prolapse, and 41% have a significant amount.

Prolapse occurs when one or more pelvic organs (the bladder, uterus, rectum) begin to bulge into the vagina. This happens because the muscles and connective tissues in the area weaken over time. Childbirth is a big cause, but prolapse also happens to women without children and women who had C-sections. 

Many women first notice symptoms with menopause. "The decrease in estrogen after menopause leads to some weakening of tissues and muscles, which also just goes along with age," says William Porter, MD, a urogynecologist in Charlotte, NC. Smokers are more likely to experience it, as are obese women. "Anything that puts extra stress and strain on the pelvic floor can cause it, including excess weight, chronic coughing, physical jobs that require a lot of lifting, chronic constipation that leads to straining," says Porter. "When you're younger you can compensate more, but when you get into menopause your tissue doesn't have the resilience it once did."

Common symptoms of pelvic organ prolapse include feeling a lump or sensation of pressure in your vagina, feeling like you're sitting on something when you're seated, incontinence, having trouble with urination or bowel movements, frequent urinary tract infections and discomfort during sex. However, many women with prolapse are asymptomatic, and it doesn't require treatment unless you experience symptoms that affect your quality of life.

So, if you do feel like your prolapse symptoms are affecting your quality of life, here are your options:

1. Kegel exercises: You already know how to do Kegels, but it's so easy to forget to just do 'em, right?  Dr. Porter says that at the very least you should contract your pelvic floor muscles before any heavy lifting or physical exertion.
2. A pessary: This is a diaphragm-like piece of silicone that you insert inside your vagina to hold everything in place. Dr. Porter says that 60-70% of women find that a pessary relieves their symptoms, but many don't like the hassle of having to deal with one, or are squeamish about it.
3. Surgery: If you want a more permanent solution, you'll be happy to hear that there are a variety of minimally invasive surgeries available for prolapse. Although until recently hysterectomies were considered a go-to solution, that's no longer the case. Surgery can usually be done laparascopically (meaning you'll have only tiny incisions) either through the abdomen or the vagina. Usually your doctor will insert a sling-type device to anchor your organs in place like your pelvic floor muscles once did on their own. They can be made in variety of materials, including synthetic mesh and skin and organ tissues from animals. 

Dr. Porter says that his favorite material is one derived from pig instestine and made by Cook Biodesign. "Often the tissues are too weak to be adequately strengthened without graft tissue," he says. "I've had great success with pig intestine, because it stimulates the body to create more collagen and heal itself." Though he adds that "each person is different, and your doctor should individualize your treatment."

If you decide to pursue surgery, you should be aware of a 2008 FDA warning about the use of synthetic mesh in pelvic organ prolapse surgeries, due to reports of it causing scarring and erosion of tissue. Talk with your doctor about the risks and benefits of the various types of surgery and surgical materials. And, as with every major medical decision, interview at least two doctors.

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