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When Pelvic Organs “Fall Down”

Stephanie Morgan, M.D., a Urogynecologist with The Iowa Clinic, spends the time necessary to help women discover the right treatment – which usually doesn't require surgery.

Pelvic Organs
Your Local Health | Written by BJ Towe

Stephanie Morgan, M.D., a Urogynecologist with The Iowa Clinic, spends the time necessary to help women discover the right treatment – which usually doesn't require surgery.

A lot of women – especially those who have experienced childbirth – experience weakened pelvic muscles and ligaments. When those muscles fail to hold the pelvic organs (bladder, urethra, uterus, small bowel, and rectum) in their place, they can drop (prolapse) and push against the wall of the vagina. For as many as one in five women, this can cause an organ to herniate (bulge) into the wall of the vagina. Fortunately, says Dr. Morgan, treating pelvic organ prolapse (POP) doesn't have to mean surgery.

“Anytime reconstructive surgery is on the table, you always wish there was something nonsurgical to try first. With POP, there is,” she says.

A pessary is a supportive ring or space-filling device that's inserted into the vagina to reduce discomfort. “It can be worn with very little inconvenience and no one else knowing – and it's the ideal solution for many patients. But not all OB/GYN practices offer pessaries, and properly fitting them requires a great deal of skill and time,” she says.

Some of Morgan's advanced fellowship training in Pelvic Floor Medicine and Reconstructive Surgery focused on nonsurgical treatment using vaginal devices for prolapse. These come in several different shapes and sizes. As a result, Morgan's practice is set up to provide customized fittings, which increases success and patient satisfaction.

“We size and fit pessaries at the office and teach each patient how to use it on her own. The success rate of properly fitted pessaries in treating POP or urinary incontinence is very high – usually over 75 percent,” Morgan says. Additionally, a pessary is inexpensive, effective, and safe; complications are rare.

Morgan urges women to be evaluated by a Urogynecologist at the first sign of POP symptoms: “In addition to a pessary, there are a lot of things we can do to increase comfort and decrease symptoms without surgery. We may also focus on weight loss, pelvic floor exercises, and/or estrogen therapy for postmenopausal women. Many times, if we can make the skin healthier, the symptoms will subside.”

Some patients with mild to severe POP do not experience symptoms and can simply be monitored annually. POP doesn't always worsen, and sometimes, it gets better. Morgan says, “Eighty percent of women with prolapse will find that the condition doesn't necessarily progress. The other 20 percent find that things get worse over time.”

In all cases, Morgan wants women to know about the full range of options available to them. Surgery, which is preferred by many patients, can be the last resort.

To learn more about POP, visit Voices for PFD at www.voicesforpfd.org and click on the “Pelvic Organ Prolapse” tab.

If you think you have POP and would like to know more about nonsurgical options available to you, call The Iowa Clinic Women's Center at 515.875.9500.

Common causes of pelvic floor disorders

  • Childbirth
  • Hysterectomy or pelvic tumors
  • Obesity
  • Frequent constipation
  • Repeated heavy lifting or straining

Call your doctor if …

  • You have tissue bulging from your vagina.
  • You have pain or pressure in the vagina.
  • You feel pulling or increased pelvic pressure when you strain or lift.
  • Pain in your lower back or pelvic area interferes with your daily activities.
  • Sexual intercourse is difficult or painful.
  • You have irregular vaginal spotting or bleeding.
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