**By Una Lee, MD
Recently I was lucky enough to have a patient who wanted to help other women, even if it meant talking about something many would find way too personal. Amy joined me on the show New Day Northwest to describe what it’s like when your uterus falls into your vagina, a form of vaginal prolapse, a condition that can feel like a heavy ball is lodged between your legs. Like many women Amy had never heard of vaginal prolapse, but she was well aware of the backache and sore hips that kept her from winning at tennis, or doing anything active without pain.
As a urologist and female pelvic medicine specialist, my most fulfilling role as a doctor is helping women like Amy understand this part of their body and talk openly about it. Pelvic organ prolapse is a condition affecting millions of women, yet many suffer silently, unsure of what’s going on and embarrassed to seek help. Hard to talk about? Well maybe a little, but that didn’t stop Amy from finding expert help, and eventually, a cure. In the pursuit of better health, it’s time for women to get empowered, not embarrassed!
What is pelvic organ prolapse and what causes it?
A woman’s pelvic organs include the bladder, vagina, uterus and bowels. Normally these organs are held in place by a supportive “bowl” in the pelvis made up of muscles, ligaments and connective tissue. This is known as your pelvic floor, or pelvic floor muscles. If part of the support system becomes weak, one of the organs can drop, potentially bulging into (and sometimes out of) the vagina. Where the weakness occurs determines whether it’s the bladder, uterus or bowels that fall, but many women have more than one organ involved.
A common symptom of pelvic organ prolapse is the sensation of a bothersome vaginal bulge. Heaviness or pain in the lower back, like in Amy’s case, can result. Some women also notice painful intercourse, or changes in urinary or bowel function.
So why does this happen? One of the main risk factors for developing pelvic organ prolapse is vaginal childbirth. Childbirth can injure the supportive structures of the pelvic floor, particularly a prolonged labor or difficult birth. A resulting prolapse can happen soon after birth or may take years to fully develop. The good news is that of all women who develop some degree of pelvic prolapse, only about one in nine will ever need surgical intervention. Other risk factors for prolapse include genetics, some diseases that are associated with loose ligaments, increased weight, aging, menopausal changes, and the effects of smoking.
Who can treat pelvic organ prolapse?
If your symptoms are complex, it’s important to seek out a urologist or gynecologist with additional training. Look for those with a subspecialty in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This indicates a level of expertise specific to the pelvic floor, to help ensure an assessment of your urinary, vaginal, and bowel function and discussion of a full range of treatment options.
What are the options for treating pelvic organ prolapse?
One option is to do nothing – really! It’s a valid approach for women who have minimal symptoms or no symptoms at all. Even women who have evidence of pelvic organ prolapse may not require treatment. When the symptoms of prolapse get in the way of life, the time is right to discuss treatment. The types of symptoms vary greatly among women, depending on what structures are involved and individual anatomy. Some women can have severe prolapse and not be bothered by it, while others who have a mild or moderate case may have a lot of symptoms. Feeling the effects of prolapse also varies a lot based on activity level and even the time of day. Lying down or taking a break from being on your feet can improve prolapse symptoms.
And here’s more good news: There is no harm in having sexual intercourse. The walls of the vagina are designed to be elastic and mobile, and can flex comfortably during sex.
But if pelvic organ prolapse causes bothersome symptoms and is affecting your health and quality of life, it’s time to discuss your options with a specialist. You will undergo a complete medical history and vaginal examination to determine your “stage” (degree of prolapse).
Non-surgical treatment options
- Pelvic floor exercises (Kegel exercises). Yes, Kegels are key to pelvic floor health, and if done properly, can strengthen weakened muscles enough to improve or prevent the worsening of early stage prolapse. Be sure to get information on the proper technique from your doctor.
- Pessaries. A pessary is a silicone device inserted in the vagina that provides mechanical support to the prolapsed organs, thus relieving symptoms. They may require some trial and error for sizing and fit, but pessaries work well for some women.
Surgical treatment options
Amy, my patient, started with both Kegels and a pessary to relieve her prolapse symptoms, but it was clear she needed more help. She remembers thinking she could have done a million Kegels and it would not have reversed her prolapse. For her the pessary was uncomfortable. Together, we made a surgical plan that would get her back to all her favorite activities.
Surgery to correct pelvic organ prolapse is as varied as the women who have it: even women with the same type of prolapse may need a different approach. Amy’s procedure was done vaginally (they also may be done through abdominal incisions). I performed a vaginal hysterectomy (removal of the uterus), a vaginal vault suspension (using sutures to restore the deepest part of her vagina to its natural position), and a cystocele (prolapsed bladder) repair.
Once Amy healed from the surgery, she was back to beating her husband at tennis and living her life without discomfort. Remember: Overcoming fear and the stigma of talking about your body (plus finding expert help) can have big rewards for your health.
Una Lee, MD, is board certified in Urology and subspecialty certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) at Virginia Mason. Other Virginia Mason physicians certified in FPMRS include: Kathleen Kobashi, MD, FACS; Alvaro Lucioni, MD and Blair Washington, MD, MHA.