It’s a potential health and quality-of-life issue for as many as half of all postmenopausal women, especially those who have several offspring, but it’s rarely ever mentioned. “Pelvic organ prolapse is when the vagina, bladder and uterus begin to sag and lie in a lower position,” explains Dr. Teresa Knight, an obstetrician/gynecologist with Women’s Health Specialists of St. Louis. “Sometimes the pelvic organ prolapse can be so severe that the organs can hang outside the body!”
During childbirth, the baby stretches and often tears the vagina, as well as the supports of the uterus and bladder, Knight continues. “These supports are not muscular but rather ligaments and connective tissues,” she explains. “These tissues recover some of their strength after childbirth because they have estrogen receptors. This is why most women do not have significant problems with prolapse until they go through menopause.”
Women who experience mild prolapse may never need medical treatment for the condition. However, when estrogen production decreases, the effects of time and gravity may become more obvious, and the prolapse may become more bothersome.
Initially, many women notice some minor urine leakage when they laugh, cough or sneeze and assume the stress incontinence is causes by weak muscles. The natural conclusion may be that doing lots of Kegel exercises to strengthen the pelvic floor muscles will resolve the problem. But that’s not necessarily the case.
“This is usually not a lack of muscle control, as many women think, but rather a loss of the support that would hold the neck of the bladder during sudden movements like laughing, jumping, and sneezing,” Knight says. “Once this support system is lost, the only way to fix it is to surgically support the bladder, which can be done by placing a sling of mesh underneath to give it support.” She notes that the procedure is done on an outpatient basis and is highly successful.
If the vagina or uterus prolapse, some women use a device called a pessary to manage the condition, says Dr. Carl Klutke, a urologic surgeon specializing in urogynecology with Washington University Physicians. A pessary is a plastic ring, similar to a contraceptive diaphragm, inserted into the vagina to prevent tissue from bulging out. The device benefits women who notice urine leakage or prolapse during sports or exercise and use a pessary only during these activities, as well as patients who have health problems that make surgery too risky.
For those who want a more permanent solution, surgical correction of prolapse may be done using several different techniques, but the most common approaches are either vaginal or through open abdominal surgery, Klutke says. The results tend to be more durable and secure when done abdominally, he adds. And while the uterus is often removed, it is not always necessary to perform a hysterectomy. However, abdominal surgery requires hospitalization and carries more surgical risks than minimally invasive laparoscopic procedures, sometimes performed with robotic assistance.
Klutke notes that surgical prolapse correction is 80 to 90 percent successful as a permanent solution. With such positive results, there’s no need for women to suffer in silence. “This is a very common problem, and one we can treat with great success,” he concludes.