WHEN IT’S MORE THAN URINARY LEAKAGE
By the time we reach our 50’s, we pretty much assume we have a handle on the type of health issues we may experience as women. The drill is all too familiar; we go in for routine pap smears and pelvic exams, and for heaven’s sake, don’t forget to get your boobs checked. Birth control concerns shift to hormone replacement evaluations. Once we get to the point that our peri-menopausal concerns and menopausal concerns are balanced, we pretty much feel that the primary female health balance concerns are addressed. But for a shockingly large number of women, there is another extremely common health issue that lingers undetected, misdiagnosed, or ignored because the symptoms it displays are often too yikes to deal with. Is anyone talking openly about urinary incontinence in an effective way? And how many women know that overactive bladder (OAB), stress urinary incontinence (SUI), urge urinary incontinence (SUI), and coital incontinence (CUI) can be early indicators of pelvic organ prolapse (POP)?
Pelvic organ prolapse is an extremely common female health issue that for the most part remains in the closet. It has been “on the record” since Egyptian times; Hippocrates wrote about inserting a pomegranate into the vagina as a treatment for POP, a type of pessary if you will. (Pessaries have been around since the 1400’s; they are a type of internal support device for the pelvic organs.) Half of all women over 50 will experience one or more types of POP, and the number of cases of POP diagnosed is predicted to increase by 45% over the next few years. Statistics vary with studies as far as the number of POP surgeries performed in the US annually; they currently show that number to be between 200,000 a year to 300,000 a year.
Yet this condition along with symptoms such as urinary incontinence, fecal incontinence, chronic constipation, and pain with intimacy remains tucked away; shrouded in mystery. Women typically first become familiar with POP when they are diagnosed with it. For the most part, women are not comfortable discussing POP because they feel symptoms are simply too embarrassing to discuss. As women, the norm is we are comfortable discussing nearly every aspect of our lives with our friends and family, and yet somehow POP has fallen between the cracks.
There are 5 types of POP, within these 5 types are 4 levels of severity; grade 1 is the least severe, grade 4 is the most severe. The types of POP are cystocele, rectocele, enterocele, vaginal vault prolapse, and uterine prolapse. Because the combinations of POP types possible and the severity of POP vary from woman to woman, what each woman experiences with POP will be somewhat unique.
With the statistics for frequency of POP being as high as they are, it’s hard to imagine that this health issue is not common knowledge among women. This leads back to the “in the closet” issues. Urinary leakage is the most common symptom of POP, and as women we speak quite relatively freely about urinary leakage. What we aren’t talking about is causing the urinary leakage.
30% of women with urinary incontinence also suffer from a loss of bowel control. I in 3 women suffer sphincter damage during childbirth. Although there are many causes of POP, and most typically it is a combination of causes that creates POP issues, childbirth is the largest, most common cause. That is followed by menopause; estrogen loss has a very specific impact to muscle tissue strength, density, and elasticity.
As women, we manage to deal with the issues of urinary leakage with paper products, not the most optimal solution. We are also not comfortable dealing with fecal leakage; the emotional baggage that comes from this issue far outweighs the physical. For the most part, women are exposed to poop in all of its forms, baby diaper changes, pet clean-up duties, manure for gardening. But when we discover that we have to deal with poop on us, it throws us for a loop. Our society is very poop-phobic in general, and as women, having fecal leakage issues flies in the face of our femininity, makes us feel less attractive, less self-confident. The impact it has to our self-image and sexuality is huge.
For some women, fecal leakage may be a once in a blue moon concern. For others, it is a more regular occurrence. Realistically, it doesn’t matter if it happens frequently or infrequently; having to always wonder when it will occur makes it difficult for women to feel comfortable leaving the security of their homes. Many women cut back on socializing or eliminate it altogether, fearful that there may be an issue while in public. No amount of tidying up in a ladies room can replace the comfort of dealing with this matter in your own home. For many women urinary or fecal leakage is so humiliating that they can’t even bring themselves to reveal it to their physicians, or if they do they minimize the degree of severity or reveal only urinary leakage and not fecal.
There is also a much bigger consequence from incontinence when we dig into the impact it has to our sexuality, and engaging in intimacy with the men in our lives. Urinary and fecal leakage can create so much anxiety in a woman that she no longer feels comfortable with the sexual aspect of her relationship with her husband, boyfriend, or significant other. Since both urinary leakage and fecal leakage can occur upon exertion, it is possible either can happen while engaging in sex. Talk about a mood breaker…
Rather than discuss this issue with the men in their lives, for the most part women choose to keep it to themselves rather than deal with the humiliation of revealing it. It’s easier to come up with an excuse to not have sex than to have to reveal and explain leakage concerns. Oftentimes men simply think their women are no longer interested in having sex, or no longer find them sexually attractive. It creates a barrier between intimate partners and the impact of this rolls over into other aspects of the relationship.
There is hope and help for women trying to figure out what is happening with their bodies. Once awareness is created regarding incontinence and other symptoms of POP, and women start disclosing these symptoms to their physicians instead of keeping them to themselves assuming they are a natural part of aging or too embarrassing to discuss, these symptoms can be evaluated and addressed. Once a woman is given a definitive diagnosis of the type and degree of POP she has, and gathers the necessary information to understand what her treatment options are, she can make the very personal choice of whether a surgical ornon-surgical treatment option will suit her needs best.
For those of us who have been diagnosed with pelvic organ prolapse and treated for it, whether surgically or non-surgically, sharing the information with other women is a step toward creating awareness about this cryptic condition. That sharing will lead to awareness which will take us a step closer to taking pelvic organ prolapse out of the closet. Once we can speak freely and comfortably about POP, women will start recognizing the symptoms and start seeking help at an earlier stage.
EVERY VOICE MATTERS
Sherrie Palm, APOPS Founder
Original article March 2011, updated October 2017