Living with Prolapse: Prioritizing Women’s Health

In the fall of 2020, Linda first realized she had an organ prolapse. Prolapses are extremely common, with a staggering 50% of women over 50 diagnosed with a prolapse issue. And yet, it is a health concern that is rarely discussed. People living with prolapse often experience embarrassment and shame - and don't seek treatment.

Prolapse occurs when a person’s internal organs shift and are pushed into the vaginal space and opening. This can include the rectum, bladder, or uterus. With so few people talking about prolapse, it’s easy to imagine how frightening this experience could be. However, Linda was unphased. As a veteran Registered Nurse, she knew what was happening. “When I had to strain for a bowel movement, something would stick out. Straining at all, or standing for too long would make it worse. I knew it was a prolapse, so I was comfortable pushing it back in with clean hands,” says Linda.

But, the issue progressively got worse, so Linda’s family doctor referred her to a pelvic floor physiotherapist. The exercises were extremely helpful, but there was still room for improvement. Linda knew she wanted to speak to a specialist, but she wanted only the most knowledgeable and experienced health care provider. So when her physiotherapist recommended Dr. Colleen McDermott, a Urogynecologist at Mount Sinai Hospital and the President of the Canadian Society for Pelvic Medicine, Linda knew she had to get an appointment.

“Prolapse is multifactorial and extremely common it affects 50% of all women over the age of 50!” explains Dr. McDermott, “Non-modifiable risk factors include advancing age, menopause/estrogen deficiency, race, connective tissue disorders, chronic diseases, and patients with some neural issues. Other risk factors include being overweight, having had vaginal births of children, smoking, and chronic constipation.” With so many risk factors, the number of women living with prolapse isn’t surprising. But that doesn't make it any less challenging to relieve. And while there are several treatment options, each comes with its own complications. For Linda a pessary seemed like a good starting point.

The conversation around pelvic floor health has to be initiated and mature women's health has to be made a priority.

Dr. McDermott describes a pessary as “A silicone based device that is worn in the vagina to support pelvic organ prolapse and improve urinary incontinence. I often tell patients it is like a ‘bra for your vagina’. It is for patients who don't want surgery, can't have surgery, are waiting for surgery, or are not done childbearing (there are no age restrictions, women in their 20s to 100s all wear pessaries).” One issue presented by pessaries is that they are not custom fit to the individual. In Linda’s case, her device worked, in that it held her organs in place; however, depending on when she was sitting or standing, it would slide backwards and put pressure on her bladder. She sized up, but ran into a similar issue. This one sat too high, causing urine to leak constantly so that Linda always had to wear a pad. And taking the pessary in and out was far too uncomfortable to do often. Linda was becoming increasingly frustrated with her prolapse, and with herself.

Linda got the relief she was looking for when Dr. McDermott fitted her with a Gellhorn pessary. Unlike other pessaries, the Gellhorn has a stem that keeps it more securely in place. There was no more pressure on her bladder, she didn’t have to worry about leaking, and she can manage her day-to-day life without worrying about her prolapse, saying “For me, the concept of keeping physically active is aligned with the concept of staying healthy. I walk every day for my physical and emotional health. I love to cook and bake which requires a lot of standing. These activities were not possible for me with an untreated prolapse for any length of time. I will forever be grateful to Dr McDermott and her staff for their help with this very treatable health issue. I want every woman to know that they do not have to suffer from prolapse.”

One thing Linda recalls is that her mother and mother-in-law rarely stood up. They sat down as often as possible. “Looking back,” she says, “I think they were going through this and were just too embarrassed to talk about it or get help. These things need to be talked about. Allowing prolapse to impact you alone doesn’t help.”

On talking about women’s health, Dr. McDermott has this to say: “Pelvic floor disorders affect almost all women that have had carried and delivered children and are more common in our postmenopausal patients. Often these symptoms are overlooked and patients are told they are ‘part of being a woman’ or ‘part of getting older.’ These issues can have a significant impact on a woman's quality of life and there are so many treatment options that can be offered. With our ageing population, the conversation around pelvic floor health has to be initiated and mature women's health has to be made a priority.”

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