Exploring Solutions for Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is an uncomfortable condition to think about, one characterized by a woman’s pelvic floor becoming too weak to hold the pelvic organs in place. As a result, those organs — the uterus and bladder, for example — sag into the vagina. The potential consequences include problems in controlling the bladder and bowel, sexual dysfunction, urinary tract infections and tissue damage.

POP will affect half of women who give birth. As many as 11 percent of women who have NOT given birth will also experience POP at some point. 

Some women who have POP will never know it. Others will not be bothered enough to want to do anything about it. For those who are bothered, there are physicians like Nabila Noor, MD.

Dr. Noor specializes in female pelvic medicine and reconstructive surgery with Lehigh Valley Health Network (LVHN), part of Jefferson Health. While Dr. Noor is a surgeon, she doesn’t want anyone to jump to conclusions when they see or hear that word. Think of her as a specialist.

“Because a woman doesn’t want surgery, she may not even take the step of consulting with a surgeon,” Dr. Noor says. “I want to reassure these women that when I meet with a patient, it is just like any other doctor appointment. I’m just getting to know you, asking you questions about your life and what’s bothering you. I’ll do a pelvic exam so I have an understanding of your anatomy, and then I’ll lay out the options for you and we’ll arrive at a plan together.”

That plan might include surgery, but there are nonsurgical actions to take as well. And some patients do decide they don’t want to do anything about their POP. 

“That’s OK,” says Dr. Noor. “But every patient owes it to herself to know what her options are.”

The pelvic floor can be weakened for a whole host of reasons — pregnancy, childbirth, trauma from childbirth and menopause. Chronic constipation and obesity can lead to POP. Heavy lifting is a serious risk factor. As a result, body builders and weightlifters are at higher risk for prolapse. And of course genetics is a factor. Thanks to a natural tendency, even women who have never had children or been pregnant can still have pelvic floor issues.

There are several actions women can take to mitigate their risk factors and strengthen their pelvic floor muscles, according to Dr. Noor. She encourages her patients to do just that.

“Even women who aren’t pregnant or thinking about pregnancy can start strengthening their pelvic floor muscles,” she says. “There are special exercises, and it’s not just Kegel exercises. No muscle exists in isolation. You can’t just be doing Kegels and not taking care of the rest of your body.” 

Ideally, “taking care of the rest of your body” should include attention to core and glute strength. 

“You should be doing your lunges and your squats,” Dr. Noor says. 

In women who are overweight, losing weight can help. “Eat healthy, focus on moving a bit more, doing more exercises,” Dr. Noor says. “Lifestyle modification as a preventive technique can be really helpful.”

If you have chronic constipation or a chronic cough, address those problems. Over the years, they can do a lot of damage to pelvic floor muscles, Dr. Noor says.

The good news for women who have POP is that there are many treatment options. The best way to learn about them is by talking with a health care professional. 

“If you know you have prolapse, go see a specialist,” Dr. Noor says. “A lot of times, women will say, ‘I saw somebody and they just told me to do Kegels and use a pessary.’ A pessary is a vaginal insert used to hold the internal organs in place. That’s a fine option, but a woman should know what all her options are. That starts with a good exam by someone who specializes in the field.”

Surgical options offer a more permanent solution, and there is a wide range of them to consider.

“Believe it or not, there are surgeries that we can do vaginally, there are surgeries we can do abdominally by minimally invasive techniques, either robotically or laparoscopically. That means patients have only tiny incisions in their belly and go home the same day,” Dr. Noor says.

“In some situations, we can use a mesh, a synthetic material to augment the repair while some surgeries may not need it,” Dr. Noor says. 

Some of the most serious cases may involve a hysterectomy or removing the uterus, but all the decision making should be shared between the patient and the physician. 

“There are so many personal issues to consider,” Dr. Noor says. “What is the individual’s lifestyle, do they plan to be sexually active in the future? Are they largely sedentary or active? All these factors must be considered.”

Ultimately, Dr. Noor considers it her job to improve the patient’s quality of life, whatever that means for that patient. 

“You tell me and we’ll come up with a plan together,” she says.