In her mid-50s, Sherrie Palm noticed she always needed to pee. While that was annoying, she didn’t feel too worried about it until she noticed a bulge near her vagina when she wiped. After three months, she investigated. Using a hand mirror she noticed a “walnut-sized” lump coming from her vagina.
“I thought, ‘OK, that can't be good, whatever it is.’ It wasn't painful. I just didn't know what it was,” the 67-year-old founder and CEO of the Association of Pelvic Organ Prolapse Support, told TODAY. “It looked like a tumor. I had never heard of vaginal tumors before.”
Palm visited her doctor who performed a pelvic exam.
“(My doctor) said very matter of fact, ‘You have pelvic organ prolapse. I’ll fit you with a pessary,’” Palm recalled. “I was a deer in the headlights. I had no clue what she was talking about.”
What is pelvic organ prolapse?
Pelvic organ prolapse occurs when the muscles and connective tissues in the pelvis, which hold up the pelvic organs, weaken causing the uterus, bladder or rectum to slip into the vaginal canal — doctors call them uterine, cystocele or rectocele, respectively. According to the American College of Obstetricians and Gynecologists, women in the U.S. have a 13% lifetime risk of having surgery to address pelvic organ prolapse.
“Pelvic organ prolapse is a condition that afflicts women of all ages and it is defined as the herniation or droppage of the internal female organs, the bladder, the uterus or the rectum, down into the vagina at different levels of severity,” Dr. Vatche Minassian, chief of urogynecology at Brigham and Women’s Hospital in Boston, told TODAY. “It gets more common as women age. It is more common in women who had children, multiple children, big children.”
While having children increases one’s chances of developing pelvic organ prolapse, the experts agree that other factors can contribute to it, including:
- Being overweight or obese.
- People who cough chronically, such as smokers.
- People who lift heavy weights.
“There are many things that cause muscle weakness and tearing of connective tissue. The biggest one is age and gravity,” Dr. Jill Rabin, professor at the Feinstein Institutes for Medical Research in New York, and author of the book, "Mind Over Bladder," told TODAY. “If you think about pregnancy, you’re carrying a progressive weight in your pelvis and uterus, which is pressing on your pelvic floor muscles for nine months. If you have a vaginal delivery, having the baby’s head come through the vagina stretches the muscle and tears connective tissues.”
The experts stress that women who never had babies, though, can also develop pelvic organ prolapse. And women who had hysterectomies can also develop it.
While women with severe pelvic organ prolapse, like Palm, might see a bulge, covered with vaginal skin, protruding from their vagina, there are earlier symptoms that could indicate a less severe form of prolapse, which include:
- Pressure in the vagina, pubic area.
- More frequent urination.
- An inability to empty the bladder.
- Anal incontinence.
But often women don’t notice the early signs. Too often they believe that peeing a little when they laugh or pain during sex are part of being a woman.
“These things are really common but they are not normal and there’s something that can be done about it and that’s really the message,” Dr. G. Sarah Napoe, an assistant professor and urogynecologist at UPMC Magee Womens Hospital in Pittsburgh, told TODAY. “Women just feel a lot of shame talking about these issues. … so they’re used to not mentioning (them).”
Incontinence is more common than pelvic organ prolapse, so not every leak means a serious problem. But it can mean that something is wrong and seeking treatment sooner rather than later can result in less invasive treatments.
“If they don’t do anything about it, these things start to impact their quality of life,” Napoe said. “Maybe they choose not to run or they to avoid social situations.”
Treating pelvic organ prolapse
Laura, who asked TODAY not to share her last name, is a mom of two in New Orleans. Before having children, she never thought about her pelvic floor. After having her second child, she noticed that she leaked when she sneezed or coughed.
“It wasn’t really pain or discomfort but I was having some problems with incontinence and I thought, ‘Oh, OK maybe this is just part of the recovery from having a vaginal delivery.’ But then it persisted,” the 39-year-old told TODAY. “I didn’t have the capacity to (know) something was wrong.”
When it didn’t improve after a year, she spoke to her doctor who recommended she see a urogynecologist. She opted for pelvic floor physical therapy instead of surgery.
“It wasn’t just like, 'Oh I sneezed and I pee,'" Laura said. "It was more than that and in hindsight I’m like what took me so long to put together the pieces?”
The first therapist she visited wasn’t the right fit. But then she met with a second therapist and they connected. She learned that pelvic floor health is more than just doing the occasional Kegel.
“When you’re pregnant everybody sort of does Kegels, right? But that’s sort of terrible advice because I wasn’t doing them properly,” Laura said. “Some people have loose muscles and some people have tight muscles or both. I learned that not only did I need to build strength but also I had to learn to release.”
Sara Reardon, a physical therapist at Nola Pelvic Health, who’s known online as The Vagina Whisperer, said that she often advises pregnant women to meet with a pelvic floor physical therapist while they’re pregnant to learn how to protect their bodies during labor. But she sees people at various stages of life.
“We do a lot of education on prevention. Teaching folks how to contract their pelvic floor muscles with exercise and how to properly poop, so they're not straining for constipation. How to pee so they can sit and relax, not push and bear down, which can weaken the muscles and ligaments over time,” she told TODAY. “So it's definitely for prevention. We definitely have tips to help improve (prolapse), if it does occur.”
Laura had noticed a difference since starting therapy and understands how to engage her muscles in a safe way when she exercises, for example. She was also fitted for a pessary like Palm. A pessary is like a diaphragm that sits inside the vagina to hold the organs in place. It's often a solution for many women with pelvic organ prolapse. But Palm opted for surgery in 2008 to treat the three types of pelvic organ prolapse she had and hasn’t had problems since.
“For definitive treatment, then surgery would be the option,” Napoe said.
Often surgery is performed laparoscopically, but traditional surgery and robotic surgery are also options. Some women balk at surgery, worried it could make things worse, but the experts say there are a variety of surgical corrections.
“The only thing that fixes the connective tissue anchoring of the organ to the muscle is surgery and the only thing surgery corrects is anatomy,” Rabin said. "Basically, it doesn't correct function.”
Rabin recommends that even people who undergo surgery also do pelvic floor physical therapy for better results.
Palm started her association to raise awareness of the condition and give women a space to talk about their experience.
"We have got to generate the dialogue to enable them to be able to ask the right questions and not only the women, but also the physicians have to be comfortable asking the right questions," Palm said. "What we hear in that space all the time with the newbies that are coming in is: 'Why wasn't I informed of this sooner and diagnosed sooner?'"