Prevalence of POP Among Women and Treatment Options

As much as 50% of women who give birth develop pelvic organ prolapse. It’s also the most common reason women turn to surgical mesh implants. However, these devices can cause serious complications, driving thousands of lawsuits against mesh implant makers. Among women who develop POP, 11% require surgery, according to a Yale University School of Medicine report.

POP is a condition in which pelvic floor muscles and tissues are no longer able to support pelvic organs such as the vagina, uterus, bladder and rectum. This causes the organs to drop (prolapse) from their normal position, according to the U.S. Food and Drug Administration. In most cases, pelvic organ prolapse affects the bladder (known as a cystocele). In this case, the bladder falls, increasing abdominal pressure. The Yale report shows women with a cystocele may also experience involuntary urine loss or have difficulty emptying their bladder.

What Causes POP In So Many Women?

POP can be caused by muscles and tissues being stretched and torn due to childbirth or due to aging. Symptoms of POP include discomfort or pain and pressure. However, many women may not feel any symptoms. A report said doctors discover stage II or greater POP in about 40% of women during routine pelvic exams. Younger patients are more at risk for POP recurrence.

Treatment Option 1: Surgery

Depending on its type, women may need surgery, the FDA reported. The agency recommends surgery for those with significant pain and discomfort. Other factors include the woman’s desire to have future children and her age.

However, the FDA has warned women about the possible complications with surgical treatments that include mesh. In July 2011, the federal agency said it was not rare for women to experience problems when using mesh implants to treat POP.

Thousands of women reported complications to the FDA between 2008 and 2010. The most common mesh complications in the FDA reports include:

• Mesh erosions through the woman’s vagina
• Pain
• Bleeding
• Infections
• Pain during sexual intercourse
• Perforated organs
• Urinary problems (i.e., leakage and/or stress incontinence)

Reports also list less-common mesh implant side effects, including:

• Vaginal scarring/shrinkage
• Recurrent prolapse
• Emotional problems associated with mesh complications

“Furthermore, it is not clear that transvaginal POP repair with mesh is more effective than traditional non-mesh repair in all patients with POP and it may expose patients to greater risk,” the FDA said in its safety warning.

Treatment Option 2: Non-Surgical Therapies

Other options besides transvaginal mesh exist for women suffering from pelvic organ prolapse. Pessaries are a removable device inserted into the vagina that provide support for pelvic muscles, the FDA said. These devices can be made out of rubber, plastic or other materials and come in a variety of shapes and sizes. A doctor fits the pessary to the patient depending on which pelvic organ has prolapsed.

While pessaries do not cure POP, they can help manage the symptoms and slow the progression of the organ prolapsing, WebMD reported. They can be a smart solution for younger women who still want children. Other candidates are women who have been told surgery may be too risky or those who do not wish to have surgery to treat their POP. Pessaries are common treatments for women who already underwent a hysterectomy.

Another non-surgical option for POP patients is pelvic floor exercises, the FDA said. Women can complete a series of contractions known as kegels, for example. These exercises help strengthen the pelvic floor muscles that surround the urethra and vagina.