Hot flashes, mood swings and no desire to have sex - all
are common symptoms of the menopause.
It is a stage in life that the majority of women dread,
it signaling the end of their reproductive years.
But, a new piece of research has shed light on how more
than half of women who go through the change; secretly grapple with an
embarrassing set of symptoms rarely discussed.
Researchers from Dartmouth, Yale and Connecticut
Healthcare Symptoms found that 51 per cent of post-menopausal women deal with
vaginal and vulvar problems. Those problems include itching, burning, pain,
discharge or odor. While others suffer
from problems with urinary frequency, fecal incontinence and pelvic organ
prolapse as well.
Despite the severity of the symptoms, researchers warn
the majority of women do not seek the medical help they need.
In this post, we will review the pelvic organ prolapse,
the symptoms, implications, and the treatment options.
Menopause &
pelvic organ prolapse at a glance
Changes in a woman’s pelvic floor function often
accompany menopause. Weakening of the pelvic support structures can lead to
pelvic organ prolapse, in which one or more organs (bladder, uterus, urethra,
vagina, small bowel or rectum) of the pelvic area drops out of place.
While there are many causes of pelvic organ prolapse
(heavy lifting, vaginal birth, hysterectomy), the lack of estrogen during
menopause thins the support structures and tissue that hold pelvic organs in
place, causing them to fall.
What is going on?
The pelvic organs are kept in place by the muscles and
connective tissues of the pelvis (pelvic diaphragm). The vagina of an adult
woman is normally a round-topped, muscular tube that also supports the other
pelvic organs. The pelvic muscles and tissues can be stretched or damaged, most
commonly by childbirth. When they don't recover, they lose their ability to
support the organs.
The location and severity of pelvic organ prolapse is
related to where in the pelvis the injury or muscular damage has occurred. You
may have several areas of injury that contribute to prolapse. Prolapse may
occur after surgery to remove the uterus (hysterectomy) if the procedure
removes or damages support of the bladder, urethra, or bowel wall. If other
conditions, such as childbirth, damage muscles or nerves in the pelvis, the
pelvic diaphragm may lose its dome shape. It may become more like a funnel and
then bulge down into or out of the vagina.
Pelvic organ prolapse may increase pressure on the vagina
and interfere with sexual activity, sometimes leading to sexual dysfunction.
Additionally, the thinning and the lack of vaginal
moisture associated with menopause can also cause problems with sexual
function. The vaginal tissue becomes frail and less supple, and stretching from
intercourse can be very irritating or even painful at times.
Lower estrogen levels during and after menopause make
pelvic organ prolapse significantly more likely. Estrogen helps your body to
make collagen, a protein that enables the supportive tissues of the pelvis to
stretch and return to their normal positions. When estrogen levels go down, so
do collagen levels. Less collagen makes it more likely that those supportive
tissues will tear.
Types of pelvic
organ prolapse
Different types of pelvic organ prolapse affect different
parts of the vagina:
* Cystocele
and urethrocele.
A cystocele occurs when the
bladder protrudes into the front wall of the vagina. A similar defect, known as
a urethrocele, develops when the urethra presses into the front vaginal wall.
* Rectocele.
Part of the rectum bulges into
the back wall of the vagina, sometimes causing difficulty with defecation.
*
Uterine
prolapse.
The uterus drops down into the
vagina. In women who have undergone a hysterectomy, a similar condition known
as vaginal vault prolapse can occur: the top of the vagina protrudes into the
lower vagina.
Menopausal pelvic
organ prolapse symptoms
Symptoms associated with pelvic organ prolapse can range
from minor pain and difficulty urinating to emotional distress. Unlike other
symptoms of menopause, such as hot flashes, pelvic organ prolapse symptoms can
increase with age.
Symptoms related to varying types of pelvic organ
prolapse include:
* Pain or a feeling of pressure in the pelvis or
vagina
*
Feeling that something is coming out of your
vagina or sight of tissue protruding from the vagina (which may bleed or feel
tender)
*
Difficulty urinating or a feeling that the
bladder will not empty (incomplete voiding); bowel movement difficulty
*
Lower back pain
*
Urinary incontinence (urine leakage during
sneezing, coughing or exertion)
*
Frequent bladder infections
*
Painful sexual intercourse (dyspareunia)
Treatments for
menopausal pelvic organ prolapse
Since lack of estrogen is the primary cause of menopausal
pelvic organ prolapse, treatment in postmenopausal women involves hormone
therapy (HT). These can help restore the vagina to premenopausal condition and
may help to strengthen the vaginal structures supporting the pelvic floor. The
most common HT is low-dose vaginal estrogen replacement, utilizing creams,
tablets or vaginal rings.
Women with no or very mild symptoms don't need treatment,
although they should avoid anything that might worsen the prolapse. Losing
weight if necessary, avoiding lifting heavy objects, and quitting smoking all
prevent prolapses from progressing. Prolapse doesn't necessarily worsen over
time, so there's no need to seek aggressive treatments, unless your symptoms
are really bothersome.
If you're experiencing major discomfort or inconvenience,
surgery is the only definitive way to relieve symptoms and improve your quality
of life. But if your symptoms are mild or you want to delay or avoid surgery,
less invasive treatments can help:
Kegel exercises
A woman with prolapse but no symptoms may be urged to
practice Kegel exercises to reduce the chance that her condition will progress.
Kegel exercises are a series of contractions that strengthen the pelvic floor.
You squeeze two sets of pelvic floor muscles at the same time: those you would
use to prevent yourself from passing gas and those you would tighten to stop
urinating. Avoid contracting your stomach muscles.
Try to do 30–40 pelvic contractions each day; you may
want to divide them into three or four groups of 10 each, spread throughout the
day. Squeeze and hold the contraction for 3–5 seconds; then rest for the same
length of time. Build up to 10-second contractions, with 10 seconds of rest in
between.
Pessary
For women who aren't good surgical candidates or want to
delay surgery (perhaps if planning to have more children), one alternative is a
vaginal pessary — a device similar to a diaphragm or cervical cap that's
inserted in the vagina to help support the pelvic area (see illustration).
Surgical treatment
Before undergoing surgical repair of a prolapse, you'll
need to have a thorough pelvic exam, to ensure that all problems have been
identified. Be sure your surgeon has expertise in the field of pelvic
reconstruction, as new procedures and anatomical knowledge have led to better
results.
Surgical techniques. Pelvic reconstruction surgery
may be performed through the vagina or abdominally; both procedures are equally
effective. A newer option is laparoscopic surgery, in which repairs are made
with instruments, including a camera, inserted through a few tiny abdominal
incisions. The prolapsed organ will be repositioned and secured with stitches
to the surrounding tissues and ligaments. The vaginal defect will be repaired,
sometimes using a piece of synthetic material, called a graft. Women can
usually leave the hospital within one to three days.
Complications. Possible complications of pelvic
reconstructive surgery include urinary tract infection, temporary or permanent
incontinence, infection, bleeding, and — rarely — damage to the urinary tract
that requires additional corrective surgery. Some women may develop chronic
irritation or pain during intercourse from a suture or scar tissue.
There's also a risk of recurrence, which seems to be
highest for cystocele and lowest for rectocele. Fortunately, recurrence rates
are dropping as surgical techniques and preoperative planning improve. The
chance of recurrence will also be reduced if a woman avoids stress, such as
heavy lifting or straining during a bowel movement, and performs Kegel
exercises regularly before and after surgery.
Some of the
prevention tips
Pelvic organ prolapse is most often a result of tissue
damage caused by labor and childbirth. Although you may not be able to prevent
the damage to your pelvic organs caused by childbearing, you may be able to
control the progression of the prolapse. Lifestyle changes that may slow the
prolapse process include:
*
Reaching and staying at a weight that is healthy
for your height.
*
Not smoking. The chronic cough associated with
smoking may cause or speed pelvic organ prolapse.
*
Correcting constipation. The straining caused by
constipation weakens and damages the connective tissue and muscles in the
pelvis.
*
Avoiding heavy lifting and jumping.
*
Doing pelvic strengthening exercises (Kegel
exercises) every day. These exercises help strengthen the muscles of the
pelvis.
Sources and
Additional Information:
