Pelvic Organ Prolapse, The Constipation Club

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Many women start off their day juggling childcare, pet care, grocery lists, dinner plans for the evening meal, and a load of laundry, all the while checking text or email messages as they shove a piece of toast down their throats. My mornings are no different; a typical AM starts off being smothered with love by two lab mix dogs who act as though they haven’t seen me in months, so excited to go out to pee that you’d think there was a steak waiting out on the lawn. I focus on getting them out the door (no small task if it’s raining), initially ignoring my own screaming bladder. A quick bathroom run, then I let the dogs in, feed the dogs, snag a caffeine boost, scan email for incoming priorities, address social media, have a 2nd cup of tea, exercise, eat breakfast, shower, try to make some magic happen with my face and hair, and on with my day. Take time to poop, are you kidding me?

Some women can’t remember the last time they had a normal bowel movement every day for a week straight. They may exercise, eat plenty of fiber, drink enough water to drown a camel, and still can’t poop. Often these women have the urge to poop - but no matter how focused they are when hunkered down on the toilet, nothing comes out. They may close the bathroom door to ensure privacy, turn on the water faucet so no one can hear sounds emanating from their bottom end, leave the cell phone in another room to focus on the task at hand and.….nothing. They often blame themselves for poor bowel habits because they are overworked, stressed, ate that chunk of pie last night, and hope it will be better tomorrow. But it seldom is.

In general, it’s no shock many women experience difficulties having bowel movements. Every muscle in our bodies is typically constricted to the point that colon peristalsis contraction is about as likely to engage as an attempt to intentionally sneeze. When we finally slow down enough to recognize the urge to poop, we often resist - we don’t “have time” or don’t have immediate access to a bathroom. If we finally allow ourselves time to give in to our body’s demands, our bowel vengefully resists. We assume we have classic constipation related to our hectic lives. We eat probiotic yogurt, and experiment with all kinds of twisty yoga moves, in an attempt to encourage our bowels to release. We sit on our toilets in silent ohm, trying to relax, in the hopes that a miracle will happen, but we still can’t eliminate.

Pelvic organ prolapse (POP) is an extremely common women’s health concern that impacts millions of women, yet is often overlooked during routine women’s wellness and pelvic exams. The pelvic floor muscle (pubococcygeus or PC muscle) supports the organs and tissues in the pelvic cavity, and for a variety of reasons becomes weak or damaged, and preventing appropriate support of organs and organ systems, resulting in a variety of symptoms.  A rectocele is one of the most common of the 5 types of POP, basically a hernia bulge in the colon, and chronic constipation is the most common rectocele symptom. When fecal matter is caught in the rectal hernia bulge, no amount of fiber is going to move it. Chronic constipation is the daily companion of women with a rectocele.

Women often suffer in silence for years with frustrating constipation, because there is little awareness of POP. According to a National Institutes of Health (NIH) study, Epidemiology and Outcome Assessment of Pelvic Organ Prolapse, based upon vaginal examination, up to 50% of women experience POP. Millions of women suffer with POP symptoms, and rectocele chronic constipation is extremely prevalent. Women who complain to clinicians about chronic constipation are often asked about their diets or exercise regimens, and may be screened for and given diagnostic tests such as thyroid panel, upper/lower GI, or colonoscopy to check for conditions that cause constipation such as under-active thyroid or digestive system disorders. However, POP often evades the screening process because so little awareness of or conversation about POP occurs at patient or practitioner level.

Since POP screening does not occur during routine pelvic exams, POP often goes undetected until in an advanced stage. Women who experience chronic constipation should initiate a conversation about pelvic organ prolapse with their gynecologist or primary care clinician.

POP is without a doubt one of the most common and invasive of women’s health conditions. We have a long way to go to increase recognition of rectocele, as well as all types of pelvic organ prolapse. The first step - a very significant step -  is increasing POP awareness.