I’m a hair stylist, and in the past month, I’ve noticed by the end of my work day, I have a heavy “pulling” sensation down there. Plus, I’ve noticed a bulge of tissue when I go to the bathroom, which seems to get worse the longer I’m on my feet. I confided in a friend, and she said it sounds like uterine prolapse. She said that her sister had one, too, but that she just had it “taken care of” with a hysterectomy. Is that really my only option?
Honey, a bulge of tissue could indeed be related to pelvic prolapse, but it’s not necessarily uterine. The bladder (a cystocele) and the rectum (a rectocele) can also protrude into the vagina, causing bulges that may have you running like mad to your gynecologist. (One of my patients showed up with a pale face and terrified eyes saying, “I have flesh hanging out of me!”)
A simple gynecologic exam can confirm your diagnosis. If it is uterine prolapse, which occurs when menopause, childbirth, or a genetic predisposition weaken the muscles of the pelvic floor, allowing the uterus to droop down and bulge into the vagina, your doctor may indeed recommend a hysterectomy. But surgery should rarely be the first line of defense.
For pelvic prolapse, I usually recommend that my patients try Kegel exercises, which strengthen the pelvic floor muscles that support the uterus and have been shown to help treat prolapse and may even be curative. I also suggest lifestyle modifications, such as timed voiding, avoiding heavy lifting and prolonged coughing, skipping running or other high impact exercise, and reducing long periods of standing (which can aggravate the bulge).
I’m also a big fan of pelvic floor physical therapy, which helps 80% of women who try it, especially when the prolapse is mild. There is also research from the American Journal of Obstetrics & Gynecology that an abnormal change in spinal curvature (caused by a sedentary lifestyle) is a significant risk factor in the development of pelvic organ prolapse. Maintaining proper posture and doing exercises that normalize the shape of the spine may also improve the symptoms of pelvic prolapse.
You may also want to see ask your gynecologist to fit you for a pessary, an insertable device that props up bulging tissue and is worn continuously to hold saggy tissue in place. If everything else fails, surgery is a last resort -- but in my experience, it can often be avoided.
Yours in health,
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