Friday, 18 November 2016

What do you know about prolapse?

Let's talk about prolapse...

What’s the best way to talk about prolapse?

It seems to me that women are better now at talking about bladder leakage – either to their friends or their GP – using phrases such as ‘don’t make me laugh’ or ‘I couldn’t go on a trampoline’. A ‘legs crossed and oops’ moment with a sneeze is easily understood and ‘wearing a pad just in case’ doesn’t need to be said in hushed tones.

The products for incontinence are much more available and taking up more and more space on the shelves – for men and women. We can also talk about the effects of ageing on the body: ‘everything heading south’, ‘not as young as I once was’, ‘laughter lines’ not age creases. I have been a specialist women’s and pelvic floor physiotherapist for over 20 years but don’t yet have the answer to “What is the right language to talk about prolapse?”

What actually is a prolapse?

Prolapse is a very common problem for women who have had children, and the risk of prolapse increases with each decade of life. Estimates are that up to 50% of all women will have a prolapse at some point in their life. Prolapse or pelvic organ prolapse is where the walls of the vagina or the uterus (womb) move downwards creating a feeling of something coming down, vaginal heaviness or bulge.

It does not always have to involve the uterus, and although some people talk of their ‘bladder falling down’, it is the wall supporting the bladder rather than the actual bladder itself. The same goes for the back wall of the vagina, which is the one that supports the bowel or back passage. You can still have a prolapse even if you have had your womb removed (hysterectomy), in which case the ‘roof’ or top of the vagina can slip downwards.

The heavy feeling associated with a prolapse may not be the most bothersome problem. Prolapse may also cause difficulties with your bladder or bowel either with leakage or problems emptying your bladder or bowel completely. This can cause a sensation of never feeling properly finished on the loo. Sometimes, a prolapse can mean that you feel the need to go for a pee less often during the day but seem to need to go more often during the night.

What can be done for this common problem?

Not all prolapses get worse over time, so it may be that you don’t need to do anything apart from taking care not to do things that are likely to make the symptoms worse – heavy lifting, putting on too much weight, getting constipated and straining on the loo.
Sometimes an operation is advised, to try and lift the vaginal wall back into place. This might include having a hysterectomy.
There are non-surgical options which include exercising your pelvic floor muscles to be stronger to help lift the fallen walls back up. Your pelvic floor muscles are slung from the front to the back of your pelvis and just like your other muscles need to be exercised – ‘use it or lose it’. These muscles help keep your back passage and bladder closed to stop leakage of urine or wind or poo. But also help support the vagina and back passage.

You might also be offered a pessary.
What is a pessary?
A pessary is a synthetic device usually made of silicone which is positioned inside the vagina to help support the walls or uterus and lift them back into place. Usually a doctor will fit the pessary, which  might  take a few attempts to get the sizing right,  and it will stay in for 3-6 months before it gets checked and replaced. You can keep using a pessary as long as there are no problems with it. A pessary is not: ‘just for the elderly’, ‘not suitable for those who want an operation’, ‘a last resort option’, but using a pessary does require follow up care to make sure that it remains correctly fitted and right for you.
 So let’s talk about prolapse
 The first thing to be clear about is that bladder and bowel problems aren’t an automatic consequence of having children or ageing – yes more likely- but not to be assumed. So don’t accept ‘well you’ve had children’ or ‘at your age……’ Instead you need to work out what you might feel ok saying to your doctor, family, partner, friends without feeling ashamed or embarrassed.
How about:
I am having a problem with my bladder and can’t empty properly, or need to return to the loo soon after I have been
I can feel a heaviness vaginally (or ‘down below’ if that seems easier) which is making me uncomfortable
I am not constipated, but can’t empty my bowel properly which leaves me feeling uncomfortable
I am aware of a bulge protruding out when I wipe myself after being to the toilet
I can feel something coming down, particularly after I have had the grandchildren for a day, or have had a long day on my feet.

Then you need to ask how best to find out exactly what the problem is and what treatments are available to help things to feel better. Your doctor should refer you to see a specialist in the hospital for further assessment and to give you access to specialist physiotherapists or nurses who can help.

My research is to try to find out what questions women and clinicians have about pessary use for prolapse and have a survey open until January 2017. If you would like to take part, click on this link:

The questions will all be included in a process to find the top ten priorities for future research.
What words do you use to talk about this subject?