To Pee, or Not to Pee

By: Edward Rutland, M.D.

As women age and experience childbirth, as well as other strenuous physical activities, certain muscle groups aren’t as strong as they used to be. A woman’s pelvic floor – the muscle group responsible for supporting the pelvic organs – can weaken due to aging, injury, physical exertion or certain illnesses, leading to a condition known as pelvic organ prolapse.

Healthy pelvic muscles and connective tissue form a sling across the opening of the pelvis, which holds the bladder, urethra, uterus, vagina, small intestine and rectum in place. When these muscles are stretched, weakened or injured, they can no longer support the pelvic organs. Urinary leakage can result.

Pelvic organ prolapse refers to the dropping of one or more of these organs from its usual position in a woman’s body, which can result in chronic pain and discomfort, anxiety, incontinence, and possible infection. These organs can descend from their normal location in the abdomen and push or bulge against the walls of the vagina, or, in severe cases, actually protrude from the pelvic area.

The condition is common. Health experts estimate that nearly half of all women over age 50 have some type of pelvic organ prolapse, but only a small percentage of affected women seek medical help, either due to embarrassment or assuming their problem is a natural consequence of aging.

The most common causes of pelvic organ prolapse are childbirth, a hysterectomy, or intense physical activity, such as lifelong participation in high-impact sports (involving running or jumping). A woman’s likelihood of developing pelvic organ prolapse also depends on her genetic background and her own unique anatomy. Women who have weak ligaments are more prone to prolapse problems than those who naturally have stronger ligaments. The condition tends to run in families, and women who have had a vaginal childbirth have a slightly higher risk than women who delivered a baby by cesarean section. Other causes include:

• Obesity
• Smoking and lung conditions that cause chronic coughing
• Occupations that require heavy lifting
• Frequent constipation
• Age (risk goes up after menopause)
• Illnesses or diseases such as multiple sclerosis, muscular dystrophy, or a spinal cord injury

Some women do not experience noticeable symptoms in the early stages of prolapse, but as the condition progresses, symptoms can include pressure, fullness or pain in the lower belly or vaginal area; pain in the groin or lower back area; irritation and/or bleeding from exposed skin; stress incontinence (urination during coughing, sneezing or laughing); pain during intercourse; or difficulty with urination or bowel movements.

Pelvic organ prolapse is not life-threatening, and treatment varies, depending on a woman’s symptoms, age and childbearing status (i.e., if she has already had or plans to have children). The condition is generally diagnosed through a pelvic exam and medical history, with a focus on past pregnancies, health problems, and level of physical activity or injuries.

Lifestyle changes can relieve mild symptoms, and include weight loss, medications, pelvic exercises (i.e., Kegel exercises), and dietary changes. A removable device called a pessary offers a non-surgical solution, and can be inserted into the vagina to hold the pelvic organs in place. For more severe symptoms, surgery can repair the supportive tissue around the prolapsed organ.

Learn more by visiting www.northernlouisianamedicalcenter.com, click on “Health Resources” and “Interactive Tools,” and take the Urinary Incontinence Quiz or the Overactive Bladder Quiz.

Edward Rutland, M.D.
RustonUrology Associates
411 East Vaughn Avenue– Suite 206
Ruston, LA 71270
318-242-7400

www.northernlouisianamedicalcenter.com/specialist

Dr. Rutland is a member of the medical staff at Northern Louisiana Medical Center.

Remember that this information is not intended to replace the advice of your doctor, but rather to increase awareness and help equip patients with information and facilitate conversations with your physician that will benefit your health.

Sources:American Urogynecologic Society,www.mypelvichealth.org, American Congress of Obstetricians and Gynecologists,www.acog.org, National Institutes of Health,www.nlm.nih.gov, WebMD,www.webmd.com.

© Copyright 2011 - Community Health Systems. These articles are for use by CHS-affiliated hospitals only.