You know how you're eating dinner and watching TV at night and every other commercial seems to be about some medical issue? Well, I'd like to talk to you about a potentially embarrassing female issue you won't find on any of those commercials because nobody seems to want to discuss it. And, yet, it's way past the time we talked with each other and with our doctors about pelvic organ prolapse. (Let's call it POP for short.) It's common. But left untreated, it can really spoil your quality of life.

What is pelvic organ prolapse?

Our pelvic organs (uterus, bladder, rectum and vagina) are supported by the pelvic floor muscles, connecting tissue and ligaments. If the structural support stretches or weakens, things start to shift out of place. Any of the female pelvic organs can drop, usually bulging into the vaginal wall. Sometimes women will even notice a bulge outside the vagina. There are several types of POP, depending on which pelvic organs are shifting.

I talked with Katherine Stevenson, MD, an OB/GYN and urogynecologic surgeon. Dr. Stevenson is also the medical director of Urogynecology Services at ProHealth Care's Women's Center at Waukesha Memorial Hospital, www.prohealthcare.org/women.

Dr. Stevenson said that risk factors include vaginal birth, age, a family history of POP, obesity, smoking and having connective tissue disorders. With the aging of the baby boom generation, physicians are seeing an increase in POP. But it's important to recognize that this is not a disorder of “little old ladies.” Plenty of younger women develop POP, too.

Retired business owner Sherrie Palm is one. She stays up-to-date on the latest medical research and is very proactive about her health. So she was shocked to be diagnosed with a condition she'd never heard of. Palm had a hysterectomy at age 40 and was diagnosed and had surgery for POP at age 54. After doing more research, she realized she'd had symptoms for years.

POP symptoms

Dr. Stevenson said the most typical symptom is feeling a bulge inside the vagina or even protruding from the vagina. Other symptoms might include:

• Pelvic discomfort or a sensation of pressure

• Urinary dysfunction, including stress incontinence, difficulty emptying your bladder fully and recurrent urinary tract infections.

• Bowel dysfunction, including fecal incontinence or constipation.

• Sexual dysfunction, uncomfortable intercourse

Many women have mild prolapse and experience no symptoms whatsoever. Dr. Stevenson cautioned that many of these symptoms may be caused by other medical conditions as well.

Diagnosis of POP

Your doctor may identify a prolapse during a routine pelvic and rectal exam; however, a prolapse may not be as evident when you are lying flat. That's why it is so important to tell your doctor about any symptoms or changes. Your doctor may do an exam while you are standing. She may ask you to mimic the symptoms by straining. Diagnosis also might involve bladder function tests, pelvic floor strength tests and imaging tests. Your primary care or OB/GYN physician can do the initial workup for a diagnosis; then you probably will be referred to a specialist.

Treatment of POP

POP is a quality of life issue, Dr. Stevenson explained, “If you don't have any symptoms or aren't bothered by them, and if you're active and healthy, then no treatment is required. If you have symptoms that cause discomfort or embarrassment, then it's time to address them.”

If you have mild prolapse and no symptoms, your doctor might suggest Kegel or other pelvic floor exercises. Dr. Stevenson recommends pelvic floor exercises for all women, not just those with prolapse. A pessary, an internal device that helps support the pelvic organs is often useful to relieve the prolapse and symptoms. It also may prevent progression of the POP. Typically, if a woman is having symptoms that impact her quality of life, a pessary or surgery will be required. A pelvic floor surgeon, either OB/GYN or urogynecologist is likely your best bet.

Be aware, not ashamed

Palm learned through her research just how common POP is. She made it her mission to get the word out to other women. Palm recently published a book, Pelvic Organ Prolapse: The Silent Epidemic, which is based on her research and personal experience (It's available in many bookstores).

“I wonder how many women are suffering in silence, whether from lack of knowledge, fear or embarrassment,” says Palm. “There is strength in knowledge. Once women know there is a medical explanation and treatment, they will talk with their doctors, get treatment and get back to a normal life.”

Because it all begins with a healthy woman.

Yours in good health,

Sue Ann Thompson

Founder & President

Wisconsin Women's Health Foundation

The Wisconsin Women's Health Foundation (WWHF) is a statewide non-profit organization whose mission is to help Wisconsin women and their families reach their healthiest potential. WWHF provides programs and conducts educational forums that focus on prevention, early detection and connecting individuals to resources; produces and distributes the most up-to-date educational and resource materials; and, awards grants and scholarships to women health researchers and related community non-profit.