I have an appointment coming up to see and OB/GYN about pelvic organ prolapse.  I'm not sure specifically which organs suffered--definitely the bladder (obvious from the incontinence) and possibly the uterus.  I'm not prolapsed "all the way" but I do worry about getting pregnant again. 

Will it be harder to get pregnant?  Could  a future pregnancy make things worse (my first baby was 10 lbs. and OP)?  Do pessaries really work, and if so, do they only work while worn?

I don't have access to any fancy research databases, but from skimming abstracts, I've become pretty convinced that corrective surgery is not the best option for me at this time.  Not that I'm closed to hearing out the doctor, but I'm skeptical about the failure rate.   

I've also been responding really well to physical therapy. 

Could Henci or anybody here enlighten me a little on this topic?  I spent a long time digging for information on a local doctor who wouldn't rush to sell me on surgery.  Based on what I've heard, he probably won't play the "must-have-cesarean" card re: future pregnancies. 

Nonetheless, I'd still like to be armed with some knowledge before my appointment next week. 

Thanks in advance!

Hi, This is the info I have about prolapse. Maybe something is useful to you. maria.

Apologies, but this isn't something I know a lot about. But if a conservative remedy such as physical therapy is helping, I would stick with that. Also, if you are a high weight woman, studies show that losing weight can help. As for repair surgery for incontinence, unless there have been some major improvements in surgical techniques--which is entirely possible because, as I said, I'm not on top of this issue--repair surgery often doesn't work all that well or only works for awhile. I don't know whether prolapse makes conception more difficult. If you are interested in doing some research on your own, for free you can get at the summaries of the systematic reviews in the Cochrane Library and you can read the summaries of pretty much every study published in the medical literature on the PubMed website. In some cases, the full studies may be available for free on the PubMed website.

-- Henci

Oops! Forgot to add the info! Prolapse info: http://www.moondragon.org/obgyn/disorders/uterineprolapse.html http://www.urogynaecology.com.au/Causes.htm http://www.clevelandclinic.org/health/health-info/docs/2600/2662.asp?index=9782 prolapse at 10 weeks of pregnancy - ok by 4 months! - http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=223845&ArtikelNr=87069&filename=87069.pdf http://www.firstaidforprolapse.com/ http://wholewoman.com/drupal/node/1017

Sorry, I can't seem to link the links. Copy and paste should work. Here they are in an easier format, I hope: http://www.moondragon.org/obgyn/disorders/uterineprolapse.html http://www.urogynaecology.com.au/Causes.htm http://www.clevelandclinic.org/health/health-info/docs/2600/2662.asp?index=9782 prolapse at 10 weeks of pregnancy - ok by 4 months! - http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=223845&ArtikelNr=87069&filename=87069.pdf http://www.firstaidforprolapse.com/ http://wholewoman.com/drupal/node/1017

Many thanks to Henci for the reply and to Maria for the links.

When I entered "pelvic organ prolapse" in the Cochrane database, I pulled up four inconclusive studies; pessaries, "conservative management," and surgery all lack evidence to support them as ideal interventions, and the abstract on estrogen treatment does not include results or concluding remarks, (perhaps because the study is still in progress).  I'm in my early 30s, so I probably don't need to consider the latter. 

My main concern is that having another baby doesn't leave me looking like one of the women in Maria's links.  :-(  On the other hand, I don't want an automatic cesarean if there's no evidence to support that route.

I was reading in Jennifer Block's book that urogynecology is a hot, hot field, and the trend is for these surgical specialists to push women into cesareans in the name of "pelvic floor preservation."  (Never mind that I was experiencing symptoms well before the baby was born).  I was hoping to hold my ground just in case this new OB holds this mentality.  A lot of specialists could look at my condition as see-I-told-you-so validation for this patently unscientific theory.

I'll continue with my research.  Thanks again.

I think that Jennifer Block was writing about pushing women with no prior problems into elective cesarean surgery as a preventive measure, which, by the way it is not. By a year after the birth, only a few percent more women experience incontinence after vaginal birth compared with women having cesareans--and that is without considering the degree to which conventional obstetric management of vaginal birth contributes to pelvic floor and anal sphincter injury and weakness. No study finds any difference after age 50 according to delivery route. (This, by the way, is one of the things that gets me frothing at the mouth. If a woman wants breast augmentation surgery, she can decide to take the risks, and she will wake up after the surgery with bigger breasts. But a woman who decides to have cesarean surgery to protect her pelvic floor doesn't get what she paid for.)

Still, in an obstetric culture in which the answer to every question is "cesarean surgery," you are likely to run into that mentalitya as a solution for your problem. My advice is to work your local network of advocates for normal birth (doulas, grassroots activists, pregnancy resource center) to find out which care providers in your community have Mother-Friendly policies . If you have such a person as your care provider, you will know that if a cesarean is recommended, you can trust that person's judgment.

-- Henci

traditional mayan uterine massage is a safe, healthy, and effective way to resolve pelvic prolapse:

www.arvigomassage.com  to read more and locate a practitioner

This group may also be of help

http://health.groups.yahoo.com/group/happypelvis/?v=1&t=search&ch=web&pub=groups&sec=group&slk=1