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Pelvic Organ Prolapse — A Common Problem For Many Women
Pelvic Organ Prolapse is a very common condition, particularly in women who have children and as women age. Pelvic organ prolapse is a general term to describe the loss of normal support of the organs in the pelvis (bladder, uterus, rectum) allowing them to drop into the vagina.
Normal support of the bladder, urethra, uterus, and rectum is provided by muscles, connective tissues (ligaments) and nerves that control the muscles. These muscles and tissues can naturally weaken with age and as a result of stretching during pregnancy. Frequent heavy lifting or straining from chronic constipation, and long term coughing from smoking, asthma, and bronchitis are common conditions which can stretch or break these tissues so they can no longer support the pelvic organs.
The symptoms of prolapse can be mild to severe. In general, women may feel pressure in the vagina or feel as if something is “falling down,” discomfort or pain in the lower abdomen and/or lower back, and pain during sexual intercourse such as the feeling as though her partner is “bumping into something.” Often these symptoms worsen throughout the day and with prolonged standing. Urinary symptoms can include leaking urine with straining such as lifting, coughing, sneezing, and laughing. Accidental urine loss is not considered a normal part of aging. With severe prolapse some women will suffer from poor urine stream, straining to empty the bladder, incomplete emptying, and general difficulty in passing urine or stool.
Pelvic organ prolapse is diagnosed through a detailed discussion with the patient and a thorough pelvic examination. The examination should not be uncomfortable. Each area of the pelvis is examined to look for breaks in the support tissues allowing each organ to fall into the vagina. Additionally, a urine sample and a study of the bladder may be performed to evaluate the possible causes of involuntary urine loss.
There are a number of surgical and non-surgical options available today to treat prolapse. The choice of treatment depends on a variety of factors such as the type of prolapse you have, the severity of your symptoms, your age and other health issues, whether or not you want to have children in the future, and your personal preferences.
In mild cases, muscle strengthening (Kegel) exercises may be used to strengthen the pelvic muscle.
A vaginal pessary is a small device, similar to a diaphragm, which is inserted into the vagina to hold the prolapsed organs in place. Pessaries are made of latex or silicone and come in many different shapes and sizes. Pessaries are generally recommended as treatment for women who are waiting for surgery, women who want to have more children in the future, and women who are unable or choose not to have surgery.
The third option of treatment is surgery. This involves identifying and repairing the specific breaks in each tissue that is causing the prolapse. At times, this may involve removing the uterus (hysterectomy) to obtain a better and longer lasting result. A woman’s ovaries do not need to be removed if a hysterectomy is performed unless the patient desires it. Therefore, she does not need to be on hormones if she has not yet gone into menopause.
If involuntary urine loss is the only problem multiple surgical procedures exist, some of which can be performed on an outpatient basis allowing the woman to go home one or two hours after surgery. If other prolapse problems are also present, all repairs can be performed at the same time.
You can help prevent prolapse from occurring or worsening. Do not strain to move your bowels. If you have trouble with constipation make sure your diet contains an adequate amount of fiber. Avoid frequent heavy lifting. Stop smoking and for those with chronic lung problems make sure it is well controlled to avoid frequent coughing. If you are overweight, modify your lifestyle to include diet and exercise.
Menorrhagia, excessive blood loss during menstruation, is a common disorder. So common that it affects 1 in 5 women at some point in their life. Every month, a woman’s uterine lining becomes thickened in preparation for possible pregnancy. When pregnancy does not occur this uterine lining is shed and is known as menstruation. In most women menses lasts from four to seven days. When bleeding lasts longer than seven days or is heavy, particularly with clotting, this is considered abnormal. Women suffering from menorrhagia can commonly use fifteen to thirty sanitary napkins, or tampons, or both in a single day. These women will often avoid daily activities such as social events, work or traveling due to these symptoms.
Treatment options over the years have included the use of hormonal therapies, uterine curettage (D & C), or hysterectomy. Endometrial ablation is a technique used to control abnormal uterine bleeding that has been available for the past ten years. Ablation procedures destroy the lining of the uterus which causes the excessive menstrual bleeding. In the past, these procedures have been time consuming, and depending on the type of procedure sometimes difficult for the operating physician to perform. Recent technological advancements have improved endometrial ablation, making this a quicker and more effective procedure, making it an attractive alternative. Most women who undergo an ablation can successfully have little or no menstrual period after this procedure.
Women who are good candidates for this procedure include:
- Women with prolonged, excessive menstrual flow who are incapacitated or severely restricted in their activities every month.
- Women who have failed past therapeutic procedures to include hormonal therapy or uterine curettage.
- Women who do not desire further pregnancy. (However this is not considered a method of sterilization).
- Women who do not have uterine or cervical pathology such as uterine cancer or large uterine leiomyomas (fibroids).
The ablation procedure offers several advantages over hysterectomy which is often performed when hormone therapy or repeated D & C procedures prove ineffective in controlling menorrhagia. Some of the benefits are:
- There is no surgical incision or organ removal.
- It can be a safe and cost effective procedure when compared to hysterectomy.
- It is performed as an outpatient procedure, no hospitalization required.
- Ovarian hormone status is not altered or affected.
- Enables women the option to resume normal activities within 4-7 days.
If you feel that you might benefit from this procedure, talk to your doctor. For many women it has given them freedom from their symptoms and an improved lifestyle, without a dramatic or extreme effect on their body.
Advances in Gynecology
Often when we think of technological advances in medicine we think of improved survival or better results. However, in addition it has meant less pain, cost, and faster recovery. Many problems, which in the past required surgery in the hospital, can now be treated in the office or an outpatient surgery center. These often involve minimal anesthesia and, since they are not performed in a hospital, the patient often is only charged their office co-pay. Three common gynecological conditions have seen significant advances in treatment in the past few years:
The most common problem women discuss with their gynecologist is heavy periods. Until recently, the two most common treatments involved were birth control pills, which can reduce blood loss, or hysterectomy (removing the uterus). However, if the women could not or desired not to take hormones many women were left with the only other major option, which was hysterectomy. If heavy periods are keeping you from enjoying your life to the fullest then you should learn about endometrial ablation. About one in five women experience unusually heavy menstrual bleeding (menorrhagia). These women can experience fatigue, anemia, embarrassing accidents and restricted activities. If you are familiar with these effects, you know that menorrhagia can disrupt your life.
Endometrial ablation is a quick, simple procedure that requires no incisions or hospital stay, and involves no hormones. It is intended to reduce or eliminate future menstrual bleeding by permanently removing the lining of the uterus (endometrium)by either the brief application of electrical energy or placing heated salt water into the uterine cavity. This procedure takes only a few minutes to perform. It can be performed with minimal anesthesia and can be performed in the doctor’s office or surgery center if the patient prefers. Women typically return home 45 minutes after the procedure. You may experience some cramping, which should go away by bedtime. Most women should be able to return to normal activities the next day. The procedure is intended to destroy all or most of the tissue that is responsible for menstrual bleeding (endometrium). After the procedure, you may never bleed again, or if you do, your bleeding should be greatly reduced. Many women may also experience the added benefits of a significant reduction in painful menstruation (dysmenorrhea). As a result, 95% of patients would recommend this procedure to other women.
Permanent Birth Control
Many women who have completed their childbearing do not wish to continue to take a birth control pill daily or use any of the other forms of reversible contraception. Up until recently, the only available options have included a surgery called tubal ligation (tube tying), or a vasectomy for the man. Permanent birth control (sterilization) is meant to prevent pregnancy for the rest of your life. There is a new procedure called Essure. The Essure procedure involves placing a soft, flexible coil through the body’s natural pathway (cervix) into each fallopian tube. This blocks the tubes so that the sperm cannot reach the egg. This does not involve any hormones. Unlike vasectomy for men or laparoscopic sterilization (tube tying) for women this procedure does not require cutting or puncturing the body and requires no stitches and therefore does not cause scars. It involves minimal cramping afterward and can be performed in the office if desired. Three months after the procedure a special type of x-ray (HSG) is performed to ensure that the tubes are completely blocked. This procedure is 99.8% effective and covered by most insurance plans.
Urinary incontinence is the unintentional release of urine. Even if you are not familiar with the term, you may be all too familiar with the embarrassment and inconvenience it may cause. You may even restrict or avoid physical activity, travel, or social engagements because of your condition. However, it is important to know that you don’t have to live with it. You should also know that you’re not alone. More than 11 million women in the US experience urinary incontinence. The majority have what is known as stress urinary incontinence (SUI), a treatable condition that affects women of all ages. Stress urinary incontinence is the unintentional release of urine during normal everyday activities — laughing, sneezing, coughing, walking, exercising and getting up from a seated position. You may also go to the bathroom frequently throughout the day in order to avoid accidents.
There are two basic causes for SUI. Most commonly, a weakening or damage in the muscle of the pelvic floor causes SUI. These muscles support the urethra (the tube from the bladder through which urine exits the body). Weakened pelvic floor muscles cannot hold the urethra in the correct position. Therefore, activities that put pressure on the bladder (such as a sneeze) may cause the urethra to loose its seal and allow urine to escape. Another cause of SUI is intrinsic sphincter deficiency. The sphincter muscle holds the urethra closed until it’s time to urinate. In women with ISD, the sphincter muscles don’t function as they should and can cause urine to leak during movements. Stress urinary incontinence is not necessarily a natural part of the aging process. The following can contribute to SUI: childbirth, pelvic surgery, chronic constipation, chronic cough, or weak tissue.
If other therapeutic approaches fail,surgery may be required to treat the underlying cause of incontinence. Surgical treatment may deliver the most reliable, permanent results. Today’s procedures are simpler, faster, do not require hospitalization, and cause minimal discomfort afterward. The procedure involves placing a “sling” of mesh tape through the vagina to support the urethra during sudden movements, such as a cough or sneeze. This allows the urethra to remain closed and prevents the involuntary loss of urine. The procedure involves three small incisions and takes about 30 minutes. Most women can return to most normal activities with in a few days.