Supporting prolapse patients through research

For Dr. Colleen McDermott, support is key for those experiencing pelvic floor disorders.

The Sinai Health urogynecologist helps women and other individuals with vaginas with pelvic floors disorders, such as incontinence and pelvic organ prolapse.

These disorders are not commonly talked about but are extremely common, affecting half of all women over the age of 50. Connective tissue of the pelvic floor stabilize a person’s bladder, bowel, and uterus and help to control them. As people age, pelvic floor disorders often occur as this supportive tissue weakens or is injured following childbirth. But that doesn’t make it an acceptable part of aging, says Dr. McDermott.

“It can have a devastating impact on a patient’s quality of life,” said Dr. McDermott. “Many have a hard time doing basic movements without experiencing discomfort or leakage, which makes it really hard for them to stay active into their golden years.”

One common type of pelvic floor problem is prolapse, which occurs when the pelvic muscles and other supporting tissues become weak, causing organs in the pelvis to drop out of place. In more serious cases, these organs can even stick out of the vagina or anus.

“Many have a hard time doing basic movements without experiencing discomfort or leakage, which makes it really hard for them to stay active into their golden years.”

Sinai Health’s program in Mature Women’s Health regularly sees patients with these disorders, treating more than 2,000 patients annually from across Southern Ontario and the GTA. It is one of few clinics of its kind in Canada.

One of the main ways to treat pelvic floor disorders is through passive medical devices inserted in the vagina to support the pelvic organs, called a pessary. Pessaries are silicone devices that often resemble a ring.

“Unfortunately, our standard pessaries are not always the best fit for patients,” said Dr. McDermott. Currently pessaries are fit by physicians and nurses through a trial-and-error process. As a result, many patients cannot be successfully fitted for a pessary, and others discontinue pessary use shortly thereafter due to discomfort.

Dr. McDermott is currently researching new ways to ensure each patient is fitted with their own custom device to maximize comfort and fit. Her team is currently looking at using 3D ultrasound imaging with detailed measurements of the vagina to provide a better understanding of the vaginal shape and surrounding pelvic structures.

“The imaging technique, called colpodynamic imaging (CDI), will be used to design custom patient-matched pessaries that may provide better fit and symptom relief for patients with prolapse,” Dr. McDermott said.

The Sinai Health team is currently in the midst of a pilot study looking at 10 patients after using CDI imaging to fit their pessaries and will follow-up three weeks afterwards to see how they’re doing.

Dr. McDermott said she’s hopeful this approach could one day be widely used to provide patient-specific care to those with prolapse. She said this could then create more opportunities for non-surgical options for prolapse treatment, ultimately helping individuals with prolapse experience a better quality of life.

“Research into improving supports for women and other patients is critical,” she said. “Health care doesn’t succeed when using a one-size-fits-all approach, so why would we use that same strategy for those living with pelvic floor disorders?”

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