Heartland Women's Group July 17, 2012

By Melissa J. Hague, M.D.
Heartland Women’s Group
9300 E. 29th St. N.

I recently saw a new patient in the office. I noted on her history that she had not had a pap test for, in her words, “a long time.” She told my nurse she had some things that were concerning her. I introduced myself and asked the usual questions. When I asked if she had any concerns, she began to tell me how embarrassed she was to come in, how she had avoided visits because she did not want anyone to examine her. When I asked if there was something in particular that she was embarrassed about, she said she had "something coming out." She had suffered from prolapse for a number of years, and had significantly altered her life because she had such discomfort when she was active. What she didn't realize is this is a very common condition and there are many things we can do to help patients find relief.

Many women suffer from pelvic organ prolapse, a condition in which the cervix, uterus, bladder, rectum, or some combination of these is bulging out through the vagina. I often tell patients this is similar to a hernia. Some cases are very mild and can be treated with physical therapy or other modalities. Other cases are so severe that a patient's mobility and activity are affected. These patients may have problems with urination or emptying the bladder, or with constipation. There are several surgical procedures that can be utilized to help patients find relief.

When we first evaluate a patient for pelvic organ prolapse, we discuss symptoms to try to determine how much the condition is impacting a patient's quality of life. We discuss a patient's average day, her occupation and activities she enjoys. We also discuss whether or not she is sexually active or plans to be sexually active in the future.

Conservative approaches to treatment include physical therapy and pessaries (plastic devices that are inserted to reduce the prolapse). There are also a variety of surgical approaches including vaginal procedures with and without mesh, and abdominal procedures.

If the prolapse is severe, depending on the cause and particular diagnosis, we may recommend a procedure called a sacrocolpopexy. This procedure has been the gold standard for treating pelvic organ prolapse for a number of years. It used to require an abdominal incision, several days in the hospital, and an extensive down-time for the patient.

With the advent of robotic surgery, we can now offer patients the same procedure, but with many advantages. Many patients have only four small incisions (similar to laparoscopy), stay one night in the hospital, and are able to return to their activities in a few short weeks. The results can be quite dramatic. Recently, one of our patients commented that this procedure has changed her life. She told me she had instant relief following the surgery. At her postoperative visit, she was very excited to talk about how she had been able to play with her grandchildren without discomfort.

If you suffer from pelvic organ prolapse, please know that many women have this condition, and there are many good treatments that can improve your quality of life. Only a physician who is experienced in treating prolapse can evaluate you and help determine the best course of action in your particular case.

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