By Kate Leishman, Specialist Pelvic Health Physiotherapist.
Prolapse: How can I avoid a mesh implant?
There’s a lot of coverage in the media regarding ladies who have had plastic mesh implants to treat their prolapse or urinary incontinence and have been left in chronic pain or with disability. These ladies are in the minority but nevertheless, this type of surgery has now been discouraged by the Scottish Government.
So what is a prolapse and how can you avoid having to have surgery…
What is it?
Simply put, a prolapse is any descent of the pelvic organs. It usually involves them pressing down into the vagina causing a lump or bulge of the vaginal wall. The most common type is called a cystocele which is a bulge and descent of the front vaginal wall caused by the bladder pressing down onto it. Then there is the opposite which is a rectocele, a bulging of the back vaginal wall caused by the rectum pressing into the vagina. There is also a uterine prolapse or cervical descent, where the cervix and uterus come down into the vagina from the top.
Most ladies don’t even know they have a prolapse in the early stages as there may be no symptoms. It may be picked up during a smear test or internal examination for other reasons. However, the main presenting symptoms are:
A feeling of ‘something coming down’
A lump or bulge felt during washing or wiping
A feeling of sitting on something, some ladies describe it like sitting on a golf ball
A dragging or heavy feeling in the vagina, abdomen or back
Discomfort during sex
Difficulties in emptying bladder or bowel
Symptoms can vary from lady to lady and aren’t related to the severity of the prolapse e.g. bigger prolapses don’t necessarily give you more symptoms. Symptoms can also come and go and you may experience ‘good days’ and ‘bad days’ with your prolapse.
What can be done?
There are 2 main management strategies for prolapse, conservative management and surgical management. Conservative management is usually tried first before surgery is considering and research would show this to be most effective. The POPPY trial in 2014 published in The Lancet journal stated that conservative management was effective in mild to moderate prolapse.
◊ Conservative Management
This involves everything other than surgery! As a Pelvic Health Physiotherapist a lot of my day to day work is assessing and treating with patients with prolapse. Lifestyle advice, weight management, pelvic floor exercises, hormone replacement pessaries and support pessaries are all used where appropriate.
Lifestyle advice: This is concentrated on reducing heavy lifting e.g. grandchildren or children, shopping bags, furniture, gardening equipment etc etc
Weight management: It is well documented that being overweight puts you at higher risk of developing a prolapse and that by losing weight you can improve your symptoms
Pelvic floor exercises: It’s best that you have a professional assessment and instruction in these to ensure you are doing them correctly.
Hormone replacement pessaries and creams: These are prescribed by the GP to improve the post menopausal vaginal tissues to help with some of the prolapse symptoms
Support pessaries: These are medical devices that are worn inside the vagina to help ‘hold up’ the prolapse and provide relief. There are many different types of pessary and usually a specialist nurse will decide which is most suitable for you and fit the pessary.
◊ Surgical Management
A gynaecologist will assess you and decide if surgery is required. This is only usually offered if conservative management has failed for whatever reason. It should be seen as a last resort as it is not always successful. Statistics show that 1 in 3 women having a prolapse repair will need further surgery in the future!! That’s only around a 60% success rate!
Surgery can take 6-12 weeks to recover from and requires significant rest for the first 6 weeks with no lifting.
You should still do your pelvic floor exercises before and after your surgery to help improve the outcome.
Contact Life Fit Wellness for more information or to book an appointment with Kate Leishman, our Pelvic Health Specialist Physiotherapist for an assessment.