Pelvic Organ Prolapse Common Problem in Older Women

LEXINGTON, Ky. (June 24, 2014) -- It's a problem many women are embarrassed to discuss, but pelvic organ prolapse is a very common disorder, especially among older women. Roughly half of women who have had children will experience a form of prolapse later in life, and more than one out of every 10 women will have at least one surgery to treat pelvic organ prolapse or urinary incontinence  by the age of 80.

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when the pelvic floor becomes weak or damaged and one or more pelvic structures drop from their natural positions into or even outside of the vaginal canal. Several structures can be involved, including the uterus, bladder, small bowel, rectum or the vagina itself.

What causes prolapse?

Prolapse is caused by damage to the tissues that support the pelvic organs. This damage is often a result of several factors, with the most common cause being the trauma of childbirth.  Other risk factors include obesity, chronic constipation, lung diseases that result in a chronic cough, prior hysterectomy (removal of the uterus), menopause, and heavy manual labor.

What are the symptoms?

The symptoms of pelvic organ prolapse include a bulge or pressure in the vagina, a pulling or stretching feeling in the vagina or pelvis, discomfort with sexual intercourse, delayed or slow urine stream, difficulty with bowel movements, and urinary and fecal urgency or incontinence.

What's the best way to treat prolapse?

Treatment depends on several factors including the age and overall health of the patient, the severity of symptoms, the stage of the prolapse, the patient’s anatomy and prior surgical history and most importantly the patient’s preference.

For women with a mild case of prolapse, physicians may not recommend a surgical intervention. However, they may recommend nonsurgical treatments that can help prevent the prolapse from becoming worse, such as losing weight, quitting smoking, and avoiding lifting heavy objects.

For more severe prolapse, some women may choose to use a pessary (a medical device that provides internal support) while others may choose to undergo surgery.

Surgery can be laparoscopic with the assistance of the da Vinci robot or approached through the vagina. Women often have other pelvic floor disorders in addition to prolapse including overactive bladder (urinary frequency, urgency and urge incontinence) or stress urinary incontinence (leakage of urine with coughing, laughing, or exercise) that need to be addressed at the same time.  

For younger women, the potential loss of childbearing ability plays a role in the patient's treatment.  Treatment should be individualized for each patient and it is important to see a physician that specializes in the treatment of pelvic floor disorders, such a surgeon board-certified in Female Pelvic Medicine Reconstructive Surgery.

Why should women seek treatment sooner rather than later?

The symptoms of pelvic organ prolapse can worsen over time.  The sooner a woman seeks treatment the sooner we can work on alleviating the symptoms and improving her quality of life.

Dr. Katie Ballert specializes in female pelvic medicine and reconstructive surgery at UK HealthCare.

This column appeared in the June 22, 2014, edition of the Lexington Herald-Leader