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Help For Pelvic Prolapse

Most women experience pregnancy at least once, and all women eventually go through menopause – two “facts of life” that increase your risk for pelvic organ prolapse. This occurs when the muscles and tissues supporting the uterus, bladder or rectum become weak or loose and one or more of the pelvic organs drop or press into or out of the vagina. While pelvic prolapse is no threat to your health, it can be a distressing quality of life issue.

Dr. Robert Chan, a Urologist at MarinHealth Urology, is an expert in urogynecological surgery. In this podcast, he discusses the types of prolapse and what you can do to keep the problem from worsening. He also talks about some surgical and non-surgical solutions for pelvic prolapse. Listen and learn what you can do to address this common condition.
Help For Pelvic Prolapse
Robert Chan, MD
Dr. Robert Chan recently moved from Texas to join MarinHealth Urology | A UCSF Health Clinic. Dr. Chan attended Stanford University and graduated with Distinction in the top 15% of his class. He majored in Biology. He attended medical school at Vanderbilt University School of Medicine in Nashville, Tennessee. During his time at Vanderbilt, he participated in international medical mission work to Cuzco, Peru and the Philippines. He specializes in general urology as well as the treatment of complex urinary incontinence, voiding dysfunction, and pelvic organ prolapse issues. Dr. Chan has published over 23 peer reviewed articles and given over 41 conference presentations. “Nothing brings me more satisfaction than helping others gain back their freedom from health issues that limit their activities and worsen their quality of life. My practice philosphy is simple. I strive to provide the highest quality care in a comfortable and warm setting, and to tailor that care as much as possible to the individual needs of each patient". 

Learn more about Robert Chan, MD

Bill Klaproth (Host):  Pelvic organ prolapse happens when the muscles and tissues supporting the pelvic organs such as the uterus, bladder or rectum become weak or loose. This allows one or more of the pelvic organs to drop or press into or out of the vagina. The good news is, there are treatments available to help this bothersome condition. And here to tell us more, is Dr. Robert Chan, a Urologist at MarinHealth Urology, a UCSF Health Clinic. This is The Healing Podcast from Marin Health. I’m Bill Klaproth. Dr. Chan, what are some of the common complaints women have when they experience pelvic organ prolapse?

Robert Chan, MD (Guest):  Often the complaints that I hear are women might feel or see some tissue coming out of the ah, opening of their vagina. This might  manifest itself like they’ll tell me that they are not able to wear a tampon anymore, or their vagina might be dry or irritated just from it rubbing on the clothing. Sometimes when it gets like really bad, women actually have trouble urinating or having a bowel movement and might have to use their fingers to push the prolapse up just so they can have a bowel movement.

Host:  So, Dr. Chan, who is at risk for this?

Dr. Chan:  So, it’s a pretty common thing that we see in women who have had kids. In fact, one in three women who give birth end up getting prolapse. Some other reasons – risk factors are aging, and menopause. With the loss of the estrogen as women get older; the tissue just gets a lot weaker and it just becomes a lot more common with age. Other things that patients might do that puts them at risk are if they are really constipated, ah, coughing, ah obese, ah or if they are just like lifting really heavy things ah on a – on a daily basis.

Host:  That’s really interesting. So, you mentioned loss of estrogen among other things and this affects one out of three women. So, why does this happen? Do we know why?

Dr. Chan:  Ah basically, it’s the pelvic floor muscles and  the connective tissues end up getting weak or tearing. It’s kind of the same process as like when people get hernias. You know with age, that tissue just becomes weaker and just more likely to tear  it you have had traumas like having a baby; it can kind of weaken that tissue.

Host:  So, are there different types of pelvic organ prolapse?

Dr. Chan:  There are. Ah, there’s about five main categories . so, if you kind of think of the vagina like – like a house and the- the different walls being ah the different things that can kind of prolapse out. One of them is if the front of the wall being like the top part of the vagina; that would be  the bladder. That can kind of fall out. That’s what we call a cystocele. Sometimes the top of the vagina can weaken and then some small intestines  falls into the vagina. That is what we could consider an enterocele. if the floor of  the house where the rectum is; if that kind of prolapses through, ah that’s called a – a rectocele. And then finally, if – if a woman still has her uterus in place; if that falls through into the vagina; that’s uterine prolapse and then in women who have already had their uterus  removed; that can prolapse as well and that’ what we would call ah vaginal vault prolapse.

Host:  So, when it comes to treatment then, what are some nonsurgical interventions?

Dr. Chan:  Well there’s some things that patients can do that ah, don’t involve surgery that can definitely help the prolapse from getting any worse than it is. Making sure that they are not constipated and straining really hard with bowel movements. Other things are if they are  lifting really heavy objects or exercise that involves heavy weights; ah they should probably kind of hold off on doing that.

Ah, finally, smoking ah tends to be really bad for causing these types of disorders partly because it makes people cough a lot but then it also kind of makes the tissue a little bit less healthy.

Host:  So, then what about more severe cases? Do those require surgery sometimes?

Dr. Chan:  Yeah, sometimes. I mean the good news is that ah pelvic organ prolapse isn’t necessarily dangerous to a woman’s health. It’s more of the quality of life issue and so doing surgery is more just to improve somebody’s quality of life. For people who can’t undergo surgery, we - we do an option where we can put a – a pessary which is a silicon device that   just kind of prevents the – the vagina from coming down.

But in cases where like it’s very bad, there’s several different types of surgeries  that we can do to kind of restore the – the support that’s lost. Ah, one of them is called the sacrocolpopexy. This one we go in with a robot ahm and attach the – the top of the – the vagina using a strip of mesh like a strong ligament ah near the tail bone. For those who are a little bit wary about mesh, we do have a – a different option where we  resuspend the top of the vagina ah to some of the patient’s own ligaments and tissue. So, those are the more extensive kind of repairs. There are three repairs if the – the prolapse isn’t so severe.

One of them is just a – anterior repair where we fix the – the bladder ah prolapse ah just with a vaginal incision and then the partner of that would be like a posterior repair where we fix the – the rectum ah portion that’s bulging through  the vagina. And then finally, one of the most effective treatment options that we have available is something called a colpocleisis where we basically sew the – the two walls of the vagina together. It’s great for older women  where intercourse isn’t necessarily a option or if they are not really that interested in it.

Host:  So, you had mentioned mesh as one of the repairs. What is the controversy surrounding mesh?

Dr. Chan:  Yeah, so there’s been a lot of news in mesh for pelvic organ prolapse repair recently. The FDA recalled some ah mesh for prolapse repairs that went through the vagina. So, all that stuff is currently off the market. However, these recommendations and warnings don’t apply to mesh that’s used for the sacrocolpopexy that’s  placed through the abdomen.  a lot of women have incontinence as well and we use mesh for that, and that type of mesh hasn’t been recalled.

Host:  So, Dr. Chan, I understand there are women who just decide to live with this when there is help and treatment available. Why do some women not seek treatment?

Dr. Chan:  I think part of it is that a lot of women think that this is just sort of a natural part of aging and getting older and having children and so, they tend to live with it because they -they don’t think that it requires treatment even though it might be a significant ah detriment to their quality of life. A lot of times whenever I finish operating on a woman, they  mention  that they wish they had sought treatment earlier and that you know, their quality of life was  a lot better and  they really didn’t know why they waited so long before they – they had it checked out.

Host:  Well, we hope this podcast urges women to seek treatment and ultimately improve their quality of life. Dr. Chan, thank you for your time and for more information, please visit, that’s www.mymarinhealthorg. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by Marin Health. I’m Bill Klaproth. Thanks for listening.