Dear Dr. Roach: I’ve been wearing a pessary since my youngest child was born 28 years ago. I’m grateful for it, since I’ve been able to continue backpacking, skiing, playing tennis, dancing, etc., without leakage. Now that I’m approaching 70, I’m realizing that removing and reinserting it might become an issue. Also, it needs to be removed for sex, which interferes with spontaneity.
What are your thoughts on prolapse surgery? Also, are there new kinds of pessaries?
Anon
Pelvic organ prolapse is a general term to describe when the muscles and soft tissues in the female pelvis weaken with age (and usually childbirth). The pelvic organs move to or beyond the vaginal walls. Not all people with pelvic organ prolapse have symptoms, and treatment is only for people with symptoms. Symptoms might include abnormal pressure or a bulging sensation; urinary symptoms, especially stress-type incontinence; and bowel symptoms.
Conservative management includes pelvic floor muscle training or a pessary, a prosthetic device inserted into the vagina, which helps reduce the abnormal position of the organs and improves the symptoms of pelvic organ prolapse. It sounds like you have had very good results. Pessaries might cause side-effects, such as vaginal erosions and discharge.
Pelvic floor muscle training is another treatment and has no adverse effects. Training takes months and is done by a physical or occupational therapist trained in pelvic floor therapy. Pelvic floor training has outcomes that are as good as a pessary once a person is trained.
When conservative management isn’t effective or causes adverse effects, or in a person who doesn’t want to try it, surgical approaches are then considered. There are several different types of surgical procedures, none of which I am an expert in, so I refer my patients to a gynecologic surgeon who is. I will note that surgery is not 100% effective, and most centres that have reported their data find that about 30% of people require a second procedure.
Given your good results with your pessary, I would think twice before surgery, but I encourage you to talk to an expert who can do a careful exam and recommend a different pessary, pelvic floor muscle training or perhaps surgery.
Dear Dr. Roach: Whatever happened to drinking a glass of prune juice for constipation?
F.A.D.
I think you are referring to a recent column where a reader was taking medications for constipation. Several readers asked why I didn’t recommend prune juice, since it contains substances that increase movement in the colon. It is a safe, effective treatment for mild constipation. But in a person who still has problems despite the most powerful medicines we have, prune juice isn’t likely to benefit them much.
One concept taught in medical school is that the severity of a condition varies greatly between different people. A disease or condition can have mild symptoms in one person and debilitating, or even life-threatening, symptoms in another. What works really well for one person can be ineffective in another, sometimes for no discernible reason.
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