People with pelvic organ prolapse have fewer treatment options than those with urinary incontinence and are more likely to have surgery.
"It's harder for me to help prolapse than stress incontinence," said Dr. John DeLancey, a professor of obstetrics and gynecology and director of pelvic floor research at the University of Michigan in Ann Arbor. Treatment options for pelvic organ prolapse are limited to using a pessary or having surgery. A pessary is a diaphragm-like device that's used to support internal organs. Although pessaries have come a long way since 400 BC, when Hippocrates described inserting half a pomegranate into the vagina to correct prolapse, they don't fit everyone well.
If a pessary doesn't work, surgery becomes an option. In it, sutures or mesh are used to support the vagina and restore the prolapsed organs to their proper positions. Although nearly a third of all prolapse operations are repeats, this doesn't necessarily mean the operation was a failure. "That person may have had 15 years of good relief," DeLancey said.
Fecal incontinence is the least understood and most difficult to treat of the pelvic floor disorders. "We've just started to study this in the last 10 years, so we don't always know what works," said Donna Bliss, a professor of nursing at the University of Minnesota.
The first therapies used are nonsurgical measures, such as pelvic floor exercises that target the anal sphincter. Another treatment is bowel habit retraining, which involves getting to a toilet at regular intervals. Some people may benefit from dietary changes or antidiarrheal drugs to bulk up the stool and make it easier to control.
Although several surgical procedures are available, "we don't have an ideal surgery therapy for fecal incontinence yet," said Dr. Howard S. Kaufman, chief of colorectal and pelvic floor surgery at USC in Los Angeles. A procedure to tighten the anal sphincter has high failure rates, and implanting an artificial bowel sphincter can cause infections and other complications.
Some doctors are attempting to correct fecal incontinence by injecting bulking agents into the anal muscle. Another experimental treatment is sacral nerve stimulation, which is already approved for use in urinary incontinence.
A dramatic difference
DeLancey pointed out that women have plenty of time to weigh their options when it comes to treating pelvic floor disorders. "They're not dangerous; they're not going to harm your health," he said. But he emphasized that treatment can make a dramatic difference in people's lives.
Maria Stubbs, who recently had a piece of mesh implanted to stop her leakage after an earlier surgery failed six years out, advised women with symptoms like hers to talk to their doctor. "Get help, because it's out there," she said.