Dr. Jones: What do Utah women who've had lots of babies have in common with female paratroopers? This is Dr. Kirtly Jones from Obstetrics and Gynecology from University of Utah Health Care. And if you want to know the answer, stay tuned to The Scope.
What Is Pelvic Prolapse?
Dr. Jones: So what do women who have lots of babies through the vagina, through vaginal birth, or maybe only one baby, have in common with female paratroopers who haven't had any children? Both groups are at increased risk for pelvic prolapse. This means their inside female parts are falling out. Having a vaginal birth and repeated trauma to the pelvic floor, as a female paratrooper can have, can cause the support to the uterus and the cervix to stretch and then drop a little lower in the vagina.
Commonly the cervix may be as low as at the entrance to the vagina and occasionally the cervix and uterus may actually be positioned outside the vagina. This is called pelvic organ prolapse. Not only can the uterus come down, but the bladder can come down leading to urinary leaking or difficulty urinating. Both situations can be uncomfortable. Today in The Scope radio studio, we're talking with Jan Baker, a nurse practitioner in the Pelvic Floor Clinic at the University of Utah. She specializes in the evaluation of pelvic organ prolapse and in the non-surgical management of this common problem. Jan, welcome to The Scope.
Jan: Thank you, Kirtly.
Dr. Jones: So how common is this? Not very many female paratroopers, but a lot of people have had babies.
Jan: Well, it's likely more common than our statistics tell us because this is, again, one of those unspeakable problems that women don't want to talk about. But it is thought that about one and a half to 1.8, almost 2 women per 1000 women have prolapse, some form of prolapse. But when we do studies of women with no symptoms of prolapse and they're examined, up to 50% of those women can have prolapse. Although it may not be where they're noticing it, but they have started to develop prolapse. So prolapse symptoms usually peak right around age 60, but about half of the women that seek care for prolapse symptoms are usually between the ages of 30 and 60. So it is quite common.
Conditions That Can Cause Pelvic Prolapse
Dr. Jones: So what conditions can cause this? We mentioned having births and we mentioned being a paratrooper.
Jan: The biggest risk factor is childbirth, then just getting older.
Dr. Jones: Oh, great.
Jan: Because, unfortunately, the longer you're alive, the more and more gravity has its effect.
Dr. Jones: Gravity wins. Gravity always wins.
Jan: Gravity always wins, but obesity, menopause, family history, race . . . Latinas and white women are more likely to get prolapse, and a previous hysterectomy also seem to play a role in the development of prolapse.
Early Symptoms
Dr. Jones: So what are the symptoms a woman might have that would suggest that they might have this problem?
Jan: Well, the most common early symptom is kind of this mild pelvic pressure or maybe a mild kind of a backache at the end of the day. Maybe some mild urinary frequency, maybe feeling like they need to go to the bathroom a little bit more frequently.
Dr. Jones: And later on?
Jan: And then, later on, they may start to notice a bulge coming from their vagina, or they may start struggling with a bowel movement and that is usually what brings women to seek care.
Dr. Jones: Yeah. So what can be done about it?
Self Care before Seeing a Physician
Jan: Well, if the prolapse is not very bothersome, watchful waiting is a very good option. Education, though, at this time, can really be important. Because, although we don't know for sure, many experts in the field believe that weight loss, managing constipation, managing a chronic cough, reducing high-impact aerobic exercises such as jumping or running or jumping out of an airplane, or a trampoline, jumping on a trampoline. Using vaginal estrogen, smoking cessation and doing a pelvic floor muscle exercise might slow down the progression.
So actually talking to women about these things, maybe that might make a difference. You know, these interventions make sense because you're not continually putting pressure on the pelvic floor, but we don't have any good research to support their use. But they do make sense and they don't have any side effects.
Dr. Jones: Well, that's good. Actually, just knowing that what you have is there and it's common and it's not cancer, it's not a tumor. This is just life on the planet Earth and we can't move to a smaller planet with less gravity. So if a woman doesn't want surgery or isn't a good candidate for surgery because of her age or medical conditions, what are some of the non-surgical options?
Jan: So if the vaginal bulge has started to bother them, a vaginal pessary is a good option for her. And it's really good for those women who don't want to have surgery, who maybe cannot have surgery because they have medical problems that make it not a safe option.
Dr. Jones: Or they're going on a walking trip to Europe right now, no time for surgery. What can we do until I get back?
Jan: And maybe they can postpone, they want to postpone surgeries, but they want to be comfortable, exactly.
What's a Vaginal Pessary?
Dr. Jones: So can you help me with what's a pessary?
Jan: Well, a pessary is a device that fits inside the vagina and it's made from rubber, plastic or a silicone-based material. Lots of sizes and shapes. And what I do in the clinic is I fit a woman. We basically put a pessary in and see how it fits. The only reason a woman would know that she has the pessary in place is that she doesn't have the vaginal bulge anymore. She should not even know that pessary is in place. And what's interesting is pessaries have been used before Christ. And what they used were pomegranates, and more recently, potatoes have been used. Although, we don't recommend those use now because we have pessaries that have been developed by scientists.
Dr. Jones: A little cheaper, though, but having said that I would rather have something that was made out of silicone than something that might sprout. Well, okay, so how well do they work?
Jan: Sixty-three to 83% of women can be fit with a pessary and of those women that can be fit, 76 to 80% of those are satisfied with their pessary.
Dr. Jones: And how long can you use them?
Jan: Well, you can use a pessary as long as you want to.
updated: October 22, 2020
originally published: September 17, 2015
