Dr. Mark Allen MD, a north Texas urologist (http://northtexasurologist.com) with North Dallas Urology Associates, often finds himself discussing issues with women during their visits to his Plano, TX office surrounding pelvic organ prolapse and pelvic floor reconstruction.
Ask the average woman about female pelvic health concerns like urinary incontinence or fibroids and she’s likely to have at least a basic knowledge of these conditions. Ask her about pelvic organ prolapse and she may look back at you with a blank stare. These are conditions that are quite common in women, especially after childbirth, where a considerable amount of pressure has been placed on the pelvic region, but yet are rarely discussed until symptoms increase and begin to interfere with normal daily routines.
More than 30 million women suffer from pelvic organ prolapse, which occurs when pelvic structures, such as the bladder, uterus or rectum, bulge or protrude into the vaginal wall. Most women will complain of discomfort in this region and will often experience vaginal pressure, abdominal pain, urinary incontinence, painful intercourse and a constant feeling that something has “fallen”.
“In the case of a prolapsed bladder, it is common in women who have given childbirth or with the natural aging process,” says Dr. Allen. “The front wall of the vagina supports the bladder. After childbirth, or when a woman ages, this wall will naturally loosen and weaken. In some case, it will prolapse which means it is no longer supported and descends into the vagina. The result of a prolapsed bladder, are problems such as urinary difficulties and stress incontinence. In the case of other organs, the same incidences can occur.”
“When a woman experiences pelvic organ prolapse for the first time, it creates stress and confusion. The pain associated with prolapse is considerable,” says Dr. Allen. “Often, women will refrain from exercise, sexual intercourse and will limit their overall physical activity because of the condition and the discomfort it causes. Many are afraid to use the restroom because it exasperates the prolapse.”
Types of Pelvic Organ Prolapse
Pelvic organ prolapse can occur in several ways. Vaginal vault prolapse can occur alone or along with a cystocele (dropping of the bladder into the vagina); urethrocele (sagging of the urethra into the vagina); rectocele (pushing of the rectum into the vaginal wall); or enterocele (bulging of the small intestine into the vaginal wall). All of these conditions are treatable. A woman who experiences symptoms associated with these conditions should consult a medical professional. There are numerous treatment options available to consider.
Pelvic Organ Prolapse Treatments
Treatments available for prolapse depend on the type of prolapse that is presented and its severity. Pelvic floor exercises called Kegel exercises or a vaginal pessary device placed into the vagina to support surrounding structures, are two traditional, non-surgical treatments.
There are now many surgical options available for women who suffer from pelvic organ prolapse. Surgical devices manufactured by American Medical Systems and new techniques have made considerable strides in recent years and physicians now can offer a number of long-term solutions. Many physicians will choose to use a mesh — either synthetic, biologic or both — to provide support for the organs necessary to restore nearby organs to their normal anatomical position.
“The mesh is a soft apparatus and has large pores designed to allow body tissue to grow into it, providing a framework of support,” explains Dr. Allen. “The use of surgical mesh is not new. It has been used in surgery for many years to help correct a prolapsed bladder (cystocele treatment) and other organ prolapses in the pelvic region. The use of the mesh proved to work successfully in many of my patients.”
Living with Pelvic Organ Prolapse
It is important for women to understand that pelvic organ prolapse can be made worse by anything that puts pressure on the belly, such as obesity, constipation, pelvic region fibroid tumors and frequent coughing. Cutting back on caffeine is also recommended because it acts a diuretic and can cause frequent urination. One should avoid heavy lifting or any other activity that puts stress on the pelvic muscles.
For those women who have more than one type of prolapse, all can often be repaired during one surgical procedure using a mesh for cystocele treatment, rectal or other. “The best news about pelvic organ prolapse is that women do not have to live with it or its associated pain and discomfort,” continues Dr. Allen. “New surgical options are available that are safe and highly effective.”
Dr. Mark Allen, MD is a Dallas-based urologist. He was interviewed for this article.