It’s not the kind of thing you generally discuss in the company of others, and perhaps that is why so many women suffer from pelvic floor prolapse without knowing that there are treatment options available.
Pelvic floor prolapse is a condition in which the pelvic organs herniate (become displaced) through the vagina—hence the reason you probably won’t think about discussing it at your next lunch date with friends—and can range from something you don’t notice at all to something that is bothersome, painful and may be putting you at risk for other health complications.
“A lot of people don’t talk about this,” said Dr. Audra Hill, an assistant professor in the Division of Urogynecology at University of Utah Health. According to Hill, many women believe that symptoms often associated with pelvic floor prolapse — such as urinary leakage or a bulge in the area of the vagina — are completely normal and that it’s the price you pay for getting older or having children.
“It is common, and some consider it to be normal,” Hill said, “but you don’t have to live with it. I find a lot of times people have no idea that something could actually be done to help these problems.”
One of the biggest challenges with raising awareness about pelvic floor prolapse is that there is no specific event or risk factor that causes it.
“There are a lot of risk factors that can go into prolapse, such as having children, being older, being overweight, being certain races—Caucasians have a higher incidence—as well as chronic constipation and genetics,” said Hill.
However, just because you have one or more of these risk factors doesn’t necessarily mean you will suffer from pelvic floor herniation. On the flip side, someone with absolutely no risks factors can suffer from this condition.
For most women, the first sign that there might be a problem is feeling a bulge down in the vaginal area. It feels like sitting on an egg or a golf ball, Hill said. For some, it’s a painful sensation; for others, it’s just bothersome. Additionally, urinary leakage can occur at the same time as vaginal prolapse , although you can have leakage without prolapse and vice versa.
“The good thing about prolapse is that it’s a quality of life problem — it’s not life-threatening,” said Hill. That leaves a lot of options for treatment, and treatment plans can be tailored to each patient based on how much or how little it bothers her—including the option to do nothing and monitor it to see if it gets worse over time.
On the less-invasive side, patients can opt for non-surgical treatments such as pelvic floor physical therapy, a process in which the patient works with a trained women’s health pelvic floor physical therapist who helps her identify the Kegel muscles and prescribes an exercise regimen to strengthen these muscles, which can help improve the sensation of bulging.
“It usually entails maybe two or three visits with the physical therapist but then a lot of self-work doing their personal muscle regimen,” said Hill. A physical therapy program usually lasts about three months with regular checkups to see if it’s helping relieve pressure and symptoms.
If the exercises alone aren’t enough, patients can opt for a pessary, a plastic ring-shaped device that you insert into the vagina (similar to a tampon) that will support and hold things up down there. There are various pessary shapes and sizes, including ones that are inserted and remain in for several months to those that a patient can insert and remove on her own.
For the most extreme cases, surgery may be required, but that generally only occurs when the prolapse is extremely bothersome. Additionally, if the prolapse is severe enough that it’s impacting kidney function, impeding the ability to urinate normally, or causing sores to appear on the skin around the vagina, surgery is usually recommended
If you’ve noticed symptoms of pelvic floor prolapse, it’s a good idea to bring up your symptoms in a discussion with your primary care provider or gynecologist. Often a primary care provider will refer you to a specialist, either a gynecologist or a urogynecologist. Some gynecologists who have experience with this condition feel comfortable treating pelvic floor prolapse, while others will refer you to a trained urogynecologist who has additional training in diagnosing and treating pelvic floor disorders.
The most important thing for people to know, says Hill, is that pelvic floor prolapse is really common—but just because it’s common doesn’t mean you have to suffer through it.
“There are some non-invasive methods available that can really help improve the quality of life,” said Hill. “Their life is so much better after they do something, and many people don’t even know that it could be fixed.”