Yes, You Can Live with Pelvic Prolapse: Here's How

Many women contend with pelvic floor problems, including urinary incontinence and pelvic organ prolapse -- when pelvic organs drop due to weakened muscles and tissues.

“Gravity is not our friend,” Sangeeta Mahajan, MD, chief of Female Pelvic Medicine and Reconstructive Surgery at UH, tells her patients.

Urinary Incontinence Solutions

One symptom of pelvic organ prolapse is urinary incontinence. Close to 40 percent of women over age 60 report urinary incontinence. There are two types: stress incontinence and urge incontinence. Stress incontinence happens when you cough, sneeze or exert yourself and experience leakage. You may also leak with intercourse. Urge incontinence is not related to activity, but is an uncontrollable and frequent urge to urinate.

“There are some people who urinate every half hour or hour all day long,” Dr. Mahajan says. “I have patients who get up three, four, five or six times a night. It has a significant impact on their quality of life.”

Yet Dr. Mahajan emphasizes that wearing diapers or pads is not inevitable. There are solutions to incontinence, ranging from conservative management to surgery.

She suggests patients first try behavior changes: cut back on caffeine to one caffeinated beverage a day (both caffeine and alcohol can exacerbate urge incontinence). Space out fluids, and keep it to 60 to 80 ounces a day. Stop fluids two to three hours before bedtime. Set times to urinate, increasing intervals. Pelvic floor physical therapy can also help improve pelvic squeeze and tone.

These changes alone can result in a 50 percent improvement, Dr. Mahajan says.

Many medications are also available. They work best in combination with behavior changes, she says.

“I tell patients you can’t just take a diet pill and eat a cheese pizza at bedtime and plan to lose weight,” she says. “You’ve got to work on taking the medicine and also work on the habits, like the drinking habits.”

Other treatment options for urinary incontinence include:

• A pessary, which is a small ring that goes in the vagina to stop leakage.
• Acupuncture to stimulate nerves in the bladder.
• Bladder Botox for overactive bladder and urge incontinence.
• Sacral neuromodulation, in which electrodes stimulate nerves in the bladder to make it less overactive, similar to a pacemaker.
• Midurethral mesh sling, which involves a minimally invasive surgery for stress incontinence.

Pelvic Organ Prolapse is Common

With regard to pelvic organ prolapse, Dr. Mahajan says it’s very common and often does not require treatment. About 40 percent of women ages 50 to 79 have some form of prolapse, according to the Women’s Health Initiative.

It’s caused by weakening of the pelvic floor -- the muscles, ligaments, connective tissue, and nerves that help support and control the rectum, uterus, vagina, and bladder. The pelvic floor can be damaged by childbirth, repeated heavy lifting, chronic disease or surgery.

Aside from incontinence, symptoms of prolapse include feelings of heaviness or pressure in the lower abdomen and genitals, discomfort, and a bulge coming out of the vagina.

The causes of pelvic organ prolapse are complex. It’s often influenced by genetics, race, aging, pregnancy, smoking and obesity.

Some women may need surgery if prolapse blocks urination or causes discomfort. “But if it doesn’t bother you, we just watch it,” Dr. Mahajan says.

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University Hospitals offers comprehensive care for women in every stage of life, from well-woman visits to diagnosis and treatment for the full spectrum of gynecologic and women’s health conditions. Learn more about OB/GYN and women's health services at University Hospitals.