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Symptoms drive pelvic prolapse remedy

I’m a mother of seven children (five of whom had big birth weights – 10 pounds 14 ounces; two at 10 pounds 4 ounces; 9 pounds 14 ounces and 9 pounds 4 ounces) and grandmother of 16. As a little girl, I had urinary problems at times, especially when our family would travel, even if it was short distances (only including across the city).

I think I have a uterine prolapse but I can’t be for certain. I have not been to a physician since I don’t have a job or any health insurance. I’ve read articles about mesh slings, fembraces and vaginal pessary, including the pros and cons of the above. I’ve never had a major surgery, except for a head injury from an auto accident. Also, I didn’t do any Kegel exercises (that I recall) after having my children, nor did I have a hysterectomy.

Thank you for your open and honest description of your history and concerns. Here is some information that may help you understand pelvic prolapse and help you describe your symptoms to a doctor.

The uterus is held in position by pelvic muscles, ligaments and other tissues. If the uterus drops out of its normal position, this is called prolapse. Prolapse is defined as a body part falling or slipping out of position. Prolapse happens when the pelvic muscles and connective tissues weaken. The uterus can slip to the extent that it drops partly into the vagina and creates a noticeable lump or bulge. This is called incomplete prolapse. Complete prolapse occurs when the uterus slips to such a degree that some uterine tissue is outside the vagina.

Pelvic prolapse is usually accompanied by some degree of vaginal vault prolapse. Vaginal vault prolapse occurs when the upper part of the vagina loses its shape and sags into the vaginal canal or outside the vagina. Pelvic prolapse may also involve sagging or slipping of other pelvic organs, including the bladder, the urethra, which is the tube next to the vagina that allows urine to leave your body, and rectum.

In some cases women with mild cases of pelvic prolapse may have no noticeable symptoms. However, as the uterus falls farther out of position, it can place pressure on other pelvic organs – such as the bladder or bowel – causing a variety of symptoms, including:

•Sensation of sitting on a small ball

•Heaviness or pulling in the pelvis

•Pelvic or abdominal pain

•Pain during intercourse

•Protrusion of tissue from the opening of the vagina

•Repeated bladder infections

•Vaginal bleeding or an unusual or excessive discharge

•Constipation

•Frequent urination or an urgent need to empty your bladder

Symptoms may worsen with prolonged standing or walking due to added pressure placed on the pelvic muscles by gravity.

Pelvic prolapse is fairly common and the risk of developing the condition increases with age. It can occur in women who have had one or more vaginal births. Chronic coughing, heavy lifting and obesity increase the pressure on the pelvic floor and may contribute to the condition. Chronic constipation and the pushing associated with it can worsen pelvic prolapse.

Treatment is necessary once the symptoms are bothersome. Most women seek treatment by the time the uterus drops to the opening of the vagina. Losing weight, stopping smoking and getting proper treatment for contributing medical problems, such as lung disease, may slow the progression of pelvic prolapse.

If you have very mild pelvic prolapse – without any symptoms – or very mild symptoms, treatment is usually done with pelvic floor muscle strengthening, such as Kegel exercises or pelvic floor physical therapy. However, keep in mind that without treatment, you may continue to lose uterine support, which could cause more severe symptoms.

Nonsurgical treatment and surgical treatment options are available. The decision about which option is best for you will depend on your symptoms, lifestyle and medical history.

In order to further discuss these options it will be necessary to have a consultation with a gynecologist, such as myself, who takes care of patients with pelvic organ prolapse.

Dr. Geoffrey Cly is an OB/GYN with Parkview Physicians Group, and has offices in Fort Wayne and Auburn. “Ask the Doctor” is a health column by doctors from Parkview Physicians Group. Send questions to Terri Richardson at The Journal Gazette, 600 W. Main St., Fort Wayne, IN 46802, or email trich@jg.net. Please put “Ask the Doctor” for the subject line.

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