Gena Dunivan, M.D.Roughly one-quarter of women in the United States over 18 report having a pelvic floor disorder, which includes pelvic organ prolapse. Experts anticipate the number to increase by 50 percent by 2050. While it is a common women’s health condition, it is one of the least discussed.
Gena Dunivan, M.D., the new director of the University of Alabama at Birmingham Marnix E. Heersink School of Medicine Division of Urogynecology, notes the lack of discussion often stems from feelings of embarrassment and stigmas centered around POP.
“It is incredible what women’s bodies can do and withstand, but this does not mean they are not susceptible to wear and tear such as with pelvic organ prolapse,” Dunivan said. “It’s time to encourage an open dialogue around this condition that affects many women. It’s time for these women to understand they are not alone and they do not have to suffer in silence.”
What is pelvic organ prolapse?
POP occurs when one or more pelvic organs falls from a normal position into the vagina, like a hernia. Pelvic organs that may be involved are the bladder, uterus, small intestines, vaginal vault and rectum. Prolapses occur when pelvic floor muscles, ligaments or tissue weaken or tear.
“There are different stages of prolapse ranging from a small bulge at the opening of the vagina to advanced stages when the bulge may protrude well out of the vagina,” Dunivan said.
What causes pelvic organ prolapse?
Dunivan notes some women with POP may not experience any symptoms, making it harder to gather robust data on the population. However, it is estimated that women in the United States have a 13 percent lifetime risk of undergoing surgery for POP. Childbirth and aging are two of the top risk factors for developing POP.
Common risks include:
- Pregnancy
- Vaginal childbirth
- Aging and menopause
- Heavy lifting
- Obesity
- Chronic cough
- Chronic constipation
- Genetics
What are the signs of POP?
A common symptom of most types and stages of POP is a sensation of heaviness in one’s pelvis. Additional symptoms include urinary problems, such as leakage/incontinence or retention, as well as difficulty with bowel movement. Depending on the severity of the prolapse, the vagina may turn inside out and become visible outside of the body. Most symptomatic women with POP report a feeling of something bulging out of their vagina or a sense of pressure or heaviness in the vagina, Dunivan says.
Treatment for POP
“There are several treatment and prevention options for pelvic organ prolapse, and many do not involve surgery,” Dunivan said. “However, the best first step is talking to your gynecologist or urogynecologist about any symptoms you are experiencing. We are here to help diagnose what type and stage of prolapse you have and develop a specialized treatment plan.”
Learn more about UAB’s urogynecology services here.
Dunivan reiterates the preferred type of treatment is prevention and early intervention. As athletes exercise to condition their bodies for success, women should incorporate pelvic floor exercises, such as kegels, to lower their risk of prolapse. Many exercises can be done in the comfort and privacy of one’s home or easily incorporated into routine workouts. Women with more severe prolapse and symptoms may also benefit from pelvic floor therapy with specialists trained to target specific pelvic floor muscles.
Maintaining healthy weight, choosing foods with fiber and not smoking can also reduce one’s risk of prolapse, according to the Office on Women’s Health.
Another non-surgical option is placement of a vaginal device, called a pessary. The device is a soft, removable device that is inserted in the vagina to lift vaginal walls. Pessaries come in different shapes and sizes to fit different bodies and types of prolapse.
Surgery is another treatment option for POP, and there are a variety of surgical options to meet a woman’s preference. Dunivan’s team at UAB Hospital offers minimally invasive vaginal, laparoscopic and robotic approaches to pelvic organ prolapse surgeries.
“Pelvic organ prolapse is not dangerous but can be bothersome and dramatically affect one’s quality of life,” Dunivan said. “With the variety of treatment options available, we do not want women suffering through this condition or thinking there are no options for treatment because of misunderstanding that it is a normal part of aging. However, treatment and prevention are limited as long as the conversations around pelvic organ prolapse are considered taboo.”