Menopause

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

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.

Aging, Menopause, Menopause Symptoms

Light Bladder Leakage and Menopause


Handkerchiefs

A post from Marilyn Suttle, the Light Bladder Leakage blogger at Poise:

So, you’re having night sweats, hot flashes, vaginal dryness, and on top of all that – you leak. Welcome to the transition toward menopause (sometimes called perimenopause.)

Perimenopause is that time in life when your periods diminish and eventually come to a stop. The transition affects every woman differently. Your passage may be smooth sailing, or you may experience any number of symptoms in varying degrees.

Menopause (the permanent end of menstruation and fertility) is typically reached once you experience 12 consecutive months without a menstrual period.

During this transition, a decline in estrogen levels may result in weakening of the pelvic floor muscles that support bladder control, contributing to LBL (light bladder leakage.)

Though not all menopausal women experience LBL, it is common. One in three women experiences it.

We reached out to urologist, Jason Gilleran, MD at Beaumont Women’s Urology Center in Royal Oak, Michigan for his insights on ways to manage LBL during menopause.

“The sooner women address their bladder leakage, the better their results,” Dr. Gilleran said. By changing the habits that contribute to light bladder leakage during menopause, you may sidestep, reverse, or even eliminate those little leaks.

Seek out support

LBL can improve dramatically in some women by strengthening the pelvic floor muscles with Kegel exercises. However, telling a woman to do Kegels without instruction is a lot like sending someone to the gym without telling her how to use the equipment.

Dr. Gilleran recommends pelvic floor therapy as a first course of action. “I refer a lot of young women, who are perimenopausal and noticing early signs, to a pelvic floor physical therapist,” he said, “They can accelerate your ability to do Kegel exercises correctly and get results. They’re not as expensive as some of the other treatments, and there are no harmful side effects.”

If you aren’t getting the kind of support you’d like from your regular physician or gynecologist, be proactive and ask to be referred to someone with special training, like a pelvic floor physical therapist or urogynecologist.

What else can you do to prevent, reverse or eliminate LBL in menopause?

Dr. Gilleran suggests the following:

Stop smoking. Smoking is a contributing factor for bladder leakage during menopause.

Minimize weight gain. Women tend to gain weight during menopause. A noted research study showed that women with an average weight of about 200 pounds who lost 10% of their body weight, had a 70% reduction in leakage.

Treat chronic coughs and allergies. A chronic cough causes ongoing pressure on the pelvic floor and, over time, can weaken it. Get pulmonary issues like persistent coughing and sneezing under control.

Go to the gym. There are many benefits to exercising. It can even improve your mood and outlook. Some patients have told Dr. Gilleran, “I don’t let LBL stop me from exercising. I wear a pad and get on with things.” Others say they don’t want to go to the gym because they’re self-conscious about leaking. “High impact exercise may not be the best thing for the pelvic floor,” Dr. Gilleran said. “Doing core strengthening exercise like Pilates or yoga is better from that stand point.”

Be gentle with yourself

While some factors contributing to LBL are within your control, others are not. “Childbirth or a family history that predisposes you to issues, like prolapse, can contribute to a weakened pelvic floor,” Dr. Gilleran said. “If you’re predisposed then you’re more likely to experience some level of leakage after menopause.”

Remember, you are not alone. One in three women experiences LBL, and there are ways both surgical and non-surgical to manage it.

“Once a woman has gone through menopause completely, LBL is a factor of what has happened to the pelvic floor tissue,” said Dr. Gilleran. “Some women come in with signs that they have changes in their vaginal tissues, while other women’s tissues are still in pre-menopausal shape. After menopause, women, in their mid-50’s or 60’s, who have intact muscles in their pelvic floor, tend to have better results with a pelvic floor physical therapy.”

When women experience bladder leakage and wait too long to see a pelvic floor physical therapist, it’s more likely that muscle loss may have taken place. The earlier you intervene, the better results you’ll have long term.

When to consider surgery

The reason some women are likely to opt for surgery is that they’ve tried conservative treatments, like pelvic floor therapy, and it failed. The surgery for LBL has changed over the years. “It used to be a fairly invasive surgery involving a bladder lift or bladder suspension, which would be done sometimes through a cut in the abdomen,” Dr. Gilleran said, “Now, most everything, is done through three small incisions in the vagina, sometimes only one. The most common type is called a sling surgery.”

The goal of the sling surgery is to place a type of backboard under the urethra. It acts as a mechanism to stabilize the tissues so that with exercise, coughing, and sneezing, the urethra itself doesn’t fall down. “It’s not designed to lift it up like we did in the past, but keep it from falling down,” Dr. Gilleran said, “To better understand it, picture yourself trying to sit down and you have no chair. What we’re doing is putting a chair there.”

Sometimes Dr. Gillleran has patients use a tampon. A tampon can actually act to stabilize, a bit like what a sling does except they use it externally. When women use a tampon and they don’t leak as much, it’s a good sign sling surgery will help them.”

Controversy over hormone replacement

Some women wonder if hormone replacement is the answer to eliminating LBL during menopause. “From a risk/benefit standpoint, it’s not something I use as an everyday practice for LBL alone,” said Dr. Gilleran, “I tend to avoid it because of the concerns with breast cancer, uterine cancer, blood clots, heart attack, and stroke – those things that have been associated with it. Hormone replacement is a very controversial issue.”

You are not alone

Dealing with menopause can be challenging, especially when it includes light bladder leakage.

If you find yourself feeling down, resist the urge to withdraw and isolate yourself.

You are not alone. One out of every three women experiences LBL – that’s about 40 million women! This is a time to reach out to your close friends and family. Many of them may be going through it too.

When you start the conversation about LBL, you will find support and camaraderie with the women in your life. It’s possible to manage LBL, and move on to living your life to the fullest.

Choose to be your most vibrant self, and enjoy your mid-life adventure.

marilyn

Marilyn Suttle is a women’s success coach and the Poise LBL blogger. You can learn more about Marilyn and the Poise products for feminine wellness at www.poise.com.

 

Poise Product Pic

Top Photo:  Since Light Bladder Leakage often makes its first appearance during a sneeze, I offer you my handkerchief collection POISED (pun slightly intended) on old handkerchief box.

Aging, Menopause

Prolapse: Fix It with Duct Tape?

When I was in fifth and sixth grade, we girls used to sit on the bleachers at recess and discuss the horror of it all:  We were going to get periods.  It truly was a shock to most of us.  How could our bodies go so wonky?

But don’t ask me why, when I read menopause articles as a grownup,  I didn’t let this fact sink in:   Bad stuff  can happen to the girl parts.   Well I guess I should call them “lady parts.”   (Ah, to be a girl again.)  Dryness, pain, atrophy, AND pelvic organ prolapse.

The websites and medical advice books push kegels.  Kegels to PREVENT  prolapse.

So everybody, right now, wherever you are, kegel away.

(If you don’t know how, check out this site from the mayo clinic.)

Kegel.  Kegel.  Kegel. Kegel.  Kegel.

My doctor says kegels really do the trick for many women.  For others, it may not be so simple.

My mom had a tough time with  prolapse, a few years ago, so I’m wondering, if despite kegels,  prolapse is in my future.  If you’ve had prolapse and would be willing to write us a post, I know others would appreciate reading about your experiences in case they’re in the same boat.  We can keep your name off the post, if you like.

Break for more kegels!

Kegel.  Kegel.  Kegel.  Kegel.  Kegel.

I’m not a medical professional,and except for my kegel coaching and the Mayo Clinic site, I haven’t given you much information here, but I wanted to at least touch on the topic of pelvic organ prolapse and menopause.

Oh and I do know that you can’t fix prolapse with duct tape, but I wanted an excuse to show you the beautiful folder I made with this amazing stuff.  I love the  tape with the paint splotches the best.