Pelvic Organ Prolapse: The Silent Epidemic (and a Book Giveaway)

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Sherrie Palm, author of Pelvic Organ Prolapse: The Silent Epidemic, sent me a copy of her book to review. Nicknamed “POP,” this condition affects so many women yet is seldom discussed. Sherrie writes at the beginning of the book, “In this time of enlightened self-help, it is hard to imagine a health condition that is widespread, yet for the most part unheard of.” Sherrie is working to change this through her writing and as the founder of the Association for Pelvic Organ Prolapse Support.

Check out your risk factors for POP with this questionnaire.

Sherrie’s book, Pelvic Organ Proplapse: The Silent Epidemic, is an honest, clearly written, and encouraging discussion of POP. I love how Sherrie weaves her own experience with POP throughout the book. For a chance to win a copy of the book, see the entry info at the bottom of this post.

Thank you Sherrie for reaching out to us, for your book, for this post, and for the important work you are doing!

Pelvic Organ Prolapse: Help and Hope 

Pelvic organ prolapse is an extremely common female health condition that has been on medical record for over 4000 years; unfortunately receives little acknowledgment. Women in every country around the world experience symptoms of POP yet have little idea what is occurring in their bodies because they are embarrassed to discuss them with anyone. It’s long past time to shift recognition and establish a dialogue.

Pelvic organ prolapse (POP) can occur when the PC or pelvic floor muscles weaken and one or more organs shift out of their normal positions into the vaginal canal. In advanced cases of POP, tissues push through the vaginal canal and bulge outside of the body. The worst case scenario is a woman’s uterus can be completely outside of the vagina. There are 5 types of POP; organs that can prolapse are the bladder (cystocele), intestines (enterocele), rectum (rectocele), uterus (uterine), and vagina (vaginal vault). There are 4 levels of severity; grade 1 is the mildest, grade 4 the most severe.

GLOBAL PREVALENCE

Statistical capture for prevalence of pelvic organ prolapse in most countries is sorely lacking and difficult to estimate because there is little screening in place and many women are too embarrassed to mention symptoms to their physicians. The current estimate of pelvic organ prolapse occurrence in the US is 3.3 million. POP is common in both developed and developing countries; there are 600,000 women in Nepal with uterine prolapse. A World Health Organization (WHO) study indicated that half of the women in Lebanon had at least 1 type of prolapse. ‘Guestimates’ indicate that there are 34 million women worldwide with POP and studies frequently estimate that up to 50% of the female population has POP. The reality is we truly don’t know what the real figures are-there has been no accurate stat capture to date.

Vaginal childbirth and menopause are the 2 leading causes of pelvic organ prolapse;nearly every woman has at least 1 hash mark on her risk factor profile. Women with POP typically have multiple risk factors, but even 1 damaging child birthing experience can be sufficient to cause problems that evolve into pelvic organ prolapse. Women in every age demographic experience pelvic organ prolapse.

STATISTICS

POP studies frequently have prominent numbers of women over the age of 50 and Caucasian, rather than including young women who have given birth and a more diverse balance of women from multiple races and nationalities. Accurate data related to occurrence and impact of pelvic organ prolapse will be more readily attainable after pelvic organ prolapse becomes common knowledge.  Because studies related to pelvic organ prolapse are now beginning to become more widespread, statistics may shift significantly in the near future. Frequently women do not disclose indicators of pelvic organ prolapse to physicians because of embarrassment related to symptoms.

Some current statistics related to pelvic organ prolapse are:

  • Research indicates that in 2010 there were 3.3 million women in the US alone with  pelvic organ prolapse;
  • 40-70% of women have urinary incontinence (stat varies greatly by study, not all UI is related to POP but UI is the most common symptom of POP);
  • There are 300,000 surgeries annually in the US for POP;
  • 1/3 of women of women with pelvic organ prolapse will have multiple POP surgeries;
  • It is suspected that more than half the female population will experience POP;
  • 1 out of 3 women suffer sphincter damage during childbirth resulting in fecal incontinence;
  • 20% of the women in the UK waiting for major gynaecological surgery are women with pelvic organ prolapse;
  • In 2010 there were 6,929,000 females in the USA who finished road races; 30-70% of women experience urinary leakage while exercising (running, jogging, aerobics).

Research related to vaginal childbirth indicates that women are predisposed to the following types of damage that lead to pelvic organ prolapse:

  • Pressure on organs/tissues;
  • Pudendal (nerve) denervation (crush or stretch);
  • Levator Ani Denervation;
  • Connective tissue damage (fascia);
  • Pelvic floor muscle weakening;
  • Mechanical disruption of rectal sphincter.

SYMPTOMS

Each of the 5 types of POP has its own symptoms, but in general the most common symptoms can include:

  • Pressure, pain, or ‘fullness’ in vagina or rectum or both;
  • Sensation of ‘your insides falling out’, vaginal tissue bulge;
  • Urinary incontinence;
  • Urine retention;
  • Fecal incontinence;
  • Chronic constipation;
  • Back/pelvic pain;
  • Tampons pushing out;
  • Painful intercourse;
  • Lack of sexual sensation;
  • Coital incontinence (leakage of urine or stool during intimacy).

CAUSES

There are multiple causes of POP; factors vary with age and it is likely that most women have more than one cause of significance and additional contributing factors that add to individual dynamic. The most common causes of POP are:

  • Vaginal childbirth – complications from large birth weight babies, long 2nd stage labor, nerve damage, forceps or suction deliveries, multiple childbirths, improperly repaired episiotomy; impact of childbirth may occur immediately after a difficult delivery or may not show up until 20 years later;
  • Menopause – age related pelvic floor muscle tissue integrity impact due to drop in estrogen level; this impacts strength, elasticity, and density of muscle tissue;
  • Chronic constipation – IBS (irritable bowel syndrome), poor diet, or lack of exercise may impact regularity, repetitive downward pushing to have a bowel movement pushes pelvic tissues down repetitively;
  • Chronic coughing – smoking, allergies, bronchitis, and emphysema can create chronic coughing jerking tissues down;
  • Heavy lifting – lifting children, repetitive heavy lifting at work, weight trainers;
  • Aggressive exercise – joggers, marathon runners, aerobics-repetitive downward pounding of internal structures;
  • Genetics – a family member with POP means you may be predisposed to POP;
  • Neuromuscular diseases – MS, diabetic neuropathy, Marfan (collagen deficiency), or Ehlers-Danlos Syndrome (joint hypermobility and tissue fragility).

It is also possible for women who have never given birth to have POP; there are several non-childbirth related causes.

DIAGNOSIS

The diagnostic process for pelvic organ prolapse will vary, based on type your physician suspects you have and the tests your physician is familiar with and prefers to utilize. Traditionally the basic check for POP will start with a pelvic exam. Once it is determined you have pelvic organ prolapse, additional tests that may be required are:

  • Digital rectal exam;
  • Pelvic ultrasound;
  • Pelvic MRI;
  • Urodynamic study;
  • Pelvic floor strength tests;
  • Hormone level evaluation;
  • Cystourethroscopy.

There are multiple treatment options for pelvic organ prolapse, both surgical and non-surgical. The first step is to get a definitive diagnosis of type(s) and degree of pelvic organ prolapse. Since there are multiple layers to the POP dynamic, you are most likely to have success with your treatment path of choice if you know exactly what kinds of POP need to be treated. Each treatment has unique benefits, and which choice you make will be influenced by your personal dynamic, type of POP, whether or not you are through having children, age, length of time you have been suffering with symptoms, intensity of symptoms, additional medical conditions, your desire to have an active sex life, and financial considerations.

The specialists who are Female Pelvic Medicine Reconstructive Surgery (FPMRS) trained in pelvic organ prolapse may be urogynecologists or urologists. Gynecologists and primary care physicians will diagnose pelvic organ prolapse, but a POP specialist will give you greater potential for successful treatment. A FPMRS urogynecologist or urologist will be able to advise patients about both surgical and non-surgical treatment options.

SURGICAL TREATMENT OPTIONS

There are multiple surgical treatment options for pelvic organ prolapse; once a definitive diagnosis is in place, you surgical choices will be outlined by your physician. Surgical treatment options include a variety of choices within each category; type utilized will vary with type/degree of POP and surgeon/patient choice:

  • Abdominal repair;
  • Transvaginal repairs (through the vagina);
  • Robotic repairs;
  • Laparoscopic repairs;
  • Combinations of the above.

Most urogynecologists utilize polypropylene mesh for many pelvic organ prolapse procedures to provide a sustainable repair. There is considerable controversy regarding the use of polypropylene mesh for transvaginal procedures; some physicians refuse to utilize mesh in any POP repairs, others use it exclusively for abdominal procedures, some use it for both. A significant number of POP surgeons feel it is an intricate tool for long term results. Worth noting is the fact that POP repairs that do not incorporate mesh frequently fail in 1-5 years because stitching weakened or damaged human tissue for support typically fails in time.

NON-SURGICAL TREATMENT OPTIONS

Often when women prefer non-surgical treatment, they are referred to physical therapists or physiotherapists. Women’s Health physical therapists have a significant variety of treatment options they can offer a woman with pelvic organ prolapse; since women’s needs vary considerably based on type/degree of prolapse; treatment regimens will be unique from woman to woman.

There are multiple non-surgical treatment options for POP, often women will utilize two or three treatment options at the same time for the best improvement of their symptoms. Non-surgical treatment options include:

  • Kegel Exercises;
  • Kegel assist devices;
  • Pessary;
  • Core/floor strengthening exercises (hab-it, pilates, Pfilates);
  • Biofeedback;
  • Electrical Stimulation;
  • Hormone replacement therapy;
  • Support garments;
  • Tibial nerve stimulation.

IMPACT TO INTIMACY

One aspect of pelvic organ prolapse that is significant and receives little press time is the impact of POP to intimacy. Coital incontinence (urine or stool leakage during intercourse), painful intercourse, or loss of sensation can have significant ramifications to an intimate relationship. Open communication between partners is ideal, but seldom occurs with the embarrassing symptoms that pelvic organ prolapse displays. Spontaneity is difficult to achieve and any of these symptoms can create a significant gap in communication. The norm is women are too embarrassed to disclose these symptoms to their partners, and men assume women are not engaging in intimacy because they have no interest. The impact to relationships is considerable. When a medical condition is not disclosed to intimate partners, it creates boundaries that are difficult to overcome. When women are not aware of the cause of the symptoms they are experiencing and are too embarrassed by them to disclose details to their physicians, they usually have no idea how to address them.

HELP AND HOPE FOR WOMEN

Pelvic organ prolapse is a global women’s health pandemic; since vaginal childbirth and menopause are the two leading causes, nearly every woman has at least one hash mark on her risk factor profile. Pelvic organ prolapse undoubtedly encompasses the widest demographic of all women’s health issues. The dynamic behind pelvic organ prolapse is likely more diverse than any other health condition women will experience. Multiple types of pelvic organ prolapse display a variety of symptoms; women’s unique childbirth, occupation, genetics, general health, and social activities history vary significantly. The demographic variable are diverse. Countless women suffer silently with symptoms they don’t understand. When we don’t recognize the cause of symptoms, our minds can be our worst enemies, imagining the most negative scenario.

There is help and hope for women with POP; treatment options evolve daily that can be utilized to control, improve, or repair this cryptic health condition. The most positive direction we can take is to increase awareness to enable women to recognize POP symptoms when they first occur. Women who have been diagnosed with POP need to come out of the closet with their diagnosis and treatment paths and share that information with other women, their mothers, their daughters, their sisters, their friends. Once we take pelvic organ prolapse out of the closet and make it common knowledge for women, routine screening protocol for pelvic organ prolapse during pelvic exams is established, POP will become more readily identifiable and women will be able to seek earlier, less aggressive treatment.

Giveaway: For a chance to win a copy of Pelvic Organ Prolapse: The Silent Epidemic, please enter a comment by October 1. Thanks!

About the Author:

Sherrie Palm is the Founder/CEO/Executive Director of Association for Pelvic Organ Prolapse Support (APOPS), a POP Key Opinion Leader, author of the award winning book Pelvic Organ Prolapse: The Silent Epidemic, a speaker on multiple aspects of pelvic organ prolapse (POP) quality of life impact, and an international women’s pelvic organ prolapse advocate. Sherrie’s points of focus are generating global pelvic organ prolapse awareness, developing guidance and support structures for women navigating POP, and bridge building within POP healthcare, research, academia, industry, and policy toward the evolution of POP directives.

The Ladies Room Doors of Italy: Part Two

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More ladies room doors from our Italian adventure. (Here’s Part One in case you missed it.)

We said goodbye to Florence and took the train to Cinque Terre. These five seaside towns on the Italian Riviera are connected by walking trails and rail. A moment of moments: The sea from the train window!

 

Read more about Cinque Terre on the Lonely Planet site.

We stayed in a a small apartment at a B and B in Monterossa al Mare, the largest of the towns. I found the sign at the top of the post on our first night, at an outdoor bar where we shared apps and sipped drinks.

We’d hoped to hike from town to town, but some of the trails were destroyed in a 2011 flood and are yet to be repaired. But it ended up that one hike was enough for me. Phew! I was not prepared for the steep steps and strenuous climbs. Cliff, a much more proficient hiker than I am, was surprised that the trail was marked “moderate.” He said it would have been rated “difficult” over here. But the rigor came with a reward. We descended (finally) to find one of the views of a lifetime. This is the town of Vernazza.

I liked this colorful display and am now painting this scene for art class. Might just turn out well enough to hang in the laundry room of the new house.

Cafes and restaurants abound in Cinque Terre. And so do great bathroom signs. Here’s a fishy one at Ristorante al Carugio in Monterrosa al Mare.

With a funky mirror:


Wine served in pitchers!


Here’s  the wine cork door to the unisex bathroom at the Cantina di Miki in Monterossa. Cliff and I tend not to seek out high end restaurants on our travels. Just too much $$. But if you go to Monterossa, this place is worth a visit thanks to its excellent food and funky, modern decor. Cinque Terre is  one of the world’s sardine capitals. Wish I had a photo of the sardines we tried, prepared five different ways.

After Cinque Terre, we took the train to another watery location. Venice! I’ve wanted to go since I learned about this place as a little girl. We walked through the train station and there is was! The Floating City.

 

I ate pasta almost every night in Italy. Look at the choices!

This was my favorite pasta of the trip, and I keep meaning to make it now that I’m stateside: Spaghetti all’arrabiatta. It’s peppery!


I worried about gaining weight on a month long trip. We walked and walked and walked, which helped of course. And although I indulged, I did so with some degree of moderation, something I wouldn’t have done twenty years ago.

The gelato did not disappoint, but we both thought the bread earned a C in Italy, at best-dry with little flavor. Perhaps that’s why I didn’t gain weight, as I can never resist good bread.

Loved the meringues. They come in  lovely colors and flavors.

We were sad to say goodbye to Venice. And yep, we rode in a gondola. Loved it!

Car rental time. Even though Cliff did a fine job, riding in a rental car put my nerves on edge. The Italians love to tailgate, and we went through some narrow passages in the hill towns.

But the rest stops are incredible-clean and modern, with fabulous fresh food and great bathrooms. Here are stall doors that advertise a fruit drink, I think.

And here’s the ladies room sign at another rest stop.


My grandon Maze would love this bathroom just for kids (and babies). Note the child- sized toilet.

and a blow dryer near the changing table for bottoms.


We were headed to Assisi in Umbria. I was relieved when we finally pulled into the hotel parking lot. And even happier to take in the view from our room.

And I loved this view when we ventured onto the Assisi streets.

I’ve been a St. Francis nut for years. Frances art abounds.

 

On to bathroom doors.

I’m not sure where I found this lovely lady.

A sign on the street:

Assisi

And at a pizzeria

Part of the pizzeria floor is covered with Plexiglas, so visitors can note the Roman ruins below.

We visited the churches and tombs of both St. Frances and St. Clare. I pondered the lives they lived and their dedication to the poor.

On our last day in Assisi, we visited the church of San Domiano, where Frances received his call from God. Here’s a handmade sign at a ladies room near the parking lot.

Nuns on pilgrimage.

 

Our next stop was the town of Montepulciano in Tuscany. Here’s the door to the bathroom at our B and B.


And the view from our window.

I  can’t remember where I found this shiny lady.

The emergency pull in the same restaurant bathroom.


This wine cellar, located right in town, is 1000 years old. We were disappointed that most of the wineries required reservations, which may not be difficult to get, but we didn’t try.

Our trip was nearly at an end. I’d been worried about being gone for a month. Happily, we got no reports of trouble from our friend watching the house, and the kids and granddkids stayed safe and healthy.

I packed very light, so I definitely got tired of my clothes. Washing clothes in the room worked really well, so we never officially did laundry. It was time to tidy up that suitcase one more time, turn in the rental car, and hop on the train to Rome.

Part Three coming up soon!

 

Period! Magazine

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I am delighted to introduce you to Paula Kragten, the founding editor of Period! Magazine. I love the layout! Love the articles! Love the mission of Period!

Thanks to Paula, for filling us in on how the magazine came to be and her vision for its future. (And don’t miss the last line, which swings us right back to menopause). Take it away, Paula:

I’m an editor/journalist from the Netherlands. For several years I worked for so called women magazines; mostly lifestyle features about interior design, architecture, travel, food, fashion. After 25 years, my workinganniversary so to speak, it hit me: I wondered why every single topic has its own magazine, except the one and only thing all women have in common: menstruation.

So I decided to start an online magazine. The Dutch edition went online in 2014. Aprils Fools Day seemed the most logical date. Most colleagues thought I was hit by the wings of a Dutch windmill.

Of course Period! is also the result of my personal interest. That started right after my own first period: at age 12. I wondered why there were so many mixed signals. On one hand: “Wow. Congrats.” But on the other: “Periods are gross so you better hide them. You should be ashamed.” That really puzzled me.

I was curious how women coped with menstruation in the dark ages or in prehistoric times. And also if periods were seen as a negative phenomenon in all cultures. Sadly I couldn’t find a single soul with the same interest.

So I went to the library – this was before the Google era – to get some answers. There was hardly any information there, besides from how things biologically work. Since then I have been collecting all the interesting publications and books on the topic I could find. That’s quite an archive right now.

About the launch:

Period! Magazine was originally intended to be a small project. Just for Holland. What happened really surprised me. Site visitors found us before I even realized the magazine was online. Lots of attention in the media. No harsh criticism at all. The involvement seemed huge. Also surprising – thanks to the translate button on social media – readers from abroad. A year after the launch in 2014, the English version went online.

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About the future:

At first I expected readers would be women like me: who know how things work biologically, but who are interested in the quirky side of the topic and use the magazine as a box of chocolate, selecting which posts which posts and subjects appealed to them most. That was the basic idea: a feel good magazine, colorful, surprising, entertaining. But when it comes to menstruation, thousands of years of civilization haven’t really brought us much. You can understand narrow mindedness in rural areas. But in a modern western society with internet?

It’s annoying enough that we menstruate ten times as much as we did a few centuries ago, that in total we’re on our period for six years of our lives and that we have to deal with the subject for about forty years. Menstruation isn’t even a condition for successful procreation. Rabbits don’t need sanitary towels. There’s no mammal that menstruates as enthusiastically as the human. Apparently, this gives us some evolutionary benefits. Interesting, isn’t it?

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However, periods are still an enormous taboo. When it comes to menstruation women are rather narrow minded. Period! is trying to carve a way by looking at the subject from as many different angles as possible. I strongly believe that is necessary.

More humor and self-mockery and less embarrassment would be nice. And some more consideration. On one hand everything has to be 100% ecologically responsible, while on the other we throw away at least 13,000 tampons and sanitary towels in the trash bin, without a second thought.

Many women don’t even know what a menstrual cup is. Or they suffer from serious menstrual complaints, but don’t do anything about it as they have been led to believe those problems are just a part of menstruation. Unpleasant odors and leakage stains are NOT the worst that can happen. This negative attitude has to change. We do humanity a favor by menstruating!

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Period! Magazine can go on forever. There are so many interesting period related things to write about. Last March I also published a book on the topic: Mooi rood is niet lelijk (best translated as Beautiful Red Isn’t Bad).

 

Periods became my full time job. That’s funny, for a woman in menopause 🙂

Photo Credits: The bottle is from Mentrosity. The other images are Period Magazine/Shutterstock.

Grandma Update: Thinking of Emerson

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In honor of the Ladies Room Door Art Series, I thought it might be fun to paint with toilet paper rolls. So I saved some. I painted my canvas a peachy pink.

And then I got busy with those rolls.

Toilet paper rolls

But now what?

And then I remembered!

Emerson, her mom reports, just started to pull herself up. One of her favorite locations? A toilet. Yucky to her mom, but hanging onto a toilet is lots of fun for Emmie.

So I decided to make my granddaughter the focus of my painting. My first portrait.

I used a photo that Cliff took of Emmie anxiously awaiting her supper.

I studied that face. And studied it and studied it and studied it.

The nose. The eyes. The expression. The curl of the hair. The coloring.


I’m not sure I’ve truly captured Emerson Grace Allen in my portrait, although Cliff kindly said he thought so.

But I had the most glorious time looking at those sweet features and thinking about her.

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All thanks to the toilet paper rolls that got the project rolling.