DEAR DOCTOR K:
My doctor checked me out because I was leaking urine. She said I have pelvic organ prolapse. Can you tell me what it is, and what can be done about it?
Pelvic organ prolapse is a condition in which tissue from the uterus, bladder, urethra or rectum drops down into the vagina. As many as 1 in 3 middle-aged women have some degree of pelvic organ prolapse.
Mild prolapse usually doesn’t cause symptoms, but more advanced prolapse can. The most common are discomfort, heaviness or pressure. A woman can feel these sensations in her vaginal area, pelvis, lower abdomen, groin or lower back. Another common symptom is constipation, due to pressure on the lower intestine. In addition, the pressure on the intestine can cause leakage of bowel movement.
With the most advanced prolapse, a woman notices a bulge of tissue protruding from her vagina. Prolapse can also cause pain during sex or an inability to have an orgasm.
The urinary leakage (incontinence) that you have had, as well as a frequent urge to urinate, are common in women with pelvic organ prolapse. That’s because when the pelvic organs drop down from their normal position, they put pressure on the bladder and the tube (called the urethra) through which urine flows from the bladder to the outside world. This can increase the urge to urinate and reduce a woman’s control over when she urinates.
Why do women get pelvic organ prolapse? Probably the most important factor is having given birth. Women who have given birth to four babies are 10 times more likely to develop prolapse than women who have never given birth. Especially when the birth has been a vaginal delivery, rather than a C-section, there is a chance that the muscles and tissues in the floor of the pelvis will be weakened. That predisposes a woman to prolapse in later years.
What can you do about it? You can probably reduce or eliminate the urinary incontinence with what are called Kegel exercises. These exercises strengthen pelvic floor muscles and often are enough to control mild incontinence.
To perform Kegels, squeeze the muscles you would use to hold back urine or to stop urinating midstream. Tighten these muscles and hold them tight for a few seconds. Repeat 10 times per session. Do approximately four sessions each day.
To keep the pelvic organs from dropping down, a pessary often is prescribed. This is a rubbery, ring-shaped device that fits into the upper portion of your vagina. Pessaries can help prop up your uterus and bladder and prevent them from dropping into the vagina.
Your doctor may recommend surgery to repair the torn ligaments (bands of fibrous tissue) in your pelvic area that have caused the prolapse.
For post-menopausal women, hysterectomy, the surgical removal of the uterus and sometimes the cervix and ovaries, is the most common treatment. Basically, the organs that are prolapsing are removed, fundamentally solving the problem.
(This column is an update of one that ran originally in September 2013.)