If you’re suffering from the feeling that things are falling out down there, you’re not alone.
It’s called pelvic organ prolapse, and it occurs when the muscles and ligaments supporting the pelvic organs weaken “typically after childbirth, a hysterectomy, or menopause” causing the organs to slip out of place and create a bulge in the vagina.
But how do you know which treatment options are best for you? And how do you know if you need surgery?
Dr. Sonali Raman, a female pelvic medicine and reconstructive surgeon with St. Elizabeth Physicians said the field of urogynecology is geared toward quality of life and patient-centered decisions. Her passion for guiding women with these issues prompted her to join the urogynecology practice at St. Elizabeth.
“If you feel like you can’t walk, exercise, or enjoy other activities without feeling uncomfortable, or if you leak urine when you cough, sneeze, or laugh, you need to come see me,” she said. “Together, we will decide the treatment option that is best for you at a time that is optimal in your life. You will have control over how to fix the problem.”
In some cases, Raman said, women don’t choose surgery, either because their discomfort isn’t severe or because they’d prefer to try a more conservative method first.
“If something is so bothersome, though, that you’ve tried conservative options and want something even more permanent, then it’s time to pursue surgery,” she said.
The first non-surgical method Raman recommends patients try is physical therapy.
“It’s just like when you hurt your knee and need to strengthen the muscles around your knee,” she said. “The same is true with the pelvic floor.”
Another non-surgical option is a pessary, which Raman likes to call a bra for your bladder or rectum. It’s a small silicone device that can be placed in the vagina during an office visit and removed by the patient at night.
“The main goal, in my role as a physician and a surgeon, is to give patients autonomy,” Raman said.
In terms of surgery for both incontinence “the tendency to leak urine because of weakened pelvic floor muscles ““and prolapse ““the loss of ligament support to the bladder, uterus, vagina or rectum ““there are both graft and non-graft-based approaches, and they’re all minimally invasive. Based on patient choice and other factors, a woman can opt for a vaginally based surgery (no abdominal incisions) or laparoscopic and robotic surgeries, which leave three to five small, keyhole-sized incisions in the abdomen.
For surgical treatment of incontinence, the best-studied, most minimally invasive treatment standard is a 20-minute outpatient procedure where a small, ribbon-like graft material “called a mid-urethral sling ” is placed underneath the opening of the bladder. “That’s the gold standard for treating incontinence,” Raman said. “When you look at objective patient outcomes in terms of leakage at five years out, 95 percent of women are dry.”
Other options include urethral bulking agents and non-graft-based approaches, which Raman might recommend based on the situation.
Recovery from incontinence procedures takes about two to four weeks, and recovery from prolapse procedures takes about four to six weeks.
“Usually, for both incontinence and prolapse procedures, patients start to feel better after about a week, but they have to remember that their body has to heal from the inside out, and that takes longer,” Raman said.
Raman sees patients at St. Elizabeth’s Fort Thomas location and offers 7 a.m. appointments.
