Pelvic prolapse, a not-so-frequently discussed topic of women’s health, has been associated with age. As more women are reaching the increasing age of life expectancy, gynecologic problems such as pelvic prolapse are becoming more commonly encountered.
But pelvic prolapse is not a condition confined to the elderly. It can also be seen in women in their reproductive age.
Pelvic prolapse may affect as many as one in four women after a pregnancy. This is most often associated with the effort of straining during childbirth. Normally, the pelvic organs are kept in place by the muscles and tissues in the lower part of a woman’s belly.
During childbirth, these muscles and tissues may weaken, thus becoming unfit to support the organs of the pelvis. However, even without the efforts of a normal delivery of a child, pelvic prolapse can be precipitated by pregnancy itself. The continuous stretch and pressure of an enlarging uterus during the whole entire period of pregnancy significantly contributes to the loosening of the tissues.
The weakened base of the pelvis can result in the protrusion or prolapse of the various organs it once held in place. The organs that may protrude into the vagina, which serves as the opening of the pelvis to the external body, include the bladder, the uterus, the rectum and even the vagina itself. Depending on the severity of the muscle damage, at times, all of the pelvic organs may come out.
Pelvic organ prolapse may be aggravated by certain factors such as obesity (as it places more work load on the already weak basal muscles of the lower belly), a long lasting cough (as coughing usually involves the effort of the whole abdominal musculature), frequent constipation (which requires straining in order to expel stools) and pelvic organ tumors.
Women who have given birth a few times or are multiparous are normally noted to have some degree of prolapse on examination. Older women are also prone to having pelvic prolapse as their genitals undergo gradual atrophy and with menopause comes the declining levels of estrogen in the blood, which can actually helps keep the pelvic muscles strong. Medical conditions such as diabetic neuropathy can also bring about protrusion of the pelvic organs.
But pelvic prolapse is not a new discovery in medicine. It has actually been reported way back into 2000 BC as Hippocrates reported several cases of pelvic prolapse managed medically. Though some women with pelvic organ prolapse may not experience nuisance symptoms, some women do become bothered by them.
These include the feeling of a bulge in the vagina or the pressure or sensation of fullness in the vagina and lower belly, coital difficulty, lower back pain especially upon standing and urinary or defecatory incontinence. Bleeding may also occur.
Can this be corrected? The answer is yes. The treatment, however, would depend on the type and severity of the prolapse. Kegel exercises or pelvic floor exercises are exercises that can be done even by pregnant women to strengthen the pelvic floor muscles.
For women who are in their menopause age, estrogen replacement therapy may add strength to the weakening muscles. However, not all women are recommended to take estrogen thus it is pertinent to consult with a doctor before doing so. Maintenance of a healthy weight can greatly reduce symptoms in some women.
Avoiding lifting heavy objects can also prevent progression of the pelvic prolapse. Vaginal support devices or pessaries have been developed and are considered safe and cost effective, and are non-surgical measures of treating pelvic organ prolapse. Most urogynecologists would use pessaries as the first line of therapy for such conditions.
For severe cases of prolapse and for those unresponsive to medical treatment, surgery may be indicated. Surgical correction is contemplated if there is too much pain, urinary and rectal incontinence and even a decrease in the enjoyment of sex.
Vaginal reconstruction for sexual improvement has been long debated. The vaginal canal can be reconstructed by a qualified surgeon to tighten loose muscles in order to improve the sexual life of a woman with prolapse.
There are several types of surgery that can be done for pelvic prolapse. These include surgery to repair the tissue supporting the prolapsed organ, to repair the tissue around the vagina and to close the vaginal opening or removal of the uterus. These days vaginal repair surgery is usually performed under regional or even local anesthesia.
Modalities vary from simple surgery to laser procedures. In most cases the procedures can be done as outpatient. When removal of the uterus is involved, many surgeons opt to repair via the vaginal route or through key-hole surgery, which leaves patients with no abdominal scars at all.
Surgery alone cannot help prevent a recurrence of prolapse; it is not without complications either.
However, the success rate of surgery for pelvic prolapse varies between 75 percent-98 percent. A combination of surgery as well as performance of the Kegel or pelvic floor muscle exercises can help sustain a more qualified life than each intervention alone.
Women need to know that they are not alone in their battles against diseases and conditions involving their reproductive organs. As society nowadays is becoming more open in discussing issues that were taboo before, women should be encouraged to seek appropriate consultation in order to fully understand their health problems and address them accordingly.
By Dr. Ivan R. Sini is head of Morula IVF Jakarta and vice president of Bundamedik Healthcare System Jakarta, Indonesia. Articles in this column, which appear every two weeks, are provided by a panel of doctors from www.flyfreeforhealth.com, the world’s first borderless health and wellness hub, providing global interactive health services. Join our free online doctor’s talk titled “Uterine Fibroids” on Tuesday, Aug. 3, 2020 from 12-1 p.m. Register your email address by SMS to +6598473224 to receive the link invite. Email us at [email protected]