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May 2011: Pelvic Organ Prolapse

29 Apr 2011

Bruce A Rosenzweig, M.D., is a board-certified, fellowship-trained urogynecologist at Weiss Memorial Hospital. His areas of expertise include pelvic organ prolapse, chronic pelvic pain, interstitial cystitis, pessary use, pelvic floor rehabilitation and surgical management of urinary incontinence.

Bruce A. Rosenzweig, M.D.
Director of Urogynecology
Lakefront Women’s Health
Weiss Memorial Hospital
(773) 564-6025

As a woman ages, particularly if she has delivered several babies, her pelvic organs can start to sag or even come through the opening of the vagina. While this can be an uncomfortable malady, a specialist in urogynecology can suggest options to treat this condition, called pelvic organ prolapse.

What causes pelvic organ prolapse?
Pelvic organ prolapse is a common problem where the normal support of the pelvic structures weakens, and these organs slowly descend into the lower vagina. This is further compounded by vaginal childbirth. Common symptoms are pressure, pain and difficulty with intercourse, urination or bowel movement. The symptoms develop slowly, but sometimes the first sign of prolapse is feeling a bulge in the vagina during showering or bathing. This often leads to concern about the organs’ further descent.

Treatment options
Once prolapse is suspected, a woman should discuss her symptoms with her doctor. There are simple as well as complex remedies. If the vagina feels dry and brittle, an over-the-counter preparation called Replens can be applied daily to increase vaginal moisture. Vaginal hormone therapy with estrogen may also be indicated. It is important to remember that vaginal estrogen therapy has far less side effects and risks as oral estrogen therapy.

If urination, bowel movement or sexual relations becomes difficult, then a specialist should become involved. Specific tests can determine if the prolapse is causing these symptoms. These tests will predict which therapeutic options would be most beneficial.

The most likely solutions are a prosthetic device, called a pessary, or surgery. The pessary is a donut shaped device in its generic format, though there are many shapes and sizes to allow the practitioner to find the proper fit. This medical device is placed into the vagina by a healthcare provider and can provide immediate relief of symptoms. The pessary needs to be removed at an interval of days or weeks to be cleaned. This will prevent infection or discharge. Pessaries are fitted to be comfortable to wear and easy to remove and replace. A woman can enjoy years to even decades of comfortable pessary use, without worry of any time limit.

There are many different surgical procedures to correct pelvic organ prolapse. A candid discussion with a gynecological surgeon will be necessary to determine which procedure is right for the individual woman. Surgery is associated with many risks, and a woman must be ready to spend a significant period of time recovering from the operation.

Next steps
Pelvic organ prolapse is a common condition that needs not be feared or ignored. A discussion of the symptoms should be part of a routine doctor’s visit and referral to a specialist should not generate concern or fear. Simple therapies can be offered or corrective surgery may ultimately become necessary.

For more information
If you would like more information about pelvic organ prolapse or other women’s health issues, or would like an appointment, please call Dr. Rosenzweig’s office at (773) 564-6025.