About ten years ago, I discovered that my mother had uterine prolapse. I say “discovered” because she didn’t tell me; rather, I was helping with her medical appointments and learned that she had a pessary. Mom was embarrassed about having this “problem,” and when I asked for more details, she dismissed me with a wave of the hand and said “it’s nothing.” But uterine prolapse is something. It’s a condition that many women are unwilling to talk about, as are their doctors. But that may be changing.
A recent Washington Post article called uterine prolapse a “hidden medical epidemic,” while John DeLancey, a University of Michigan professor of gynecology and urology who pioneered diagnostic techniques for pelvic floor damage called it a “stigmatized condition.”
Another recent situation that may help change discussion of women’s “little secret” is the recent announcement by the Food and Drug Administration (FDA), which made the news, concerning safety issues with the surgical mesh used to repair uterine prolapse, aka pelvic organ prolapse (POP).
Because of ongoing safety concerns, including severe pelvic pain and perforation of the uterus, the FDA has ordered manufacturers (there are five) to address these safety issues and has reclassified these medical devices from class II (moderate risk) to class III (high-risk). This is critically important information for doctors and potential patients who may be considering use of this device to help manage their uterine prolapse.
What is uterine prolapse?
Uterine prolapse tends to affect baby boomers-women around age 56 start to notice a weakening of their pelvic floor muscles. This weakening can result in uterine prolapse as well as urinary and fecal incontinence. By age 80, about 50 percent of women have one or more symptoms of uterine prolapse (see below). Ten percent of these women require surgery, and the cost of the procedures are estimated to reach $83 billion by 2020.
Uterine prolapse occurs when the pelvic floor muscles and ligaments that support the uterus stretch and weaken, allowing the uterus to drop down into or protrude out of the vagina. This condition typically affects postmenopausal women who have had one or more vaginal births, but loss of estrogen, gravity, and repeated straining from constipation over the years all can contribute to uterine prolapse. Risk factors include giving birth to one or more large infants, difficult labor or delivery, use of forceps during delivery, frequent heavy lifting, chronic coughing, previous pelvic surgery, obesity, chronic constipation, and being white or Hispanic.
Signs and symptoms of uterine prolapse include:
- Tissue protruding from your vagina
- A feeling of heaviness in your pelvic area
- Urinary leakage or retention
- Low back pain
- Feeling as if you are sitting on a small ball
- Difficulty having a bowel movement
The severity of these symptoms can range from mild to severe, but if your symptoms are interfering with your daily activities, you should seek help from a physician as soon as possible.
How to prevent and treat uterine prolapse
If symptoms are mild or not bothersome, no treatment is necessary. However, uterine prolapse can worsen as time passes and eventually require some type of therapy. A uterine prolapse can grow to the size of a grapefruit it left untreated, and it can block the tubes that attach the kidney to the bladder.
To help delay worsening or provide symptom relief, women are encouraged to perform Kegel exercises-in fact, you’re never too young to begin doing Kegels! Other preventive steps include not doing any heavy lifting, maintaining a healthy weight, and avoiding constipation by getting plenty of fiber in your diet.
Read about Kegel exercises banish mild urinary incontinence
Treatment options for moderate to severe or advanced cases of uterine prolapse include:
Vaginal pessary. This is a device that is specially sized to fit into your vagina for the purpose of holding your uterus in place. With instruction, you can learn how to insert a pessary into your vagina and remove it for cleaning. Pessaries come in several forms, including a ring type, an inflatable donut form, and the Gellhorn. A doctor can fit you for a pessary and explain how to remove and reinsert it. Possible side effects of using a vaginal pessary include irritation of the vaginal tissues, vaginal sores, and interference with sexual intercourse.
Surgery. Severe cases of uterine prolapse may require surgery. Approximately 200,000 surgeries to correct uterine prolapse are performed in the United States each year. Your options include grafting your own tissue, donor tissue, or a synthetic mesh material to help support your pelvic organs. Surgical mesh was first implanted for abdominal repair of POP in the 1970s, and it was then used for transvaginal repair in the 1990s. In recent years, transvaginal POP repair has been associated with a growing number of adverse events, which triggered the recent FDA ruling.
Surgical repair of uterine prolapse can be performed through your abdomen or vagina, perhaps using minimally invasive (laparoscopic) surgery, which requires smaller incisions and use of a lighted camera-type device. In some cases, doctors recommend a hysterectomy to remove your uterus.
If you are still of childbearing age and want to have children, surgery is typically not recommended because delivery may undo any surgical repair. Women who have major medical issues also may not be eligible for uterine prolapse surgery and may get better results with a pessary.
If you are experiencing any of the signs or symptoms of uterine prolapse or have concerns or questions about it, arrange to talk with your gynecologist or internist. The most immediate thing you can do is start Kegeling!
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Sources
Food and Drug Administration. FDA strengthens requirements for surgical mesh for the transvaginal repair of pelvic organ prolapse to address safety risks.
Medscape. Vaginal support pessaries.
Washington Post. The hidden medical epidemic few women have been willing to talk about, until now
