It seemed an odd request.

Maggie Jensen, 67, hooted and laughed when recalling the moment.

During a pelvic exam, her doctor handed her a mirror and asked her to take a look—down there.

“I saw a big bulge in the mirror,” Jensen said. “My bladder had fallen.”

Jensen had developed a condition called pelvic organ prolapse.

Certain organs drop through the pelvic wall, causing a bulge around the vaginal area. The bladder may drop, or the uterus and rectum, or all three.

That happened seven years ago, when the Fruitport, Michigan, resident was 60.

She’d been playing golf with her husband, Jerry, when she first noticed it.

“I told Jerry on the golf course, ‘Something is really wrong,'” Jensen said. “But my doctor just told me to stop drinking coffee, take Tylenol for the inflammation, drink lots of water and maybe we should talk about a pessary.”

A pessary, Jensen’s doctor explained, is shaped like a ring and is inserted much like a diaphragm. It helps to hold up pelvic organs.

Since she didn’t feel any pain from the prolapse, Jensen shrugged it off.

“You get used to things,” she said.

Years went by.

The bulge seemed to get a little bigger.

Gradually, Jensen felt other things go wrong. She had difficulty going to the bathroom in the mornings.

“So I took fiber,” she said.

‘A little bell’

Jensen had never been the sedentary type.

Fit and trim, she loved to golf with her husband. She enjoyed swimming and hiking. When the cold arrived in Michigan, she and Jerry traveled south to Florida or to Arizona and stayed active there.

Meanwhile, the bulge got bigger and annoyed her a bit more.

Back in Michigan she returned to see another doctor, who convinced her to get fitted for a pessary.

“We tried all kinds of sizes of the pessary,” Jensen said.

None of them would work.

Upon closer examination, Jensen’s doctor realized the ligaments in her pelvic area had been damaged.

“I’ve had two sons,” Jensen said. “I had deliveries by forceps for my first son… and I’m guessing the ligaments were damaged then. There was nothing to hold the pessary in place.”

Next option? Mesh.

Vaginal mesh is one option to repair prolapse by using it to help lift sagging organs into place.

“I had to really think about that,” Jensen shook her head. “I’ll admit it. Surgery scared me.”

A couple more years went by.

“Weird, how you get used to things,” Jensen said. “It’s not like you’re feeling ill, you know? Just uncomfortable sometimes. Like I had to go to the bathroom all the time, but I didn’t really.”

Finally, the annoyance had grown to be too much.

Jensen steeled herself to make that appointment for surgery.

“It was like a little bell went off in my head,” Jensen said. “I got on the web, searched, and I found a female surgeon with great ratings.

“I found Dr. Leary at Spectrum Health. Maybe having a female surgeon would make me feel better about this kind of surgery.”

Quality of life

Elizabeth Leary, MD, a urogynecologist with Spectrum Health Medical Group, met Jensen in October 2020.

“I have to say, Maggie had very advanced prolapse,” Dr. Leary said. “But it is not uncommon for women to let this sort of thing go when the problem develops slowly over time. Women learn to put up with it.

“They don’t realize how good they can feel until the problem is fixed.”

One in seven women will need prolapse surgery, Dr. Leary said.

“There are many reasons women develop prolapse, but by far the biggest risk factor is childbirth. Think of the vagina like a nylon,” she said. “When a woman gives birth, it leaves a few more runs in the nylon, weakening the material.

“For someone active like Maggie, the prolapse was affecting the quality of her life more and more over time, until it would actually start making it difficult to walk or sit.”

Women can take some preventive measures, such as daily Kegel exercises that strengthen pelvic muscles. It’s something Maggie now does daily.

“Imagine you are trying to keep yourself from passing gas in a crowded room. You squeeze to hold it and pull up,” Dr. Leary said. “Start with squeezing for three to five seconds, relax for the same amount of time, then do it again.

“Work up to doing 10 repetitions for 10 seconds long of these up to three times per day,” she said. “If you are having trouble finding these muscles or you aren’t sure if you are doing Kegels correctly, we have an amazing physical therapy team that can help you learn to do these the right way.”

Over time, the prolapse symptoms may get better or disappear altogether, she said.

Weighing options

Dr. Leary discussed surgical options with Jensen.

One type of surgery can narrow or close the vagina to support pelvic organs.

“Colpocleisis is a type of obliterative surgery and the least invasive,” Dr. Leary said. “The surgery closes the vagina permanently, sewing together the front and back walls of the vagina to shorten the canal and prevent bulging. It is an outpatient procedure that takes less time in the operating room than reconstructive surgery while having the highest success rate of any procedure done for pelvic prolapse.”

The other type of surgery is reconstructive.

Reconstructive surgery can be performed either through the vagina or through small incisions in the abdomen. This often includes removing the uterus and returning other organs back into their original positions and supporting them either with the patient’s own tissue or with mesh implants.

This surgery, too, is done as an outpatient procedure, requiring three to four hours.

This time, Jensen did not hesitate.

Once she had made her decision about which procedure she wanted, she agreed to schedule surgery in a matter of days.

“Dr. Leary and her team made me feel so comfortable that all my fears were alleviated,” she said. “I felt respected and reassured. I was finally ready.”

She underwent surgery in December 2020 at Spectrum Health Butterworth Hospital.

“For me, I needed to use a catheter for one day after the procedure, but that’s it,” Jensen said. “It was the happiest day of my life when I could use the bathroom without any discomfort or dealing with a bulge.”

Jensen is already back on the golf course, enjoying the game.

“Dr. Leary was right,” she said. “I didn’t realize how good I could feel until it was done.”

Read more: https://healthbeat.spectrumhealth.org/back-on-course-pelvic-organ-prolapse-treatment-relief/


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