Giving Women Options

By Laura Freeman

It’s not the first topic women tend to bring up during their regular doctor visits. Too often, they suffer in silence, embarrassed and perhaps unaware that they are far from alone.

“Pelvic organ prolapse is very common, especially in women who have gone through childbirth, or are getting older. Connective tissue disorders, heavy lifting and straining are also risk factors,” said Geneva Dunivan, MD, director of UAB’s division of urogynecology and reproductive surgery. “Sometimes we see younger women after childbirth, but most of the cases we see are women in their 60s or older.”

When the pelvic floor weakens, and muscles and ligaments are no longer able to hold organs in place, gravity takes its toll, pulling downward on the uterus, bladder, rectum and vagina, causing one or a combination of the organs to bulge out of place.

“Women may feel a heaviness or experience a frightening bulge of pelvic tissue where it shouldn’t be,” Dunivan said. “Prolapse can cause or worsen incontinence symptoms, affect a sexual relationship and undermine confidence. Women may begin limiting their social interactions and activities as they become unsure of where they can go and what they can wear or do.”

A spectrum of treatment options are available, depending on how far symptoms have progressed, which organs are involved, and what a woman’s goals for treatment are.

“Some women simply need the peace of mind of knowing what is happening and may want to stay with conservative measures,” Dunivan said. “We talk with them and give them the information they need to make a personal decision. In milder cases, pelvic floor exercises can help to strengthen muscles and support structures. Medications to help with urinary incontinence may have a role, and estrogen creams can help tissues. When bulging is the primary problem, women may choose to be fitted with a silicone device that can be inserted to hold organs in place.”

As symptoms become more advanced or interfere with daily activities and relationships, patients may want to consider surgical options.

“In choosing from different types of surgeries, our recommendation will depend on the type and degree of the individual patient’s symptoms, their health, as well as their goals and preferences,” Dunivan said. “Again, it is important give them the information they need to make the right decision for themselves.

“One option for prolapse cases that can be approached vaginally is native tissue repair. This procedure has been around awhile and attaches stitches to ligaments and other stronger pelvic tissue to make repairs and support the organs. In some cases, we might use a permanent surgical material to connect to a ligament for extra support. In the past, a hysterectomy might be part of the repair, but we are seeing more patients who want to keep their uterus and this is usually possible.

“Laparoscopic and robotic surgeries also offer advantages when we need to make repairs through the abdomen. We can work through a smaller incision with greater precision and minimize recovery time.”

Reserved for patients in fragile health who are no longer sexually active, there is another procedure that closes the vagina or shortens it.

“It’s a faster surgery that reduces the time patients are under anesthesia,” Dunivan said. “It also avoids the need for an abdominal incision, which also reduces risk, and helps older and more fragile patients recover faster.

“Pelvic organ prolapse is a topic women should feel free to discuss with their doctors. There is a lot of ground to cover in a primary care visit, and there may not always be time to bring up the topic. But it should be discussed occasionally as female patients have children, get older or deal with other risk factors like lifting heavy weights or straining. Even having an item on a symptoms checklist can get the conversation going or alert the physician that this is a health issue that needs follow-up.”

If a physician doesn’t have time to deal with the problem personally, the patient can be referred to specialist who deals with it every day.

To women experiencing prolapse, Dunivan’s message is: “You don’t have to suffer in silence. There is nothing to be embarrassed about. It’s something that happens to many women, and there are a lot of things that can be done to make it better. So speak up.”