Why pelvic prolapse should be part of the conversation on women’s health
Increasing awareness of pelvic prolapse could help women prevent and treat the common disorder.
In spite of the fact that nearly one-third of U.S. women have a pelvic floor disorder, they’re not widely spoken about. Pelvic prolapse, which affects 3% of women and is a risk of vaginal childbirth, is no exception.
When a woman has pelvic prolapse, one of her pelvic organs — her uterus, bladder, bowel or rectum — presses into or out of the vagina or anus. It is caused by a weakening or loosening of the tissues and muscles that support the pelvic organs, which commonly occurs after vaginal childbirth or as a woman ages and goes through menopause.
Pelvic prolapse is a treatable condition, but women may find it difficult to broach the subject with their doctor. Since it isn’t widely spoken about, women may ignore the symptoms and ignore the discomfort.
Symptoms of pelvic prolapse
The symptoms of pelvic prolapse are fairly easy to recognize and diagnose once you know what you are looking for:
- Discomfort or pressure in the vagina.
- Pain or difficulty inserting tampons.
- A feeling of uncomfortable fullness or bloating.
- Something bulging inside, or coming out of the vagina or anus.
- A pressure that worsens with standing, coughing or straining the pelvic muscles.
- Urinary incontinence.
- Pain during sex or exercise.
Causes of pelvic prolapse
Although it might happen for no apparent reason, pelvic prolapse is most often caused by the following:
Vaginal childbirth – Vaginal childbirth causes extreme strain on the muscles of the pelvic floor and may result in pelvic prolapse. Multiple childbirths increase the risk of developing the condition, and so does giving birth to a baby weighing over 8.5 pounds.
Chronic pressure on the abdomen – Pressure from chronic coughing, heavy lifting, obesity and constipation can all contribute to pelvic prolapse.
Aging – as with most urogynaecological problems, the risk of developing pelvic prolapse increases with age. About 37% of women affected are 60 to 79 years of age, and about half are 80 or above, according to womenshealth.gov.
Depending on the stage and complexity at the time of diagnosis, there are several non-surgical treatments available:
- Pessary device – A pessary is a soft, flexible disk or donut inserted into the vagina to hold up the pelvic organs. Patients can learn to remove and reinsert their own pessaries between doctor visits.
- Muscle therapy – Doctors may recommend strengthening the pelvic floor muscles through physical therapy or exercises such as Kegels.
- High-fiber diet – To prevent excessive straining during bowel movements which can put pressure on the pelvic floor, doctors may prescribe a high-fiber diet or stool-softening medication.
If non-surgical approaches are not effective, there are several types of minimally invasive surgery. The most common of these are vaginal, laparoscopic and robotic-assisted sacrocolpopexy.
- Vaginal surgery - Vaginal surgery is done internally through the vaginal opening. This option can be appealing because there are no incisions on the abdomen.
- Laparoscopic surgery - This surgery is done through small incisions in the abdomen. Surgeons use hand tools while being guided by a tiny laparoscopic camera.
- Robotic-assisted sacrocolpopexy - Using robotic instruments guided by a surgeon, doctors can move the organs back into place and pull up surrounding tissues.
There are several things you can do throughout your life to decrease your chances of pelvic organ prolapse:
- Perform daily Kegel exercises — Kegel exercises are an easy way to train and strengthen the muscles that hold up your pelvic organs. To do a Kegel exercise, simply squeeze your muscles as if trying to staunch the flow of urine. Try 10 repetitions of three-second squeezes. If this feels challenging, work up to it slowly. Kegel exercises are safe and can be done several times a day, sitting or standing.
- Maintain a healthy weight — Being overweight causes extra downward pressure on the pelvic floor muscles, causing them to sag and eventually contribute to pelvic prolapse. Talk to your doctor about how to achieve a healthy weight.
- Cure chronic cough — Coughing puts sharp pressure on the pelvic floor muscles, and can cause your the muscles to give way over time. See your doctor to get to the bottom of why you are coughing and quit smoking immediately if you do.
- Avoid chronic constipation — Forcing a bowel movement is hard on your pelvic floor muscles. Constipation can be prevented by maintaining a high-fiber diet. Your doctor may also prescribe medications to help with constipation.
- Stay mindful of risk factors - If you have known risk factors for pelvic prolapse such as multiple vaginal births, giving birth to large babies, obesity or increased age, keep an eye out for symptoms so you can start treatment early.
Pelvic prolapse is an issue that should become part of the women’s health conversation. It is both avoidable and treatable, so no woman should have to live with symptoms.
If you want to find out more about pelvic floor disorders, St. Joe’s Medical Group is offering a free seminar on December 11 at 6 p.m. at St. Mary Mercy Livonia. Find out more at stjoeshealth.org.