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Specialist clinics
6 OCTOBER 2019 • HEALTHCARE INNOVATIONS Understanding pelvic organ prolapse
Pelvic organ prolapse isn’t uncommon, explains consultant gynaecologist and obstetrician Miss Avanti Patil
• T e commonest symptom is the sensation of a lump or a bulge ‘coming down’ causing discomfort inside the vagina
• Frequent urination; incomplete emptying of the bladder; urinary leakage on coughing, sneezing or laughing; and frequent cystitis due to bladder prolapse
• Constipation or incomplete bowel emptying; needing to push back the prolapse to allow stools to pass; low back pain due to bowel prolapse
• Discomfort or a lack of sensation during sexual intercourse
• T ere may not be any symptoms at all, however, and the prolapse may only be revealed following a vaginal exami- nation by a healthcare professional, such as during a smear test. It’s also worth noting that a small prolapse can often be normal.
HOW IS PROLAPSE DIAGNOSED? Your doctor will perform a vaginal examination as well as a speculum (a plastic or metal instrument) examina- tion to check which part of pelvic fl oor is prolapsing.
DOES THIS CONDITION ALWAYS REQUIRE TREATMENT? No. If you only have a mild prolapse or have no symptoms
from your
prolapse, you may choose to take a ‘wait and see’ approach. T e following may ease your symptoms: • Lifestyle
changes such as losing
weight; managing a chronic cough by stopping smoking; and avoiding constipation, heavy lifting or high-impact exercises
• Doing pelvic fl oor exercises — you may be referred to a
Patients who come to my urogynae- cology clinic, she explains, say things like: “I feel a lump or a bulge from down below, doctor. What could it be?” Well, it can be a sign of prolapse.
WHAT EXACTLY IS PELVIC ORGAN PROLAPSE (POP)? T e ‘pelvic fl oor’ is a group of muscles that form a kind of hammock across your pelvic opening. Normally, these muscles and the ligaments surrounding them keep the pelvic organs in place. T ese organs include your bladder, uterus, vagina, small bowel and rectum. If these support structures are
weakened by overstretching, the pelvic organs
can bulge into the
vagina. T is is what’s known as pelvic organ prolapse (POP).
HOW COMMON IS POP? It’s diffi cult to know exactly how many women are aff ected by prolapse, since many don’t consult their doctor about it. However, it does appear to be very common, especially in older women. Half of women over 50 will have some symptoms of POP, and by the age of 80, more than one in 10 will have had surgery to treat a prolapse.
WHY DOES POP HAPPEN? Any event that increases pressure within the abdomen can lead to POP, including: • Pregnancy / childbirth • Ageing, particularly after the menopause
• Being overweight • Constipation, persistent coughing and heavy lifting
• Following a hysterectomy, the top of the vagina (vault) can prolapse
• Genetics may also play a role Often, it’s a combination of these factors that results in a prolapse.
WHAT ARE THE DIFFERENT TYPES OF PROLAPSE? T ere are diff erent types of prolapse, depending on the organ that’s bulging into the vagina. • Cystocele — the bladder bulges into the front wall of the vagina
• Rectocele — the rectum bulges into the back wall of the vagina.
• Uterine prolapse — the uterus hangs down into the vagina
• One in 10 women who have had a hysterectomy can have the top of vagina (vault) prolapse down
WHAT ARE THE SYMPTOMS OF POP? T e type and severity of prolapse will determine the symptoms. T ey can include:
physiotherapist who specialises in prolapse management
• Using vaginal oestrogen cream
WHAT ARE THE OPTIONS FOR TREATING POP? Your options for treatment will depend on the type of prolapse you have, how severe it is and your indi- vidual circumstances. Treatment options include physiotherapy, pessa- ries and surgery. Pessaries are plastic or silicone
devices which fi t into the vagina and help support the pelvic organs. T ey come in various shapes and sizes, but the most common type is a ring pessary. You may choose this option if you don’t wish to have surgery, are thinking about having children in the future or have a medical condition that makes surgery more risky. Pessa- ries should be changed or removed, cleaned and reinserted regularly. T is can be done by your doctor, nurse or
sometimes by yourself. It’s possible to have sex with some types of pessary although you and your partner may occasionally become aware of it. T e aim of surgery is to relieve
your symptoms while ensuring your bladder and bowel each function normally following the operation. If you’re sexually active, every eff ort will be made to ensure that your sex life is as enjoyable as ever after the operation. Your decision to have surgery will
depend on the severity of your symp- toms and the impact the prolapse has on your daily life. T e type of surgery will depend on the type of prolapse, symptoms, your age, general health, desire to have an active sex life and whether you plan to have children in the future. Some women may choose to delay having surgery until their family is complete.
HALF OF WOMEN OVER 50 WILL HAVE SOME SYMPTOMS OF PELVIC ORGAN PROLAPSE, AND BY THE AGE OF 80, MORE THAN ONE IN 10 WILL HAVE HAD SURGERY TO TREAT A PROLAPSE
MEET THE EXPERT operations
In recent years, a number of new have
been developed
where a mesh (supporting material) is sewn into the vaginal walls. T e risks and benefi ts of mesh are unclear, and it’s currently recommended that oper- ations using mesh for prolapse repair are only performed in the context of research. Current evidence doesn’t recommend the routine use of mesh to treat prolapse as the fi rst surgical intervention, due to higher compli- cation rates when compared to non-mesh repairs. Your gynaecologist will advise you
about which procedure is best for you — the pros and cons of each option, the risks and the recovery plans — so you can decide whether you wish to go ahead with your operation. T e key points to remember are
that prolapse isn’t life-threatening, although it may aff ect the quality of your life. Not everyone with prolapse needs surgery, but you may wish to consider surgery if other options have not adequately helped.
Miss Avanti Patil, MBBS, DFFP, FRCOG, is a consultant gynaecologist and obstetrician at Buckinghamshire Healthcare NHS Trust, Bucks. She has special interests in urogynaecology (urinary incontinence, urodynamic and pelvic organ prolapse, vaginal reconstructive surgery) and postpartum perineal problems. Miss Patil is the lead clinician
for the gynaecology arm of the obstetrics and gynaecology speciality, and keeps ‘patient- centred satisfaction goals’ as a mainstay of her practice. Miss Patil has a wide range of expertise in general gynaecology providing high-quality care to women with menstrual disorders, pelvic pain, endometriosis, contraception and the menopause. Miss Patil is also a specialist
consultant for women with spinal injuries (for their gynaecology issues) at the National Spinal Injuries Centre, Bucks. She enjoys spending time with her daughter and has a passion for meditation.
Medical secretaries: Mrs Lindsay Gough and Mrs Gill Corbett T: 07702 499189 / 01296 337988 E:
lgcprivatepractice@gmail.com
Private Hospitals: BMI The Chiltern Hospital, Great Missenden, Bucks BMI The Shelburne Hospital, High Wycombe, Bucks
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