Every year dawns with new hope, a clean slate, renewed energy. We make resolutions, set goals, aspire to be healthier. Our positive mindset often loses steam however, and we slowly slip back into comfortable old habits whether they are healthy for us or not. When it comes to POP navigation, the same holds true.
We plot a course from diagnosis through treatment in a state of shock and frustration; discovery upon diagnosis, anger that we are experiencing POP, and disillusionment that there is no easy fix. Once we get past the preliminary emotions, we become determined to find resolution, trusting there must be a treatment that will work for our particular needs. We explore multiple paths, hoping for the best treatment choice, but often struggle with the decision to move forward with surgery because there is so much controversy regarding the best surgical choice.
Pelvic organ prolapse (POP) is seldom as simple as pelvic floor muscle weakness, connective tissue damage, nerve damage, or displaced organs; it’s often woman’s unique combination of multiple structural concerns. While women may have multiple common denominators, every one of us brings a somewhat unique blend of internal damage, causal factors, and lifestyle impact to the plate.
The POP dynamic is a complex one. Realistically if surgery for pelvic organ prolapse was easy, everyone would do it. But it’s not easy. And it’s not logical for everyone to jump to surgery at the first opportunity. Show me a woman who is not sure about moving forward with POP surgery and I’ll show you a woman who should spend more time experimenting with non-surgical treatment options. The right time to move forward with POP surgery is a very personal decision that few women are comfortable with immediately after POP diagnosis. Everyone heading into surgery has fear; being sure you want surgery is not about being fear-free, it’s about recognizing that you are not happy with the results non-surgical options have provided, and feeling comfortable moving forward.
While trying to understand their pelvic organ prolapse diagnosis and treatment options, some women will seek guidance from a single POP specialist. Some seek counsel with multiple practitioners. As with other health concerns, practitioners often provide different suggestions for treatment. When making the difficult decision which treatment is the best option, women struggle; how is it possible to figure out the best treatment choice for POP when practitioners often disagree on what the that treatment should be? Fear and frustration abound in the pelvic organ prolapse dynamic; we all want to feel good, and to live our lives to the fullest, and who wants to have major surgery?
So how do we choose the best treatment option? If non-surgical treatments are your choice, a FPMRS (Female Pelvic Medicine Reconstructive Surgeon) urogynecologist or urologist will often fit a pessary, a vaginally inserted device that supports the pelvic organs. Additionally a women’s health physical therapist can guide you through a multitude of treatment options such as pelvic floor and core exercises, myofascial release therapy, biofeedback, or electric stimulation.
If surgery is your treatment of choice, the question may become to mesh or not to mesh. There is much to sift through to understand the difference between polypropylene, cadaver tissue, biologic, or native tissue repair, to better understand and evaluate the safest and most effective choice. The dialogue then turns to which is the best approach. Vaginal, abdominal, laparoscopic, and robotic procedures are all surgical technique options, and within those choices are subsets of approaches practitioners utilize.
I’ve had surgery for three types of POP (cystocele, rectocele, and enterocele, grade three), and after intense Q&A sessions with my urogynecologist, I quickly opted to have a transvaginal mesh procedure rather than experiment with non-surgical treatment options. In the six plus years since my surgery, I have not regretted the decision for a moment. Do I know what will happen to my body one, six, ten, or twenty years down the road? Of course not; I recognize that every surgery comes with risk, and so much still needs to be researched, recognized, and analyzed in the POP arena. The bottom line is I made the right choice for me at the time I needed to make a decision. That does not mean my choice would be the right choice for every woman, and there seldom is an “easy” choice. We all want to be the best we can be and navigate the least risk factor. But at the end of the day, we must take some calculated risks based on the guidance we receive from our specialists and the research currently available. My suggestion for women is pretty basic because as POP awareness expands, treatments will continue to evolve and improve.
Moving forward into 2015 as the veil of silence surrounding pelvic organ prolapse is lifted, every aspect of POP treatment will advance. Each woman suffering from physical, emotional, social, sexual, employment, or fitness ramifications of POP needs to dig and dig deep. Step one for women who suspect they have POP is to consult a FPMRS urogynecologist or urologist to determine exactly which of the five types of POP and grade of severity is occurring. Take the time to self-educate to better understand pelvic organ prolapse. And find pathways to network with other women who have experienced POP such as APOPS POPS Forum.
Together we will move forward and find the answers we seek. From my heart to yours: