Julian Whitaker, MD

“From the time women are 12 years of age, we face many female issues: menstruation, pregnancy, childbirth, and menopause. Then we reach 65 and feel that all of this is behind us and we’re home-free—only to find our insides are falling down. I was shocked when this happened to me as I had never even heard that it could happen.

“My gynecologist booked surgery to repair a prolapsed bladder and told me he would also remove my ovaries and uterus because I ‘no longer needed them.’ Four of my friends had already undergone this surgery and all of them got infections. One gal was even hospitalized for many weeks due to complications. I decided to cancel the operation, and when I did, my doctor told me I should go see a psychiatrist!

“I want to know why doctors only suggest surgery and don’t mention other options. Are there alternatives? I hope you can help me. I want to be able to pass information on to others who are struggling with this horrible problem. Knowing what my life has been like I can honestly say that I would not choose to be a female if I had the choice.”

This letter, from a 76-year-old I’ll call Lorraine, who subscribes to my newsletter, articulates a very common problem, especially among older women, called pelvic organ prolapse. And as Lorraine suggests, the knee-jerk reaction of conventional physicians is often surgery. Sometimes surgery is necessary, but it is certainly not the first or only treatment option. Let’s look at drug- and surgery-free solutions that stand to benefit millions of women.

What Is Pelvic Organ Prolapse?

The bladder, uterus, vagina, and other organs in the pelvic region are held in position by muscles and ligaments. Pelvic organ prolapse occurs when these structures are unable to support the organs and they descend downward. A number of conditions may contribute to this problem, including obesity and nerve disorders, but the leading cause is stretching and weakening of the musculature during childbirth.

According to the National Association for Continence (NAFC), at least half of all women who have given birth to one or more children will eventually experience some degree of prolapse. And it usually comes on later in life as hormone levels fall and muscles and other tissues become weaker and lose their elasticity.

Symptom of pelvic organ prolapse include heaviness and pressure—a feeling Lorraine described as her “insides falling down.” In severe cases, the rectum (rectocele), bladder (cystocele), or uterus (uterine prolapse) may descend or even protrude through the vaginal opening. The strain exerted on these organs can cause painful intercourse or constipation and other bowel problems. The most common complaint is stress incontinence, that embarrassing leakage of urine brought on by exercise, sneezing, coughing, or other activities.  

Exercise Your Pelvic Muscles

Because pelvic organ prolapse is most often the result of weakened muscles, pelvic floor muscle training, commonly called Kegels, should be a first-line treatment. Many women tend to dismiss the importance of this simple exercise, but it works wonders for strengthening and toning the muscles that hold the pelvic organs in place. Every woman, regardless of age, should do Kegel exercises for five minutes a day to help prevent prolapse and urinary incontinence or to lessen symptoms if they are already present.

Although Kegels aren’t difficult, they can be tricky until you get the hang of them—and you have to remember to do them. For detailed instructions—for both men and women—on how to perform pelvic floor muscle training (Kegels) correctly, click here.

Biofeedback, which reinforces proper technique, is very helpful, as are weighted vaginal cones that force you to use these muscles to hold the cones in place. Another option is electrical simulation via a probe inserted into the vagina, which strengthens the muscles through involuntary contraction.  

Other Noninvasive Therapies

For more advanced prolapse, a vaginal pessary may be indicated. Pessaries are devices typically made of rubber, latex, plastic, or silicone that come in a wide range of sizes and shapes. Inserted into the vagina, they provide support for the pelvic organs and are a useful tool for both preventing prolapse and controlling incontinence. Although they don’t work for everybody, many women report improvements, especially in stress incontinence, when worn continuously or during exercise or other activities that exacerbate symptoms.

I know of no drugs specifically for pelvic organ prolapse or stress incontinence, and studies do not support the use of hormone replacement therapy for these conditions. However, topical estrogen definitely restores vaginal tone and is reported to improve incontinence in many women.

We’ve also had pretty good success at Whitaker Wellness with acupuncture. I recall one patient who was seeing the acupuncturist for an unrelated condition, but her stress incontinence unexpectedly improved. Another therapy we use is a Chinese herbal blend called BetterWOMAN. Dutch researchers evaluated 100 women between the ages of 20 and 80 with various bladder control issues and found that after taking this supplement for 40 days, 65 percent reported marked improvements in urinary leakage, frequency, and urgency. Some, but not all, of these women had stress incontinence, but it might be worth a try.

Prevention Is the Best Medicine

Then there’s surgery to strengthen the ligaments or repair the pelvic floor. I cannot comment on the appropriateness of Lorraine’s recommendation for surgery except to say that her doctor’s remark about removing her ovaries and uterus because she “no longer needed them” is preposterous. I would not argue that surgery is sometimes the best treatment, but I want to share a shocking statistic. Experts estimate that by age 80, one in 11 women will have surgery for pelvic organ prolapse, and some of them will be repeat surgeries!

These figures needn’t be so high. We must bring pelvic organ prolapse—which many women are too embarrassed to talk about—out of the closet. Lorraine is incensed that she didn’t know anything about it and that she was offered nothing but surgery. She has a point. Ladies, you need to be made aware of this very, very common condition and educated about what you can do to prevent it. And physicians need to exhaust all treatment options before recommending surgery.

Thanks, Lorraine, for shedding much-needed light on this problem.

Recommendations

  • Talk to your doctor about biofeedback, vaginal cones, and electrical stimulation. Pessaries must be fitted and monitored by a physician. Topical estrogen requires a prescription and can be ordered from compounding pharmacies.
  • BetterWOMAN can be ordered by calling (800) 810-6655. Use as directed.

References

Modified from Health & Healing with permission from Healthy Directions, LLC. Copyright 2008. Photocopying, reproduction, or quotation strictly prohibited without written permission from the publisher. To subscribe to Health & Healing, click here.