Pelvic organ prolapse — Part 2
PREVENTION is always better than cure, and there are several ways to reduce the risk of prolapse. These include:
• Regular pelvic floor exercises
• Maintaining a healthy weight
•Eating a high-fibre diet with lots of fruits, vegetables and whole grains to prevent constipation
•Avoiding heavy lifting
• Giving up smoking.
Treatment for pelvic organ prolapse is varied and depends on several factors. If symptoms are mild and do not interfere with normal activities, then lifestyle changes such as weight loss and Kegels (pelvic floor exercises) are the first option. Kegels involve contracting and releasing the pelvic floor muscles to gradually increase strength and tone over time.
To first identify these muscles, you can feel them if the flow of urine is stopped. This should not be done frequently or repeatedly because it can be harmful to the bladder. After you have identified which muscles they are, sit comfortably and squeeze then relax the muscles 10 times in a row. As you get more comfortable, the contractions can be held for a few seconds. Always remember to rest between sets and limit the total number to prevent fatigue. These exercises have the added benefit of improving incontinence symptoms and improving the sexual experience.
If symptoms are moderate, then devices such as pessaries may be used. These come in varying shapes and sizes and are used to keep the proplapsing organs up in place inside the vagina. Some pessaries have additional modifications to assist with urinary incontinence symptoms if those are also present. Pessaries have to be fitted by a doctor, and have to be changed frequently (at least every three months) to prevent infection, ulceration and other complications. When being changed, the doctor should do an examination to ensure that the vagina remains normal. The pessary is also a good option for some women who are not well enough for surgery, or for younger women who have not yet completed childbearing and do not wish to have surgery as yet. For older patients who are post-menopausal, a vaginal oestrogen cream is commonly prescribed with the pessary. If prolapse happens after surgery to remove the womb has already been done, then special pessaries are required.
For more severe symptoms, or for symptoms that do not respond to more conservative management, then surgery may be required. Surgery typically involves removal of the womb if it is prolapsed. Reinforcement for the other prolapsing organs (commonly the bladder and bowel) is also done to reduce their prolapse. In younger patients who wish to retain their uterus, suspension procedures are done to attach the uterine supports to stronger ligaments in the pelvis.
Incontinence surgeries are different procedures, so those symptoms may not be eliminated by prolapse surgery. Depending on the severity, type of surgery done, and persistence of risk factors, symptoms may recur after surgery, and are more difficult to treat in this case.
Pelvic organ prolapse is a very treatable disorder, with most women having significant improvement in symptoms with treatment. Prevention is the best key, and early intervention is always better. See your gynaecologist today if you are suffering from any of the symptoms.
Dr Anna-Kay Taylor Christmas is a consultant obstetrician and gynaecologist at the Obs and Gynae Centre, Winchester Business Centre. She can be contacted at drtaylorchristmas@gmail.com or 908-3263, 906-2265, 325-7362.
