Is It IBS or POP?

Every year countless women are given a diagnosis of IBS; many of them after inconclusive test results. Despite the fact that half of all women over fifty as well as countless younger women from childbearing age and up suffer from POP (pelvic organ prolapse), tests and exams to accurately diagnose this health issue are seldom recommended. We all want a name to put to the symptoms we are experiencing; we all want clarification that those symptoms are not in our heads. Many of us do our best to utilize the diets, medications, and behavior modifications our physicians recommend, trying to find some relief for the discomfort we have to deal with daily. Pelvic organ prolapse is an extremely common female health condition that has many overlapping symptoms with IBS. The real question is how many women diagnosed with and treated for IBS actually have POP instead?

 Chronic constipation is the most commonly reported gastrointestinal issue in the United States accounting for more than 2.5 million physician visits a year; many treat themselves without medical intervention. Constipation is a symptom, not a disease. You are considered to have constipation issues if you have more than one of the classic symptoms for longer than 3 months: straining during elimination at least 25% of the time, 2 or fewer bowel movements in a week, incomplete evacuation more than 25% of the time, hard stools more than 25% of the time, painful elimination, or bloating. If 3 days pass without a bowel movement, your feces may become harder and more difficult to pass. What women are not aware of is that chronic constipation is both a cause and a symptom of pelvic organ prolapse. Although constipation has multiple causes such as poor diet, lack of exercise, hormone fluctuation, or inadequate fluid intake, women with POP can address these issues and still obtain no relief. 

 A rectocele is 1 of 5 types of POP; a bulge type pocket occurs in the rectum and pushes into the rear vaginal wall. Fecal matter gets stuck in this hernia bulge, resulting in relentless, long term constipation. No amount of fiber eating is going to cure a rectocele. Women will find it extremely difficult to have a bowel movement; often after much pushing and straining a small amount of stool will come out but it will not be a complete bowel movement. You are left with a continual sensation of fullness and the urge to have a bowel movement is there nearly all the time.

 Occasionally something causes a system shift and a woman with a rectocele will be able to have bowel movement-occasionally is the operative word here. Some women find if they push up on the perineum during a bowel movement, they are able to have a complete b/m. Others find that inserting a finger into the vagina to assist a b/m is beneficial, pushing the stool along from the inside (please wash your hands first if you are going to try this maneuver). Sometimes women resort to use of laxatives, finding nothing short of that will work. The flip side of the coin is women with POP often have a strong urge to poop immediately, sometimes resulting in fecal incontinence. Since this is also a common IBS flag, the assumption by women experiencing these sensations (and often their physicians as well) is they have classic IBS when in fact it is a POP flag. 

It is imperative we provide more thorough curriculum to clinicians broad-spectrum regarding the symptoms of pelvic organ prolapse; it would save a millions of women from medical tests that are at times inappropriate and unnecessary.