Women come into Dr. Audra Hill’s office having lived for years with uncertainty and discomfort. Some are fearful and embarrassed about going out in public. Others limit physical activity, like walking, riding a bike, or even intimacy with a partner.
These women suffer from pelvic floor prolapse, a non-life-threatening condition in which the pelvic organs herniate (become displaced) through the vagina. It can range from unnoticeable to bothersome, from irritative to putting you at risk for other health complications.
“A lot of women don’t know what it is and don’t say anything,” said Hill, an assistant professor in the Division of Urogynecology at University of Utah Health. “Some say ‘It’s my cross to bear for having children.’ They have no idea something can be done.”
Much like miscarriage, Hill said, “Nobody wants to bring it up, yet it’s amazing how many women relate. But you don’t have to live with it.”
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.
Risk factors include “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 no risk factors can suffer from this condition.
For most women, the first sign that there might be a problem is feeling a bulge in the vaginal area. It feels like sitting on an egg or a golf ball, Hill said. 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,” said Hill. 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 through 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. The therapist helps the patient identify her Kegel muscles and prescribes an exercise regimen to strengthen these muscles, which can help reduce the sensation of bulging.
“It usually entails maybe two or three visits with the physical therapist but then a lot of self-work over three months doing their personal muscle regimen,” said Hill.
If the exercises aren’t enough, patients can opt for a pessary, a plastic ring-shaped device inserted into the vagina (similar to a tampon). Hill compared a pessary to an elbow or knee brace for a tennis player. It offers support and decreases the bulging sensation.
For the most extreme cases, surgery may be required. According to Hill, a severe prolapse can impede normal urination and cause skin sores around the vagina. In those cases, she would recommend surgery.
If you’ve noticed symptoms of pelvic floor prolapse, it’s a good idea to discuss your symptoms with your primary care provider or gynecologist. You may be referred 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 this condition.
What’s important for people to know, says Hill, is that pelvic floor prolapse is common — but that doesn’t mean you have to suffer.
Whether opting for an exercise program, a pessary, or surgery, her patients express relief at their improved quality of life. “We’ve essentially given them their life back,” Hill said. “They are able to pick up their grandkids in their arms and enjoy life once again. It is definitely life changing.”