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Pelvic Organ Prolapse: Why Do Women Suffer Silently?

August 14, 2018

Women, known as the gender more likely to visit the doctor’s office for a medical issue, still remain largely quiet when it comes to pelvic organ prolapse.

“This is something that affects 13 percent of women, but many are still embarrassed to discuss it with their physicians,” says Dr. Paul Tulikangas, a urogynecologist with the Hartford HealthCare Tallwood Urology & Kidney Institute. “They suffer silently and, in the long run, they even adjust their lifestyles to accommodate it instead of seeking treatment.”

Pelvic organ prolapse, or POP, occurs when the layer of connective tissue holding the bladder, rectum and uterus in place weakens and the organs begin to protrude from the body through the vagina, often disrupting normal urination or bowel movements and interfering with sexual function.

There are several ways the team at Tallwood can help women with POP, including:

• Guidance with lifestyle changes, such as losing weight or practicing pelvic floor exercises to prevent the condition from worsening.
• Inserting a vaginal pessary into the vagina to help lift the uterus and vaginal walls.
• Prescribing a vaginal estrogen cream.
• Minimally-invasive surgery to repair the prolapse and restore normal anatomy.

Dr. Tulikangas was invited by the American College of Obstetricians and Gynecologists (ACOG) last year to author clinical guidelines for the nation’s obstetrician-gynecologists when treating women with POP as part of the group’s Practice Bulletin.

“This is a common reference for physicians treating POP,” he says. “For it, I reviewed and referenced hundreds of papers and incorporated my clinical experience caring for women. Ultimately, the guidelines are produced to standardize and improve the quality of care.”

Among the changes made since the guidelines had last been updated in 2011 was the industry shift away from using synthetic mesh to help hold the vagina and uterus in place. After problems with the product were revealed several years ago, Tulikangas says ACOG wanted to offer specific direction as to when it should be used. Many patients, he adds, are able to have reparative surgery with no mesh, but for some, the addition of a mesh or graft support might improve their outcomes.

“We found that there are fewer complications using mesh in laparoscopic and robotic surgery versus prolapse procedures done through the vagina, for example,” he offers. “Physicians are urged to balance the risk of using the mesh with its potential benefits for the patient. Shared decision-making to understand a patient’s goals and concerns is critical.”

His research also supported use of the POP Quantification standard for determining the extent of each woman’s prolapse to ensure that care plans are tailored to a patient’s individual needs.

“Evaluation of the extent of the prolapse is important before treatment so the surgeon has a way to measure postoperative success,” he says.

For more information on treatment for pelvic organ prolapse, click here.