Non-Surgical Treatments for Prolapse
Dr. James Haley discusses non-surgical treatment for pelvic organ prolapse and the various treatment options available.
Pelvic Organ Prolapse at Just 32 Years Old
At just 32 years old, a uterine prolapse was the last thing Laurie expected. After all, everything had been going great for Laurie and her husband Christopher. Even though they had suffered from a devastating miscarriage at 10-1/2 weeks – after nine months of trying – they tried again, and were blessed with a beautiful, healthy baby boy. Feeling – and Seeing – Something Strange Down There During a workout one evening, Laurie felt a strange pressure between her legs, sort of a tugging feeling. She wasn’t quite sure what it was, but she knew something wasn’t right. Later while washing herself in the shower she felt — and saw — a visible bulge. Laurie freaked out! She had no idea what was happening, or if this was something dangerous. After talking to her husband, they knew she needed to see her doctor. Consulting with Dr. Haley She had known Dr. James Haley for years and had trusted him with many of her GYN issues. She knew his expert advice would be valuable, since he was not only an OB/GYN, but also a double board-certified urogynecologist. She made an appointment with her doctor right away. During her exam, it was discovered that Laurie had a stage 3 uterine prolapse. A stage 3 uterine prolapse is when the uterus drops down and protrudes out of the vagina. Laurie was confused and scared. Her doctor explained that while not dangerous or life-threatening, prolapse can cause pain and discomfort, and may make some desired activities difficult or impossible. It was also explained to her that if left untreated, it would stay the same or progressively get worse. ‘Worse’, Laurie thought, ‘what could be worse than a part of your body protruding out of your vagina?’ Her doctor told her it could lead to problems with incontinence, cause discomfort during sex, and lead to complications in another pregnancy, among other things. Stage 3 Uterine Prolapse – How Did This Happen? Laurie wondered what could have caused this to happen. There can be numerous causes such as: Having one or more babies come through the birth canal Obesity Activities involving a lot of heavy lifting and straining Age Smoking, and other factors. All in the Family Pelvic organ prolapse can also be a hereditary disorder, meaning that it runs in families. Since our genes influence the strength of our bones, muscles, and connective tissue, some women are born with weaker tissues and are a higher risk for prolapse. After talking to her mom, Laurie discovered that she had a prolapse and a hysterectomy before she was 30 years old. Laurie had no idea! She also learned that all of her mom’s sisters experienced pelvic organ prolapse as well. Prolapse Solutions Laurie knew she had to learn what could be done to correct it, regardless of the cause. Her doctor told her that pelvic floor exercises can improve the symptoms in mild and moderate cases (first- to second-degree prolapse), and sometimes also prevent the organs from slipping down further. But in Laurie’s case, her prolapse was too far gone. Her doctor then explained that in cases as severe as hers, a hysterectomy is often needed to correct prolapse. Laurie knew she and Christopher wanted more children, so she didn’t even want to discuss that option, so her doctor suggested using a pessary. A Pessary Helps Hold the Uterus Up A pessary is a soft, removable device that can be inserted into the vagina to support its internal structure. Basically, it would help to hold her uterus up, back where it belonged. Her doctor would insert it and she would come back for follow-up visits to remove it and make sure all was going well. There are very few side effects with the use of a pessary, and they are usually alleviated by just removing it. Laurie went home that day feeling informed and hopeful. She discussed her options with Christopher, and they decided she should give the pessary a try. She thought, ‘Who knows, maybe the pessary would help the uterus stay where it belonged, even after she removed the device.’ That was not the case. The Pessary Worked for Years, But Wasn’t Ideal for Laurie The next few years went by with Laurie using the pessary and having it changed as needed. It wasn’t that it hurt, but she could often feel it during intercourse and while exercising. Not ideal. She and Christopher had discussed getting pregnant again but after a GYN appointment, it was affirmed that her prolapse was not any better and had actually gotten a little worse. Her doctor also informed her that the pessary would need to come out if she got pregnant and that, with the weight of a baby in her uterus, there was a big possibility she could spend much of her pregnancy on bedrest. Laurie had a full-time job, as well as a 3 ½ -year-old at home, so this was not an option for her. Making a Difficult Decision After lots of praying, discussing, and researching — and finally at 37 years old — Laurie and Christopher made the very difficult decision for her to have a hysterectomy. This was one of the toughest decisions Laurie ever had to make. Laurie underwent a partial hysterectomy, vaginally, removing her uterus only. After six weeks, she was feeling back to normal, physically that is, but emotionally still feeling the loss of not being able to have any more children. She and Christopher felt very blessed though, they did have a healthy and active, 5-year-old. Thankful for Dr. Haley’s Expertise and Compassion Laurie was very thankful for the expertise and compassion of her doctor through the whole journey. “Dr. James Haley had been helping me with my OB/GYN issues for many years. So, when I needed an expert, I knew I could trust him. Dr. Haley helped me get my life back on track and guided me along my journey.” – Laurie While her case was severe, not
Bathroom Again – Gabrielle’s Story
By James Haley, MD, FACOG, FPMRS “As GYNs, we address bladder issues on a daily basis, so when we discovered that our longtime patient suffered from a prolapsed bladder, we asked her to share her story of life before — and after — bladder surgery”, says Dr. Haley. Living with a Prolapsed Bladder “I knew every bathroom in town,” recalls Gabrielle, a vibrant woman in her mid-50s, a common age for women to experience bladder problems. “I never leaked but I had to use the bathroom ALL the time,” she explained. “My husband used to complain, ‘I hate running errands with you because you have to go to the bathroom at every stop.’ “I knew every bathroom in town. I never leaked but I had to use the bathroom ALL the time,” Gabrielle discussing her bladder problems “It started in my late 40s, when I began getting this weird feeling that my bladder had ‘fallen’. It got worse and worse, and it just became this constant pressure. It affected everything. When I exercised it was never painful, but I felt this constant sensation of pressure. I finally talked to my GYN, and he said it was caused by a prolapsed bladder.” What is Prolapsed Bladder? Prolapsed bladder, also known as fallen bladder or cystocele, is a condition where the bladder drops down from lack of support. Pelvic floor muscles and tissues hold the bladder and other organs in place, but they can weaken over time. This causes the bladder to descend from its fixed position and slip downwards into the vagina. In more severe cases, the bladder may dangle completely outside of the vagina. What Causes Prolapsed Bladder? There are four main reasons a woman may develop a prolapsed bladder: Childbirth: A difficult delivery, long labor, a large baby or multiple births Strain: Heavy lifting, strained bowel movements, excessive coughing Menopause: Lack of estrogen, which is vital in maintaining the health of vaginal tissue Obesity: Excess weight, which puts undue strain on pelvic muscles and tissues What are the Symptoms? Sensation of pressure in the bladder or vagina Leakage of urine when coughing, sneezing, laughing, etc. Protrusion of tissue from the vagina A sensation that the bladder is not completely empty right after urinating Difficulty urinating Pelvic pain or discomfort Painful intercourse Life After Treatment Gabrielle relates that she was given multiple treatment options but ultimately chose a permanent treatment solution called a surgical bladder lift, which was a great success, even years later. “That surgery literally changed my life. It’s been five years, and I’ve never had a problem. AND no more crazy bathroom trips!” Gabrielle on life after treatment When Should You See Your Doctor? If you notice that you have any of these symptoms and you suspect a prolapsed bladder, you should see your doctor immediately. This is not a condition that repairs itself. It usually worsens over time. However, it can be fixed, thanks to many modern methods available today. Why Our FPMRS Specialists are Experts in Bladder Prolapse Our board-certified OB/GYNs Dr. Michael Litrel and Dr. James Haley have earned board certification in Female Pelvic Medicine and Reconstructive Surgery. FPMRS is a surgical subspecialty addressing the problems women experience with the changes to their anatomy from having children and pelvic prolapse. FPMRS surgeons are also known as board-certified urogynecologists. Cherokee Women’s Health Specialists has unique surgical expertise in the Southeast United States as an OB/GYN practice with three double board-certified urogynecologists. To schedule an appointment, call our office today at 770.720.7733 or schedule an appointment online.
The Bulge After the Baby: You’re In Good Hands
You just had a baby, but something feels “off “down there. You’re not quite sure what to expect because you’re new to the whole postpartum process, but you’re certain that a bulge in your vagina is not normal. When the vaginal pressure does not ease up, you decide to check in with your doctor, only to find out that you have a type of Pelvic Organ Prolapse called Uterine Prolapse. As scary as this diagnosis may sound to you, there are options available to relieve symptoms, or repair the prolapse. Uterine Prolapse: Causes and Treatments You wonder how this prolapse happened. One day your uterus is snugly in place, and the next, you are suffering the unpleasant symptoms of pain, pressure and an aching lower back. A prolapsed uterus is a common occurrence after a vaginal birth, but even women who have never given birth can also develop a prolapse. When damage to the fascia, ligaments and muscles of the pelvic floor occurs, it can cause the uterus to sag into the vaginal canal – leading to incontinence, and a feeling that something is “stuck” or “falling out.” These problems may worsen with age, as decreased estrogen causes the pelvic floor to relax even more. Fortunately, you don’t have to deal with these meddling symptoms. There are options, depending on the severity of your symptoms. Relax – not every uterine prolapse will require surgical repair. You and your doctor can work together to decide the best course of action to fit your lifestyle and diagnosis. Many women with mild symptoms find that pelvic floor physical therapy is helpful in reducing symptoms. Those with more moderate symptoms might find reprieve by wearing a device known as a pessary, which is fitted to your vagina, and worn internally. A pessary can help to lift the uterus out of the vagina, and relieve many of the distressing symptoms. If your symptoms are more severe, Pelvic Reconstructive Surgery may be the best option to ensure that you are not living with the troublesome effects of uterine prolapse. You are not alone! Many other women are dealing with the inconvenience and pain of a prolapsed uterus, and you don’t have to suffer in silence. Make a list of questions and concerns and contact your doctor today. A prolapsed uterus doesn’t have to rule your life. We Are Specialists in Female Pelvic Anatomy Physicians who are board-certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) understand complex female anatomy, and are able to offer a range of effective treatment options when problems occur. In fact, Cherokee Women’s is the only OB/GYN practice in the southeast with multiple OBs who are also board-certified in FPMRS. You’re in good hands–during your pregnancy and after. Talk to your FPMRS physician about your options to find relief for your symptoms and help that “bulge” disappear.
The Great Mesh Debate: Unraveling the Basics
Pelvic organ prolapse (POP) is a condition that affects nearly one-third of middle-aged women. It occurs when the muscles that support the pelvic organs weaken, leading to a bulge or protrusion in the vaginal area. Many patients often describe this condition as a “vaginal hernia.” Symptoms of POP can include pelvic pressure, urinary incontinence, and sometimes discomfort during sexual activity. The weakening of the pelvic muscles and tissues causes the organs to shift from their normal positions, and the severity of symptoms can vary from person to person. Why Is Mesh Used in POP Surgery? In some cases, a woman’s natural tissue may not be strong enough to support a successful repair of the pelvic organs. This is where synthetic mesh or biologic grafts come into play. The use of these materials is intended to provide additional support and durability for the pelvic organs after surgery. However, since the 2008 FDA Public Health Notification about the use of transvaginal mesh in POP repairs, the subject has been a source of significant controversy and concern. Many women have seen advertisements or heard from others that mesh can be dangerous, leading to hesitations about its use. Patients frequently ask, “Are you going to use mesh in my surgery? I’ve heard it’s risky.” It’s important to understand that while there are potential risks, the use of mesh, when done by a trained and experienced surgeon, is generally safe and has a low complication rate. The Importance of Specialized Surgeons in POP Treatment Pelvic organ prolapse requires specialized care from doctors who have received advanced training in female pelvic medicine and reconstructive surgery (FPMRS). Board-certified surgeons have undergone rigorous training in diagnosing and treating POP, including the use of mesh in surgical procedures. For patients to achieve the best possible outcomes, it is crucial that they receive treatment from surgeons who are skilled in these procedures and understand the specific risks and benefits. When mesh is properly placed by a board-certified pelvic reconstructive surgeon, the risk of complications is significantly minimized. Part of the job as FPMRS specialists is to clearly communicate the potential risks and benefits of each procedure to patients, ensuring they are well-informed and confident in their treatment decisions. Individualized Treatment Plans for Optimal Care A key aspect of treating pelvic organ prolapse is creating a personalized treatment plan that is tailored to each patient’s unique needs. This starts with a thorough consultation that includes: Discussion of Symptoms: It’s important to understand the specific symptoms that are most bothersome to the patient. Complete Physical Exam: A physical exam helps the surgeon determine the exact nature and severity of the prolapse. Comprehensive Treatment Plan: This plan may include both non-surgical and surgical options, depending on the patient’s condition and preferences. For some women, non-surgical options such as pelvic floor exercises or lifestyle changes may be sufficient. However, for those requiring surgery, we explore the most suitable approach, including whether mesh might be used. It’s also essential to discuss lifestyle changes—such as maintaining a healthy diet, quitting smoking, and engaging in regular exercise—that can help prevent a recurrence of the prolapse. Empowering Patients with Knowledge The decision to undergo surgery for pelvic organ prolapse can be daunting, especially with the concerns surrounding mesh use. However, when patients are provided with accurate, evidence-based information, they are better equipped to make informed decisions about their health. Surgeons aim to empower patients byc explaining all available options and offering reassurance that, when performed by a skilled surgeon, mesh procedures have a high success rate and low risk of complications. If you’re experiencing symptoms of pelvic organ prolapse and are unsure about the best course of treatment, a consultation with a pelvic floor specialist can help you understand your options. Remember, you have choices, and individualized care is key to achieving the best possible outcome. To schedule an appointment or surgical consultation, call 770.720.7733. Or, simply schedule an appointment online. We are here to support you in every step of your treatment journey.
