It’s a common condition in women, and one that only increases with age. About 30 percent of women will develop a condition called “pelvic floor prolapse” in their lifetimes.
The pelvic floor is a group of muscles that hold the uterus, bladder, bowel and other pelvic organs in place. Pelvic floor prolapse can mean any of the pelvic organs falling down when they otherwise shouldn’t.
“Prolapse is any kind of weakness or bulging of the vaginal tissue. [It’s] basically any kind of weakness in the pelvic floor that results in the falling of organs in the vaginal fault,” said Dr. Josh Lohri, director of the Pelvic Floor Center at Charleston Area Medical Center’s Urology Department.
As women age, the muscles and ligaments that make up the pelvic floor weaken. Vaginal births, pelvic surgeries like hysterectomies and gaining weight also increase a woman’s chances of prolapse.
Of the women who develop the condition, about 10 percent will have surgery to correct it, Lohri said. Many of them will have multiple surgeries.
“You fix one compartment and another compartment basically gets compromised as a result of that so ... somebody may present with bladder prolapse and they fix that and several years down the road as the vagina has kind of compensated, you get weakness,” he said.
Vaginal pressure is the most common symptom of the condition, Lohri said.
“They use the comment it feels like they have a, whatever it may be, a watermelon, a cantaloupe, a softball, something between their legs that otherwise shouldn’t be there,” he said.
Other symptoms include trouble passing urine, constipation and discomfort during sex. Some women also notice blood.
“They present with vaginal bleeding or bleeding somewhere and you evaluate them and everything is hanging out,” he said. The women often don’t realize it, he said.
Lohri recommends kegel exercises, which consist of contracting and relaxing the muscles that make up the pelvic floor.
“We have a pelvic floor physical therapist that we work with fairly regularly in women that have mild prolapse or those that are not looking for a surgical fit right off,” he said.
If left uncorrected, the worst cases of pelvic floor prolapse can cause infections and even kidney failure, recurrent urinary tract infections and vaginal ulcerations.
“These are things that we would be much more inclined to proceed surgically or at least some sort of correction,” Lohri said.
There are surgeries to correct the condition. They include using a patient’s own tissue to resupport the floor of the pelvis and using surgical mesh.
The use of transvaginal pelvic mesh has been controversial.
U.S. District Court Judge Joseph Goodwin in Charleston oversaw more than 50,000 cases over the implantation of vaginal mesh as part of federal litigation across the country.
Women claim the mesh produced by multiple companies degrades and shrinks, requiring replacement and causing other medical problems.
“The theory is if you use mesh, which is a permanent fixture, then it’s a more longterm durable repair,” he said. “Obviously there’s some complications with that.”
Lohri said he recommends women be mindful of the symptoms and don’t be afraid to get a procedure done to fix it.
“Most of all these surgical procedures are done on an out-patient basis with a less than 24-hour stay, so there’s not a five-, six-hour operation,” he said. “It’s not a weeklong hospital stay. It’s pretty minimally invasive stuff that can be done with good long-term results.”
Besides surgery, a doctor may recommend pelvic floor physical therapy as a treatment.
CAMC’s Pelvic Floor Center opened two years ago and gives patients a sort of one-stop shop for dealing with the condition. Lohri said there was a huge demand for the kind of services offered at the center, which are common at bigger university settings.
“We’ve got our own on-site urodynamic suite,” Lohri said. “We work with some of the colorectal surgeons and work with the pelvic floor physical therapists to kind of have everything at least, if not everyone, here at the same office at the same time, at least a multidisciplinary approach. At least we can have all the sources readily available.”
Reach Lori Kersey at email@example.com, 304-348-1240 or follow @lorikerseyWV on Twitter.