According to Johns Hopkins Women’s Center for Pelvic Health, “about 95 percent of women walk around with some form of pelvic organ prolapse.”
“Most of the time,” Hopkins continues, “the condition is mild, but up to 50 percent have symptoms that can significantly affect their quality of life.”
That said, Dr. R. Carrington Mason, a urologist with Cleveland Clinic Indian River Hospital, quashes any fears that this is a sudden or urgent epidemic.
“You don’t have to treat it,” Mason quietly explains, “just because it’s there. It has to have some symptom and ‘bother’ factor to it.” And, he adds, “what bothers some women doesn’t bother others at all.”
For the record, the American College of Obstetricians and Gynecologists defines the pelvic organs as “the vagina, uterus, bladder, urethra and rectum. These organs are held in place by muscles of the pelvic floor. Layers of connective tissue also give support. Pelvic organ prolapse occurs when those tissue and muscles can no longer support the pelvic organs and they drop down.”
This can be – at least in part – a result of pregnancy or childbirth, but women who’ve never had children can also experience prolapse.
“The question,” according to Mason, “is how much of it is symptomatic and how much of it is actually causing functional change in what people are doing.
“Just because someone has an anatomic sag of the bladder or the rectum doesn’t mean that they have to have something done with it. But is it causing constipation? Is it causing retention of urine? Do they get urinary tract infections? Is there something that is altering their lifestyle in terms of what they do,” are among the questions Mason asks.
Asking the right questions is, it seems, Mason’s raison d’être.
“The most common and most effective diagnostic tool for pelvic organ prolapse,” he says, “is a good physical examination and a good chat with a patient because [that’s where] you can hear what’s going on.”
For example, Mason points out, “there are some ladies who leak two drops [of urine] and they think they’re going to die. And then there’s other ladies who leak through diapers and they just think they’re wasting my time. Everybody has different bother levels as far as what would drive them to go get something done.”
And, of course, different pelvic organs affect different systems, and that means there are multiple types of prolapse.
Women suffering from uterine prolapse often report a sensation of dragging, heaviness or pulling in the pelvis, with a feeling of “sitting on a small ball.” It can also be accompanied by low backache and, in moderate to severe cases, protrusion from the vaginal opening. Uterine prolapse may also cause difficult or painful sexual intercourse.
Lower levels of bladder support can lead to a “reservoir effect” where the bladder is not completely emptied when the urine is passed. The remaining urine then irritates the bladder, leading to bladder spasms, which causes urgency and is sometimes severe enough to produce an involuntary leakage (incontinence). A lax and irritable bladder may also leak during intercourse, due to the pressure exerted upon it.
Women suffering from rectal prolapse complain of a sensation of bulging in the vagina when they strain to open their bowels. There is in effect an “S-bend” effect in the vagina, where feces move into the reservoir created by the prolapse. Despite the urgency to open the bowels, very little bowel motion is likely to occur, as the reflexes tend to be lost due to this pouch effect. Constipation and irritable bowel syndrome may also result from this.
The good news, according to Mason, is newer robotic techniques and skin grafts have made fixing these problems faster and safer than they were before and he is clearly eager to explain to his patients in detail how he does that before they consent to any procedure.
The much-maligned “mesh” products are now gone and, as Mason puts it, with skin grafts and robotic techniques, he can perform the needed procedures “in an hour and a half and they go home the same day, as opposed to having hospitalization and that sort of thing.”
“In my prior life before I moved here [from] the teaching hospital Methodist Dallas Medical Center,” he adds, “we had an OB-GYN residency program and all the OB-GYN residents rotated with me to learn how to do all this, so I’ve been involved with teaching at that level” for some considerable time.
Dr. R. Carrington Mason is an accomplished urologist with the Cleveland Clinic Indian River Hospital. His office is at 3450 11th Court, Suite 303. The phone number is 772-794-9771.
