Wednesday, May 15, 2013

"Help! Something's Falling Out Down There!": Pelvic Organ Prolapse

Twice last week I had some pretty nervous ladies come in thinking that their insides were about to drop out on the floor.  In both cases, they had some mild to moderate pelvic organ prolapse and I was able to reassure them that they weren't going to die or inadvertently drop internal organs on the ground while they walked around the Safeway.  Pelvic organ prolapse encompasses a variety of conditions were portions of the female anatomy are starting to droop downwards to various degrees.  It may or may not be associated with pain, pressure, bowel or urinary dysfunction, or irritation/bleeding of the vaginal tissues.

In many cases the cause of this condition is thought to be related to having had a number of vaginal deliveries of large children.  It can also happen to patients with chronic constipation, obese patients, or patients with tissues that are just getting weaker and less supportive over the years after the onset of menopause.  Occasionally we also see it in younger patients as well.  The treatments for the condition(s) depend in part on how much the symptoms are bothering the patient, if there is incontinence present or absent, or if there is pain involved.  Surgical options such as vaginal hysterectomy with bladder/rectal repairs are frequently chosen but some patients prefer to avoid the operating room for a number of reasons including age, financial reasons, recovery time, other medical conditions, etc.  Nonsurgical remedies include Kegel exercises, wearing tampons or using a device called a Pessary which can be fitted in the office by the doctor.  Some patients simply reduce the prolapse with their fingers if it occurs intermittently.  For patients who have had previous surgeries and then had recurrent prolapse symptoms, we have specialists called Urogynecologists to whom we sometimes refer our patients.

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