I was walking through the operating room one day when a cardiac surgeon stopped me and asked for help.
“I’m about to do surgery on an older woman and we cannot get a urinary catheter into her bladder. Could you lend us a hand.”
The woman had a problem called pelvic organ prolapse. That means that her uterus and bladder had literally dropped out of her body through her vagina and was easily seen between her legs. That changes the angle of the opening to the bladder and the surgeons could not get the catheter in. For me, it was a familiar problem and I quickly inserted the catheter. After thanking me on my way out the door, I turned and said, “I may be the first gynecologist to do a cardiac cath.” We all smiled and they went on to do their surgery.
Pelvic organ prolapse is more common than you think. It means protrusion of pelvic organs (uterus, bladder, small intestine, or rectum) into the vaginal wall. There are four stages of it, from organs lowering into the upper vagina to dropping completely through and outside of the vagina.
Symptoms include ongoing vaginal pressure, loss of urine, fecal leakage, and painful intercourse. A survey found that for women over 50, as many as half have some dropping of their pelvic organs. Most treat it as a best kept secret. It’s no wonder; pelvic organ prolapse can do a number on a woman’s self-esteem.
The good news is that there are a number of ways to treat it. 1) Hysterectomy (removal of the uterus), 2) Reconstructive surgery to lift up the pelvic organs, and 3) Use a pessary, a device used to prop up descending organs.
The most common causes are weakening of the tissues after menopause due to loss of estrogen, and tears in the support tissues due to childbirth that allows abdominal pressure to slowly press the organs downward. Obesity is another contributing factor.
Pessaries have been around since the 16th century and are attributed to Ambrose Pare. He hammered oval rings out of brass, silver and gold, and fashioned them out of cork.
Today they are made of inert plastic or silicone so they don’t absorb vaginal secretions and are present in most gynecologists offices. Some look like a birth control diaphragm. Others are different shapes. If you feel pressure or they fall out, you just need a different size. If you want to have sex, just remove the pessary before. Otherwise, you can leave it in for a long as 3 months before taking it out and rinsing it off with warm water in the sink.
They are placed into the vagina to keep the pelvic organs lifted. They should be painless when inserted and while they are in.
A new study published in February in the journal Menopause followed women who used a pessary for 5 years to see how satisfied women were using them and how commonly women had complications.
Seventy-five percent of women reported significant improvement in their symptoms and continued using their pessary for the entire 5 years. There were minimal complications. For those who discontinued use of the pessary, they did so within two years and chose to have reconstructive surgery.
The most common reason women gave for stopping the use of the pessary was shortening of the vagina which caused discomfort when inserting the device. Some didn’t like it because it didn’t improve their symptoms and others discontinued use because they couldn’t insert it themselves and depended on their family to do it for them.
But the study shows that for most women dealing with this common and troublesome issue, use of a pessary was a satisfactory way to treat the problem without surgery and it could be used safely and comfortably for years.
If you have any of these concerns, talk with your healthcare provider.
