Rectocele, a form of POP, Image from FDA
Mesh News Desk, August 17, 2016 ~ You've heard the term "pelvic organ prolapse" and may have seen the shortcut POP. But what does it mean and how likely are to be be affected by this condition?
What is Pelvic Organ Prolapse?
Pelvic organ prolapse was called the female version of a hernia. Prolapse refers to the dropping of the pelvic floor, the uterus or even part of the colon. The lowest part in the pelvic floor is the vagina so unfortunately gravity pushes the dropped organs down to and even outside of the body through the vagina. That bulge can be measured in degrees of prolapse called the POP-Q system.
Transobturator mesh, from Scottish Pelvic Floor Network
Why does this happen?
Childbirth is one reason women experience POP. A difficult delivery or a very large child may compromise the pelvic floor, its muscles and ligaments. Some women may have inherited weaker collagen making organs less likely to stay in place for her lifetime. Smoking is also thought to weaken tissues since smoking deprives them of much-needed oxygen. Obesity puts more pressure on the entire abdomen as does pushing on the pelvic organs due to constipation.
Menopause can increase the likelihood of POP as can a hysterectomy. During that procedure, a woman’s uterus and ovaries may be removed leaving a large empty space where surrounding organs may prolapse or cave in due to gravity. That is one more thing to consider before agreeing to undergo a hysterectomy.
Pelvic mesh manufacturers, that predicted a multimillion dollar industry from creating pelvic mesh to treat POP, often refer to it in the literature as a disease” that needs “treatment.” This is an overstatement of the condition of POP.
The condition of prolapse is just that - a “condition” not a disease. It is often without symptoms or pain. Women may feel a slight pressure in the vagina. They may experience difficulty urinating or having a bowel movement.
Sometimes the woman is surprised to find something bulging out of her vagina and that is the first clue that she is experiencing pelvic organ prolapse.
Urologists estimate up to fifty percent of women will experience some degree of prolapse in their lifetime. With that many women affected, you would think this condition would be discussed more often than it is.
What are the treatments?
In the case of POP, a woman maybe fitted with a pessary, which is a small silicone device placed in the vagina to hold back fallen organs. A woman may have to undergo several different fittings to find the one that is right for her. A pessary can be removed to be cleaned and for sex.
Pelvic floor exercises may be recommended to strengthen the pelvic floor.
A suture repair may tack back into place fallen organs. Its success is very dependent on the condition of one’s tissues.
At one time, doctors recommended pelvic mesh as a first option for treatment but with more than 100,000 defective product lawsuits filed in the U.S. and the numbers growing, many doctors have decided to stop using polypropylene pelvic mesh. Those with surgical skills may opt instead to harvest a portion of a woman’s own fascia to create a biocompatible mesh that her body won’t reject.
A repair using a fascia involves healing from the harvest surgery as well as the pelvic surgery, but a woman is far less likely to suffer pain and the repeated surgeries associated with a polypropylene pelvic mesh repair.
Even the conservative Food and Drug Administration (FDA) says mesh for pelvic organ prolapse repair has complications that are “not rare” and mesh should not be a first line treatment for the condition of prolapse.
Ask your doctor if he or she is well-versed in non-mesh repairs. If not, it may be time to seek new medical counsel for your condition of pelvic organ prolapse. ##