Do you feel pelvic fullness or heaviness, pulling or aching, painful or uncomfortable intercourse, difficulty with urination or bowel movements?
You may have a condition called pelvic prolapse or pelvic organ prolapse. It is not a dinner table conversation topic, but it is a common problem many women have.
Prolapse is a condition in which one or more of your pelvic structures – bladder, uterus, rectum or if you have had a hysterectomy, the top of your vagina – has fallen from its normal position. There also is an area between your rectum and your uterus or the top of vagina where your small bowel can push the vagina forward.
Symptoms usually worsen as the day progresses or get worse with exercise, bowel movement or lifting.
It is a progressive disease – meaning it likely will worsen with the passing of time.
So, why does this occur?
The answer can be complicated, but some risk factors include a history of vaginal birth, advanced age, obesity, hysterectomy, Caucasian or Latina ethnicity, chronic constipation, chronic heavy lifting, chronic cough, smoking or connective tissue disease like Ehlers-Danlos.
You can tell it does not sound like fun, but there are both non-surgical and surgical ways the problem can be corrected.
Non-surgical options include weight loss, kegel exercises (with or without pelvic physical therapy) and/or the use of a pessary (a plastic device you insert much as you do a diaphragm that can help prolapse and/or urinary leakage and keep the vagina in the proper position).
There are a lot of different shapes and sizes of pessaries, and you and your physician can determine which type is the best for you. They are a little high maintenance as they must be removed and cleaned regularly. In addition, they cannot be used during intercourse.
Surgical options can vary, depending on many factors. Basically, there are two categories of surgeries designed to restore organs to their natural position – obliterative and reconstructive. Obliterative surgery closes or narrows the vagina, but intercourse is not possible after this procedure.
Reconstructive surgeries can include a variety of techniques. One is known as Modified McCall Culdoplasty. Another is Utererosacral suspension. Some are performed vaginally, while some are performed using either laparoscopic or robotics assisted surgery techniques. Each has advantages and disadvantages.
Your physician can help you determine which would be best for your diagnosis.
In general, surgical repair is between 75 and 95 percent effective, with approximately 10 percent risk of recurrence.
There also is approximately 50 percent risk of developing urinary incontinence after prolapse repair if it was not already present prior to repair.
At the end of the day, what you need to know is that there are treatments available for prolapse.
If you are having symptoms, make an appointment with your gynecologist to talk about your anatomy and treatment options.
Dr. Serena Vance is an OB-Gynecologist at St. Bernards OB-GYN Associates. She received her medical degree from Kansas City University of Medicine and Biosciences. She then completed her residency at Summa Health Systems and Akron City Hospital. If you would like to schedule an appointment at St. Bernards OB-GYN Associates, call 870-935-3990.
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