STORY BY

Deborah Mann Lake

 

The Battle of a Different Bulge

Pelvic Organ Prolapse

For Rosa Mitchell, 79, the moment of decision came when she could no longer push her bulging bladder back up into her body.

For Palma Beckett, 72, it was a slow realization that there had to be a better way to live.

For Allie Lawler, 57, it was finding the right physician after five years of suffering.

All three had pelvic organ prolapse (POP), which affects millions of women in the United States. It occurs when pelvic floor muscles and ligaments become weak and can’t support pelvic organs including the bladder, uterus, urethra, small intestine, rectum and vagina. Organs drop and protrude into, or even out of, the vaginal canal. Complications include chronic urinary tract infections, incontinence, bowel dysfunction and lower back pain.

“The majority of women don’t seek treatment for POP,” says urogynecologist and surgeon Gazala Siddiqui, M.D., assistant professor of obstetrics at The University of Texas Medical School at Houston. “I see women every day with organs that have dropped down. They can’t fully empty the bladder and keep getting urinary tract infections which can spread to the kidneys. In older patients, it can make them really sick and can even lead to sepsis.”

According to the National Association for Continence, up to 50 percent of women who have borne children will have some degree of pelvic organ prolapse. Although it is more common in older women, even younger women in their 30s, 40s and 50s have prolapse, Siddiqui says. But less that 30 percent of patients seek treatment for it.

Childbearing, long labors, multiple pregnancies, obesity and hormone changes after menopause can all weaken the pelvic muscles and cause organs to drop.

A better way

“You go through life not paying any attention and then one day you say, ‘There’s got to be a better way,’ “ says Beckett, who came to Houston from Alpine for the surgery. “I didn’t dare sneeze more than once and I couldn’t laugh too hard. I was uncomfortable because I knew I was leaking urine and leaking is never fun.”

Mitchell, who has seven children, also had trouble with incontinence. “Certain medications that I take would keep me from going and then later I would have to go and I wouldn’t make it to the bathroom,” she says. “As big as the bulge was, sometimes it would drop down and it got to where I couldn’t push it up anymore.”

 Lawler did not have incontinence, but she suffered from the pressure of her bladder falling into her vaginal wall. “I felt like there was a balloon up there, or like when you’re young and you have a tampon sticking there. It finally got to where it was bulging out. It looked like a round ball,” she says.

The good news is that prolapse can be fixed by vaginal surgery, which doesn’t require an abdominal incision so there is less pain and a faster recovery. Within a few days of the procedure, most patients don’t even feel they had surgery done, Siddiqui says. If the patient has incontinence, it can be fixed at the same time with a vaginal sling.

“It’s nice to not have that hanging down there,” said Mitchell, who had surgery to repair the prolapse several months ago. “I was concerned that surgery wasn’t an option at my age with all my problems.”

Women who cannot undergo surgery for health reasons can be treated with a pessary, which acts like a diaphragm to keep organs from coming through the vaginal wall. It can be cleaned with soap and water once every three weeks. In some cases where a very elderly patient is considered too frail to have general anesthesia, a 45-minute procedure to close the vagina can be done under spinal anesthesia.

Siddiqui says that of the 2.9 million women estimated to have POP, only 200,000 have it surgically corrected. Lawler, a nurse, admits she put off her surgery out of fear.

“I knew the surgery was coming. I knew I couldn’t live like this,” she says. “I found Dr. Siddiqui and loved her. I feel like the good Lord answered my prayers and got me to the right doctor.”

Waiting longer than necessary can mean more extensive surgery and a longer recovery, experts say.

“Don’t take this as a normal part of aging,” Siddiqui says. “It’s not. My oldest patient was 91 when she had the surgery. Age is just a number. Don’t let that affect your life. If you have another 10 to 15 years to live, they can be productive years.”

“It made quite a difference,” says Beckett, who had her surgery a year ago. “Life is so much easier as far as containment is concerned. I can laugh, giggle and run a little bit. Life has come back to normal.”

 

 

 

Last Updated: 11-04-2009

 

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