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The Sling the Mesh campaign has hit the headlines recently, revealing that many women who have undergone pelvic organ prolapse surgery have experienced life-changing complications from synthetic vaginal mesh. Can self-care help keep surgery at bay? London’s leading gynaecologist and Director of The Gynae Centre, Dr Alex Eskander, tells us more about looking after your pelvic floor.

What Is Pelvic Organ Prolapse (POP)?

‘Pelvic organ prolapse refers to the protruding of one or more of the pelvic organs (the uterus, bowel, vagina or bladder) down into the vagina,’ Dr Eskander said. ‘Usually these organs are held in place and reinforced by the pelvic floor muscles. When these muscles become weaker, the pelvic organs can droop and protrude from the vagina.’

Symptoms Of Pelvic Organ Prolapse Include:

• Discomfort during intercourse
• Problems with urination, for example: feeling as though you aren’t emptying your bladder properly; a slow stream; needing to urinate more frequently; leaking a little urine during exercise or when coughing or sneezing (what is known as stress incontinence)
• Experiencing a bulging feeling or as though something is coming down or out of the vagina.
• Pelvic pain or discomfort
• Constipation

How Common Is Pelvic Organ Prolapse?

Pelvic organ prolapse is surprisingly common, affecting about 1 in 12 British women.¹ It is particularly prevalent in postmenopausal women who have had children, but it can affect younger women who have not had children.^{2 3 4}

What About Surgery?

Every year, thousands of women in the UK receive surgery for pelvic organ prolapse. While for some women with severe prolapse it is the only option, it should be considered a last resort. Aside from the risk of surgery complications, it is not uncommon for a woman to suffer a further prolapse.⁵ What’s more, in any and all cases of prolapse, self-care measures are essential.

What Alternatives Are There To Surgery And Vaginal Mesh For Pelvic Organ Prolapse?

‘For moderate to severe prolapse, only surgery can completely repair the problem,’ Dr Eskander told us.⁶ ‘But that’s not to say that all women who develop a prolapse should be fatalistic about it – with milder prolapses there are things you can do early on which may help to prevent it from getting worse, or even perhaps improve it.’ In fact, as the authors of a key 2014 study asserted: ‘There is evidence that in nonsurgical populations, pelvic floor muscle training (PFMT) and lifestyle advice improves symptoms and stage of pelvic organ prolapse.⁷

Pelvic Floor Exercises

‘A weak pelvic floor is the main cause of prolapse (which can happen for varying reasons), but training the muscles through exercises will increase strength to better support your pelvic organs. Pelvic floor exercises are absolutely essential for all women suffering prolapse, irrespective of how severe it is and whether they will be undergoing surgery anyway,’ Dr Eskander said.

How To Do Pelvic Floor Exercises

You can identify your pelvic floor muscles if you try to stop the flow of urine when you’re passing water (don’t do this more than once though; repeatedly stopping mid-flow is not good for your bladder). Once you’ve identified your pelvic floor muscles, you can exercise them by simultaneously:

• Squeezing as if to stop your flow of urine
• Squeezing as if to clench a tampon within your vagina
• Squeezing your buttocks as if to stop flatulence

You can start off by doing eight repetitions of this, with each squeeze lasting a few seconds (up to 10 seconds). You can do your repetition sets three times per day, and build up strength over time, adding more repetitions each week. It usually takes a few months before you start to notice improvement. There are also devices that can help, and a doctor or physiotherapist can provide guidance and a pelvic floor exercise plan for you.

Other Self-Care Measures that can help:

• Losing weight if you are overweight
• Eating plenty of fibre (fresh vegetables, fruit, and whole grains) to stave off constipation and straining
• Steering clear of heavy lifting and long stretches standing up
• Quitting smoking if you are a smoker (coughing can aggravate a prolapse)

If this does not help you may try vaginal pessaries, recently reinvented using silicone, they are much softer and more gentle on the vaginal wall. The Gynae Centre is London’s finest private women’s healthcare clinic, providing leading-edge treatments across the spectrum of gynaecological issues. For an appointment call 020 7580 8090.