With aging, many women experience a problem with the uterus, bladder, or rectum dropping from their normal positions, a condition called pelvic prolapse. It is often associated with urinary incontinence, pain with intercourse, and back ache. Some women feel as though they were about to give birth after standing for long periods of time.
Allowed to progress, this condition results in the uterus prolapsing completely out of the body, a condition called Procidentia. Symptoms are worsened by excessive coughing, as with COPD, or sudden weight gain, common after menopause. The vaginal tissue becomes dryer and thinner after menopause, making prolapse symptoms worse.
Pelvic floor exercises help some women with prolapse symptoms. They are called Kegel exercises, and the easiest way to learn how to do them is to try to interrupt your stream when urinating. Exercising this muscle several times per day can prevent progression of prolapse, and can reduce incontinence.
Other options include a device called a pessary, that is inserted into the vagina to give support to the pelvic structures. Pessaries come in a variety of shapes and sizes, and you cannot feel a properly fitted pessary, just like you cannot feel a tampon. Every woman’s anatomy is slightly different, and there is no one size fits all pessary. Generally we measure your vagina, and try on several sizes. You may want to wear a pessary home and come back to recheck it the next day for size and fit.
Most women are able to insert and remove their pessary themselves, but others come to the office every 2-3 months to have it removed, cleaned and reinserted. Most women also use vaginal creams, estrogen cream and a cleansing cream, to maintain the health of the vaginal tissue. A neglected pessary can cause erosions and infections, but properly cared for, they can last for years. The silicon pessaries used today do not cause odors.
Surgical correction of pelvic prolapse usually involves a hysterectomy and possibly a bladder tack. The problems associated with these operations are well known, with mesh erosions into the vagina or bladder. If the mesh is too tight it may have to be removed. The mesh can cause scarring over time with symptoms like pelvic pain and pain with intercourse, or inability to empty or control the bladder.
Dr. Holley does not do these operations, but she can refer you to a center of excellence to have it done by an experienced surgeon if you need this surgery.