Sherrie Palm, the Founder and Executive Director of the Association for Pelvic Organ Prolapse Support opens up about pelvic organ prolapse (POP), a silently pervasive reality facing women.
Media Planet~Certain health conditions and symptoms of POP are often not shared during doctor visits. Why is this case?
Sherrie Palm~Despite nearly 4000 years on medical record, stigma continues to shroud pelvic organ prolapse in silence. Urinary incontinence, fecal incontinence, tissues bulging from the vagina, and painful intercourse are symptoms few women are comfortable speaking about out loud. I feel all pelvic organ prolapse symptoms need to be talked about out loud, to enable women suffering in silence to recognize they are not alone, to increase awareness of POP, and to clarify that treatment is available.
Media Planet~What types of symptoms did you experience that you knew something was wrong?
Sherrie Palm~The symptom that got my attention is the symptom that gets most women’s attention-vaginal tissue bulge. I noticed the bulge for about 3 months when I would wipe after urinating before I got curious enough to get a hand-held mirror to see what was going on down below. I had no idea what the bulge was or what it meant, I simply knew it needed to be addressed. At grade 3, my bulge was pretty pronounced. However I had other POP indicators for years prior tissue bulge. Fourteen years before my POP diagnosis, I had a hysterectomy. Prior to that procedure, I couldn’t keep a tampon in. I now know that this is a symptom of POP. I also suffered with chronic constipation for decades as well as difficulty staring my urine stream, also symptoms of pelvic organ prolapse.
Media Planet~Could women do a “self-examination” to find any irregularities which may be POP?
Sherrie Palm~All women should perform vaginal self-examination; vaginal tissue bulge is very easy to see. Examine yourself at the end of the day after gravity and daily activities have pulled/pushed organs downward (especially if on your feet all day while working). Take a hand-held mirror into a locked, well-lit room and simply take a look at your vagina while standing to see if tissues are bulging out. In lesser grades of severity, the bulge may be a tiny marble sized ball, or only a tiny bit of the cervix may be viewable. As the grade becomes more severe, the size of the bulge increases. At grade 3, mine was quite obvious.
Media Planet~What are the options for treatment, and what type of treatment worked for you?
Sherrie Palm~There are multiple options for treatment, both non-surgical and surgical, and I encourage women to explore non-surgical until they've had time to do their homework and know for sure they are ready to move forward to surgery. Physical therapists provide tissue manipulation as well as multiple treatment modalities for POP. Nonsurgical options include Kegel exercises (which must be done properly), kegel assist devices, pessaries, hormone replacement therapy, electrical stimulation, biofeedback, tibial nerve stimulation, myofascial release therapy, targeted core/pelvic floor exercise regimens, urethral injections, support garments, and relatively new radio frequency and laser vaginal rejuvenation therapies. Women typically utilize multiple non-surgical treatments at the same time. Often women get tired of time-intensive maintenance and want a more permanent fix, thus move on to surgery.
Media Planet~What factors should one consider when deciding whether to have surgery?
Sherrie Palm~It is important to explore non-surgical treatments while you evaluate POP, recognize behavior impact as well as track symptom cause and effect (if I pick up something heavy, my POP feels worse), and explore as much information about surgical options as possible prior to making the decision to move forward. POP surgery may be vaginal, abdominal, robotic, laparoscopic, or a combo of these; there is no “best type” of surgery for all women. What is most important is locating a qualified POP surgical specialist. Female Pelvic Medicine Reconstructive Surgeons (FPMRS) are the POP surgical specialists and may be either urogynecologists or urologists. It is pivotal women write down their questions so when they see a specialist, they capture as much information as possible.
Media Planet~Is there a chance of Pelvic Organ Prolapse recurring after surgery?
Sherrie Palm~There is always a chance POP may return after surgery; no medical procedure comes with a 100% lifetime warranty. By consulting with a reputable FPMRS surgeon, checking references, following doctors orders post surgery regarding lifestyle behaviors that should be modified, and evaluating whether utilization of mesh is a proper fit for individual needs, risk of recurrence is radically reduced. February 2016 is my 8th year anniversary for transvaginal POP surgery for grade 3 cystocele, rectocele, and enterocele. Mesh was utilized for the cystocele and rectocele, and a consult with my urogynecologist a few months ago confirmed I have no granulation, the mesh is still intact where it was placed, and POP has not returned.
Media Planet~There are 5 types of prolapse. Does every case of POP vary with symptoms?
Sherrie Palm~We are as unique on the inside as we are on the outside. While types of POP and symptoms are often similar among women, lifestyle, age, employment, and fitness level translate to a diverse variety of experiences. Everyone interprets pain and pressure differently. Combinations of POP type are impacted by quality of life measures which cannot be standardized because they vary radically. Physical, emotional, social, sexual, fitness, and employment impact are very personal and individual.
Media Planet~What’s the most common misconception about POP?
Sherrie Palm~Narrowing it down to one misconception is very difficult, there are many. I’d say the most common misconception is the prevalence figure currently accepted (3.3 million women in the US). Research frequently indicates up to half the female population experiences POP; the reality is we simply do not know because POP screening is not a part of routine pelvic exam protocol. Diagnostic clinician curriculum falls far short of need related to POP. But I’d be doing the women APOPS serves a huge injustice if I failed to mention an additional misconception- that “POP is asymptomatic in early stage”. If women don’t know POP exists, how can they recognize symptoms are POP related?
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We have so much more to learn. It is imperative we shift awareness not only within the lay community, but also within multiple fields of clinical practice which address women's pelvic health screening. Pelvic organ prolapse is a global women's health pandemic; since vaginal childbirth and menopause are the two leading causes, nearly every woman has at least one hash mark on her risk factor profile.
Pelvic organ prolapse undoubtedly encompasses the most diverse and expansive demographic of women's health conditions. Countless women suffer in silence with symptoms that they don’t understand. When we don't know what to tie symptoms to, our minds can be our worst enemies, imagining the most negative scenario.
There is hope for women with POP; treatment options evolve daily that can be utilized to control, improve, or repair this extremely common, cryptic women’s health concern. The most positive direction we can take as a society is to increase awareness to enable women to recognize POP symptoms when they first occur. From clinician directives side, screening during routine pelvic exams would be a great first step to shift women’s pelvic health forward.
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