Women Find Help for Little Discussed Problem
Laura O’Brien knew something was wrong in November 2007 when she felt pressure in her pelvis, as if her uterus had dropped down.
"I could feel it falling," she recalled. "I told my fiancée, ‘I think I’m losing my uterus.’"
O’Brien, then 52 and a widowed mother of two grown boys, enjoyed a physically demanding life. She worked as an occupational therapist at a school for autistic children, exercised daily at a gym and pursued a rigorous regimen of ballroom dance classes. In 2006, she won a championship at a U.S. Ballroom Dance competition in Florida. "I’m in great shape," she recalled thinking.
"It was a shock to believe this was happening to me," she said.
O’Brien suffered from prolapse, which occurs when the connective tissue holding organs in place gradually weakens, causing organs to fall.
"Everybody thinks they’re the only person in the world who has this because nobody talks about it, but it’s a very common condition," said Sandra Culbertson, MD, professor of obstetrics and gynecology and vice chairman, clinical affairs at the University of Chicago Medicine.
As many as 11 percent of American women will have surgery at some time during their lives for prolapse or for urinary incontinence, which often is associated with prolapse.
There is no proven way to prevent prolapse, although exercises to strengthen the muscles of the pelvic floor, which support the uterus, bladder and bowel, may lessen the severity, Culbertson said. Causes include heavy lifting, straining during childbearing and heredity. "There’s definitely a genetic component," she said.
O’Brien scored three for three: She lifts children at work; her first son weighed 10 pounds at birth; and her mother was treated for prolapse…by Culbertson, in fact.
"My reaction was panic," O’Brien recalled. "I did not want to go through any procedures."
Treatment options range from simple outpatient procedures to complex surgeries to support the vagina and repair weakened tissue. "It’s a quality of life issue," Culbertson said. "It depends on how much a patient is being affected by prolapse and what they want to be doing in the future."
For O’Brien, Culbertson recommended a hysterectomy and sacral colpopexy, which involves using polypropolene mesh to attach and anchor the vagina to the tissue covering the sacrum. Picture mesh "suspenders for the vagina," Culbertson explained.
She also recommended repairs for cystocele, or bladder prolapse, which occurs when the supportive tissue between the bladder and vaginal wall weakens, and for rectocele, when the thin wall separating the rectum from the vagina weakens.
"For someone like Laura, who is very active, I wanted to provide a repair that would last forever," Culbertson said.
O’Brien scheduled surgery for April 2008 to give herself the summer to recuperate. She started a strengthening program that included Kegel exercises, which contract and relax pelvic floor muscles, and her fiancé did the exercises with her.
He was at her bedside after surgery, and while she recuperated, they put finishing touches on plans for a June wedding. By summer, she had resumed dancing. Now the couple takes spin cycle, kick boxing, yoga, pilates and dance classes together. "I feel great," O’Brien said.
Sylvia Wright, a 44-year-old mother of three daughters, felt the first symptoms of prolapse two years ago. "It felt like I needed to press on my stomach," she recalled. Another doctor diagnosed it as the start of a hernia.
Hoping to avoid surgery, Wright, of Momence, Illinois, avoided heavy lifting, but her symptoms got worse. Her uterus cramped whenever she walked vigorously, and it felt as if the tip of a water balloon were poking out of her vagina. An office procedure by another gynecologist failed to help her.
"By then, I was totally distressed," Wright recalled.
In summer 2010, she consulted Culbertson, who offered her a range of options including surgery similar to O’Brien’s, but with one important difference: Surgery had evolved to allow the use of less-invasive robotic technology, permitting faster recovery.
"Dr. Culbertson explained everything in detail, giving me choices," Wright recalled. "I went from being very frightened to having total confidence in her ability to do this.
"I chose the option that was going to give me back my lifestyle -- basically being active with my family," she said. "We like to camp. I want to be able to go for a hike without feeling I could be damaging my body."
Within a month after a robotic hysterectomy, sacral colpopexy, cystocele and rectocele repairs in August 2010, she was "up and running again," Wright recalled. "Dr. Culbertson is a phenomenal surgeon. I was blessed with surgery that I’m confident is going to last."
The University of Chicago Center for Pelvic Health helps women by offering multidisciplinary consultations, physical therapy, outpatient treatment and education, Culbertson said.
The center’s goals include dispelling myths and restoring confidence, she said. "Treatments are available."