Q: I'm a postmenopausal woman who suffers from urinary incontinence. I've just learned that my incontinence is due to pelvic organ prolapse. What does this mean? What is the treatment?
A: Pelvic organ prolapse is a condition in which tissue from the uterus, bladder, urethra or rectum drops down into the vagina. As many as one in three middle-aged women have some degree of pelvic organ prolapse.
Mild prolapse usually doesn't cause symptoms, but more advanced prolapse can. The most common are discomfort, heaviness or pressure. A woman can feel these sensations in her vaginal area, pelvis, lower abdomen, groin or lower back. With the most advanced prolapse, a woman notices a bulge of tissue protruding from her vagina. Prolapse can also cause pain during sex or an inability to have an orgasm.
You ask about incontinence. Along with a frequent urge to urinate, incontinence is common in women with pelvic organ prolapse. That's because when the pelvic organs drop down from their normal position, they put pressure on the bladder and the tube (called the urethra) through which urine flows. This can increase the urge to urinate and reduce a woman's control over when she urinates.
Why do women get pelvic organ prolapse? Probably the most important factor is having given birth. Women who have given birth to four babies are 10 times more likely to develop prolapse than women who have never given birth. Especially when the birth has been a vaginal delivery, rather than a C-section, there is a chance that the muscles and tissues in the floor of the pelvis will be weakened. That predisposes a woman to prolapse in later years.
Kegel exercises to strengthen pelvic floor muscles may be enough to control mild incontinence. To perform Kegels, squeeze the muscles you would use to hold back urine or to stop urinating midstream. Tighten these muscles and hold them tight for a few seconds. Repeat 10 times per session. Do approximately four sessions each day.
Another treatment option is a pessary, which is a rubbery, ring-shaped device that fits into the upper portion of your vagina. Pessaries can help prop up your uterus and bladder and prevent them from dropping into the vagina. (I've put an illustration of how a pessary helps to control pelvic organ prolapse on my website, AskDoctorK.com.)
You may also consider surgery to repair the ligaments, or bands of fibrous tissue, in your pelvic area. Surgery helps to relieve symptoms and restore normal anatomy, bowel and bladder function, and the ability to have sex.
For postmenopausal women, hysterectomy, the surgical removal of the uterus and sometimes the cervix, is the most common treatment. There's some question about whether surgeons should also remove the ovaries of postmenopausal women during this procedure. If you're considering a hysterectomy, ask your doctor about the individual risks and benefits of removing your ovaries.
• Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115