Yikes! What is that? Mary Pippen thought as she froze in her tracks. She was in the middle of a training session for a triathlon when her body suddenly felt…off. “It felt like something fell in my vagina — like a tennis ball was trying to push its way out,” she recalls. “I had to grab my bottom and push back whatever had dropped inside me. I thought I’d need to have someone call 911 because I didn’t have my phone with me. But as I stood there and nothing else happened, I realized it wasn’t a life-threatening situation. I wasn’t in pain or bleeding, I didn’t feel like I was going to pass out — there was just a strange pressure.”
“I walked home, Googled my symptoms, and figured out that the problem was with my uterus. It hadn’t come all the way out — it was just poking out an inch or so — so I called my gynecologist. The nurse assured me this wasn’t an emergency and scheduled me to see the doctor two days later. During those 48 hours I was scared and uncomfortable, to say the least.”
“At the exam, the gynecologist diagnosed me with uterine prolapse cystocele, which means my bladder bulges into my vagina, and rectocele, which means my rectum bulges into my vagina. He explained these conditions to me, and when I seemed surprised, he said, ‘What did you expect? You’re 50, you’ve had four kids, and you run.’ He basically told me to live with it. I didn’t know how to respond. At the time, I didn’t know what prolapse was — I didn’t even know enough about the female body to know what to ask. Honestly, I just wanted to get out of there. So I went home, and whenever my uterus dropped, I would just push it back up and go about my business.”
Pelvic Organ Prolapse: Powering Through
“Looking back, I’d had some symptoms that I either ignored or reported too vaguely. In 2004, I started having trouble with constipation: I’d start a bowel movement and it would get stuck, so I’d strain. I told my doctor I was constipated, but I didn’t describe the stuck sensation; she told me to eat more fiber and drink a lot of water, which I was already doing. So I started popping laxatives once a week. In 2012, I stopped being able to wear a tampon — it would slide, which was hard because I was going through perimenopause and my periods were all over the place.”
“Plus, over time, I had lost sexual sensation and my ability to have an orgasm. I later found out this was related to the prolapse, but at the time I didn’t understand it — I thought it must be psychological. It made me lose interest in sex, which was hard on my marriage. I went into a deep, dark depression before the diagnosis. I felt gross and unwell and unsexy.”
“A few months after I received the diagnosis, I found the Association for Pelvic Organ Prolapse Support (APOPS) and went to a urogynecologist who diagnosed me with stage three uterine prolapse, told me a lot more about it, and advised surgery. I had a laparoscopic hysterectomy with vaginal vault suspension to support my bladder and the other remaining organs. After surgery, I took six weeks off from work, and I did physical therapy to strengthen my pelvic floor. Honestly, I was fine with having a hysterectomy; I had no emotional ties to my uterus, and I was happy not having any more periods.”
“Unfortunately, a few months later, my bladder fell, and I had to have another procedure to secure it back in place. I still have the rectocele, but it’s manageable — I make sure I have enough fiber and water, and I take Miralax ($22.74 for 45 doses, Amazon) and magnesium citrate supplements ($15.06 for 250 tablets, Amazon) to keep my bowel movements regular and soft enough to pass without straining.
After Surgery: A Total Turnaround
“At the physical therapist’s urging, I stopped running and instead, I swim, cycle, or work out at the gym. Prolapse robbed me of being able to do triathlons and play tennis, both of which my family would do with me. I miss those activities, but I’m not willing to risk going back to where I was with this condition.”
“On the upside, sex is awesome again. I can have orgasms and my libido is back. And I generally feel much more comfortable. One of the things I learned with physical therapy is how to feel vaginal pressure and figure out what doesn’t feel right. It’s amazing — this condition has been going on since B.C. yet it isn’t talked about. It turns out my mom had prolapse, but she didn’t tell me about it! And while I do hate pelvic organ prolapse, I’m also grateful for it because after going through this journey, I’ve become a more empathetic, stronger woman. I’m now on the board of directors of APOPS so I can help other women reclaim their health!”
—as told to Stacey Colino
Silent Epidemic: Up to 75 percent of women will experience pelvic organ prolapse.
“Many people don’t talk about pelvic organ prolapse because they consider it taboo,” says Benjamin M. Brucker, MD, assistant professor of urology and obstetrics-gynecology at NYU Langone Health. But it’s incredibly common: According to research in the journal Menopause, the condition (in which the bladder, uterus, or rectum descends into the vagina or bulges into the vaginal wall) affects 50 percent to 75 percent of women between the ages of 30 to 59.
Risk of pelvic organ prolapse increases with age, as body tissues get lax. But the most common causes are pregnancy and childbirth. “There also seems to be a hereditary component,” adds Kimberly Kenton, MD, chief of female pelvic medicine and reconstructive surgery at Northwestern Medicine in Chicago. And obesity raises the risk by 47 percent.
An ob-gyn or urogynecologist can diagnose prolapse during an exam. Symptoms include a feeling of pressure in the vagina, a pulling feeling in the groin, constipation, trouble emptying the bladder, and/or pain during sex.
Treatment is warranted if the symptoms are bothersome. And that doesn’t just mean physical discomfort, says Dr. Brucker. “Prolapse can have a negative impact on sexuality and body image and can lead to depression and social isolation.” Adds Dr. Kenton: “It’s a quality of life issue—you don’t have to live with it.” If a woman has early prolapse, pelvic floor muscle training such as physical therapy or Kegel exercises may prevent worsening of the condition, she says. For moderate to more severe prolapse, a custom-fitted silicone device called a pessary can be placed in the vagina to support the pelvic organs. For later stages, reconstructive surgery may be needed.
This article originally appeared in our print magazine.