"We refer to pelvic prolapse and incontinence as 'the silent epidemic,' because women are embarrassed by it, they don't realize how common it is and, as such, they tend not to talk about it," explains obstetrician/gynecologist Donald J. DeBrakeleer, DO, FACOG. "The fact is, one out of every three women over the age of 45 has some type of urinary incontinence, and one out of two suffers from some type of pelvic prolapse.
With ordinary incontinence, commonly known as bladder leakage, women can experience "urge incontinence"—the overwhelming need to go, even if they just went to the bathroom, and/or being unable to hold it long enough to reach a bathroom. Or, they can experience "stress incontinence"—leaking during exercise, coughing, sneezing, laughing or other body movements that put pressure on the bladder. Some women experience both.
Pelvic prolapse is a weakening of the supporting tissues or muscles of the pelvic floor. While there are a variety of forms and severeties, common symptoms of pelvic prolapse include a bulge or lump, a pulling or stretching feeling in the groin area, difficulty with intercourse, low back pain, urinary or fecal incontinence, difficulty with bowel movements and a delayed or slow urinary stream.
The initial line of treatment involves strengthening the pelvic floor through Kegel exercises and vaginal cone weights, while the second course of action involves pessaries—strong, diaphragm-like devices that support the tissue and muscles.
"When these first-line therapies aren't effective, there are numerous surgical options—many of which can be performed using a minimally invasive approach," says Dr. Brakeleer. Options include repairing the prolapse with natural tissue, tightening the ligaments through sutures or using special mesh materials to provide the needed support. Dr. Brakeleer's practice is one of only a handful across the United States selected to participate in key studies requested by the FDA for mesh-augmented vaginal repairs.
"It's unfortunate that a lot of women don't discuss these conditions with their gynecologist when there are many simple treatment options," says Dr. Brakeleer. "I have a sign hanging in my office that I found in a craft shop. It reads, 'I laughed so hard the tears ran down my leg.' I can tell you how many women comment on how well they relate to it."