Pelvic organ prolapse: How a pessary changed my life

Pessaries and pelvic organ prolapseI’ve heard pelvic organ prolapse described as a silent epidemic.  Why so hush hush for a condition that affects possibly 50% of women over 50?   I had heard of a prolapsed uterus.  But, my very large, uncomfortable, growing, fleshy protrusion in the fall of 2010 was my bladder.  Why me?  I am thin, fit and active.  A gynecologist and urologist performed the corrective surgery in 2011. Since the gynecologist believed that the uterus contributed to pushing the bladder out of place, I opted for a hysterectomy in addition to having mesh sewn into the vaginal wall to keep the bladder in place. Although I had more than 400 stitches, recovery was painless and quick.  All was well for 18 months.

In August 2012, I returned to the urologist due to spot bleeding and feeling the rough edges of the mesh protruding into the vagina and out.  He dismissed my concerns by saying that, as we age, we have weak areas of our body.  What?  I was angry, incredulous and confused.

My original gynecologist had moved.  Her partner confirmed that my bladder had badly prolapsed again and some of the mesh edges were coming through.  I could either have the mesh removed and be sewn up with little or no vagina left, have different or bovine mesh put in, or live with it.  Terrible choices.  During a referral consultation, I was told that two large babies and chronic constipation had been contributing factors.  I already knew this.  The vaginal wall was like worn-out elastic.  Re-do of the mesh might help, but only temporarily.  This doctor mentioned pessary use but dismissed it as inconvenient and not very successful.  I then went to a physical therapist for several months for advanced Kegel exercises, which helped on some days but not every day.  No relief there!

Next, I saw a gynecologist on a TV show about pelvic organ prolapse and went to see him.  He concluded that the vaginal vault had collapsed because of the hysterectomy, causing organ shift. So many conflicting opinions!  His solution was a sacrocolpopexy, in which a mesh support is secured to the vagina and anchored to the tailbone. But, since I had scar tissue from a childhood appendectomy, gall bladder removal, tubal ligation and a hysterectomy, I might require open abdominal surgery through a big incision.

PessaryOn the verge of complete panic now, but still determined to get all the information I could, I went to University of Michigan in June 2013. I outlined my checkered journey to Dr. Megan Schimpf, a female pelvic medicine and reconstructive surgery specialist with the Pelvic Floor Disorders program. After examining me, she recommended trying a pessary because of the high rate of success but yet a low complication rate. And, it wouldn’t mean I couldn’t have surgery later if I still wanted to do that. Half an hour later I practically danced out of the office.  I could not have been more relieved or happier and remain completely satisfied.  The pessary is comfortable, low maintenance and holds the bladder and offending mesh in place. Fortunately the exposed mesh isn’t near the pessary or causing any problems, so we can monitor that over time.

I have my life back!  But, I can’t help but wonder if I could have avoided the original surgery and three years of anguish and discomfort if I had been offered this alternative at the beginning.  I would strongly encourage any woman coping with pelvic organ prolapse to read and research the condition and give the pessary a chance to do its simple magic.

Anne is 67 years old and lives in Bloomfield, Michigan.

The University of Michigan’s Von Voigtlander Women’s Hospital is a leader in women’s health care. Consistently ranked among America’s top gynecology programs by U.S. News & World Report, U-M is committed to unsurpassed patient care for women.