Stop Procrastinating in 2012
Marja Sprock, MD FACOG

Problems with holding on to or elimination of urine and or feces are usually not topics most people like to talk about. Prolapse of vaginal contents (the vagina giving in to gravity), is another problem that a lot of people try to hide. Most of these problems do not disappear as slowly as they were brought on, but gradually start taking over your life.

Prolapse for example literally drags you down. Most prolapses are much better after a night of rest, however during the day they usually start falling down again.

Also if the bladder is prolapsed, it may get rest at night and empty better, however you will not. It will keep you up most of the night and will make you feel dragged down for the rest of the day.

It is amazing how much better women feel once they have taken the step to do something about their prolapse.

Taking care of your prolapse can be done by exercising and strengthening of your pelvic floor muscles, a pessary (support shelf placed in the vagina) or surgery. What will be done depends on the degree of the prolapse; not all of them peek through the opening of the vagina, not all give trouble with urinating or having a bowel movement. And it depends on the owner of the prolapse, you. Are you happy with the result after training your muscles, are you happy with a pessary or do you rather have it taken care of potentially permanently?

Prolapses come in different degrees of severity and you can’t compare yours to your neighbors or best friends, however you are not the same people either and may have totally different desires, wishes and fears.

In July of 2011 the FDA issued a warning which imposed a lot of fear into women who had chosen to have their large prolapse repaired with a permanent vaginally placed mesh.

Also the lawyers were and are jumping on the issue of the vaginally permanently placed mesh. Hopefully in 2012 we can put it all in perspective and women will not have to procrastinate out of a misplaced fear.

The FDA warning has not served women with severe prolapse well and also the media have taken the warning out of proportion. If surgery is chosen to repair a large prolapse or a prolapse that has recurred, a mesh will diminish the chance that it will come down again.

In a recent article in the December issue of Obstetrics and Gynecology it is clearly shown that the anatomic success rate is higher to correct an anterior wall prolapse with a permanent polypropylene mesh than without it. Realizing that the failure rate of surgically repairing the prolapse of the front wall of the vagina, is quoted up to 40%, you may at least want to consider it.

Numerous women are now procrastinating their prolapse treatment and in the mean time, they get no sleep at night, can’t evacuate their bowel movement without manual help or have a continual dragged down feeling of the vagina and lower backache.

Sometimes you’ll have to take some action and get properly informed, not just scared by assumptions.

Pelvic floor muscle training will never worsen the condition and may help some women enough; you may want to get some instruction (available in our clinic) to assure you get the most benefit out of it. A pessary is a little non-permanent shelf inserted in the vagina, which can hold the organs up. It does require cleaning at least once every 3 months in the clinic, or sometimes you can take care of that yourself.

“Are you still placing meshes” , I was asked by a friend not too long ago and the answer is yes I am. After every repair for prolapse there is risk of pain, infection, bleeding, pain during intercourse, perforation of organs like bladder or bowel or ureter and urinary problems, the only problem unique to meshes is erosion (showing of the material inside the vagina). The risk of mesh erosion is there (less than 10% chance), no matter if we place the mesh through the vagina or through the abdomen with the robot or laparoscope. I agree, sounds scary and may want you to procrastinate again. Everything in life we do has potential risks, not sleeping well at night and feeling dragged down the whole day is not a solution. Also more than half of the showings of the mesh in the vagina are without symptoms and if needed a lot of them can be dealt with in the office. There is no free lunch, but a mesh erosion is usually easier to take care of than another surgery for prolapse.

The FDA reported vaginally placed mesh problems are less than 1% of all vaginal mesh surgeries performed. In reality if your repair did not work out well without a mesh, you have no FDA to report to. If you are younger and quite healthy a laparoscopic or robotic repair which is always done with a mesh may be your answer. However if you are a little older and like to have outpatient surgery and you have a large debilitating prolapse, you may have to stop procrastinating and get a vaginally placed mesh to hold up your prolapse and enhance the chance that it will stay up and in.

If you are ready to stop procrastinating in 2012 and are ready to take care of your vaginal prolapse, urinary or fecal incontinence or trouble with emptying see Central Florida UroGynecology in Rockledge. We are your “go-to center” for urogynecologic and cosmetic gynecologic surgery needs and questions.

Call 321-806-3929 for an appointment or leave a note.