rectocele

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Taking Pelvic Organ Prolapse Out of the Closet
Pelvic organ prolapse. Pessary. Urogynecology. Terms that all women should be familiar with, terms that few women are. Pelvic organ prolapse is an extremely common female health issue that has probably been around since women started having babies yet sadly remains in the closet. Frankly, women are just too embarrassed to talk about it. We need to change this dynamic. We need to change it now.

Every year hundreds of thousands of women are diagnosed with POP, and countless more suffer silently with symptoms that they can’t make any sense out of; is it a digestive thing, is it a colon cancer thing, is it a female hormone fluctuation thing? When we don’t know what to tie symptoms to, our minds can be our worst enemies, imagining the most negative scenario.

Half of all women over the age of 50 suffer from at least one type of pelvic organ prolapse (there are 5 types), many women in their 20s, 30s and 40s have POP as well. The 5 types of pelvic organ prolapse are cystyocele (bladder), rectocele (large bowel), enterocele (intestines), vaginal vault (vagina caves in on itself after uterus is removed-hysterectomy), and uterine (uterus). When the PC or pelvic floor muscles weaken, one or more of these organ/tissue areas drop down into the pelvic cavity below their normal positions.

Each of these 5 types of POP has its own symptoms, but in general symptoms can include:

  • Pressure, pain, or “fullness” in vagina or rectum or both. 
  • Feeling like your “insides are falling out”. 
  • Urinary incontinence. 
  • Urine retention (you have to pee, you just can’t get it to come out). 
  • Fecal incontinence. 
  • Constipation. 
  • Back/abdominal pain. 
  • Can’t keep a tampon in. 
  • Painful intercourse. 
  • Lack of sexual sensation. 

There are multiple causes of POP; it is likely that most women have more than one cause that fits their health pocket and lifestyle. The most common causes of POP are

Vaginal childbirth-complications from large birth weight babies, forceps deliveries, multiple childbirths, improperly repaired episiotomies. (It is also possible for women who have never given birth to have POP; there are many non-childbirth related causes.)
Menopause-age related muscle loss due to drop in estrogen level; this impacts strength, elasticity, and density of muscle tissue.

  • Chronic constipation-IBS (irritable bowel syndrome), poor diet, lack of exercise can all cause constipation. 
  • Chronic coughing-smoking, allergies, bronchitis, and emphysema can create chronic coughing. 
  • Heavy lifting-repetitive heavy lifting at work, lifting children, weight trainers. 
  • Joggers, marathon runners-constant downward pounding of internal structures. 
  • Genetics, having a family member with POP means you are more likely to have POP issue. 
  • Neuromuscular diseases such as MS or muscular dystrophy or a condition like Marfans (collegan deficiency). 

There is hope for women with POP; there are both non-surgical and surgical treatments that can be utilized to control, improve, or repair this health issue. The most positive direction we can take is to increase awareness so women start recognizing POP symptoms when they occur. Women who have been diagnosed with POP need to come out of the closet with their diagnosis and treatment paths and share that information with other women, their mothers, their daughters, their sisters, their friends. The sooner we take POP out of the closet, the sooner women will be able to start identifying it and seek professional diagnosis and treatment. 
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