Not too long ago, I was finishing up in the bathroom when something felt odd as I wiped. Hmm, I thought, and then like any 50-something woman checking Instagram on the toilet would do these days: I turned on my Iphone camera, stuck it between my legs and snapped a selfie like no other (one I would most definitely not be sharing with anyone).
What I saw made me gasp: There was a golf ball-sized blob of tissue poking out of my vagina.
Don’t worry—that’s about as graphic as I’m going to get about me personally, because no one, aside from my doctor and my ever-loving boyfriend, is interested in that particular topography. In fact, I quickly deleted the photo, lest my 14-year-old twins decided to mess with my phone. No one can afford that much therapy.
But I’ll tell you, I’d have been a lot less freaked out had I known what I was looking at. It wasn’t until after lots of ill-advised googling, paper gowns, and the kinds of tests that you endure by imagining yourself on a beach with an umbrella drink that I learned that I had Pelvic Organ Prolapse (POP), which is essentially when your pelvic floor muscles get tired of supporting the organs in the neighborhood of your uterus. Without strong pelvic floor muscles, your cervix, uterus, and/or your bladder start heading southward, as can the walls of your vagina and/or your rectum. You may not even notice a mild case, but if your POP is severe (stage 3 or 4 out of four stages) you may be able to see or feel something, well, popping out.
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Symptoms of the Shift
Once I understood what it was, I realized that I had many of the classic symptoms, the most noticeable of which was a feeling pressure between my legs, as if I were carrying a small sack of apricots in my vagina. Depending on what is prolapsing and how severely, women can also have low back pain, bladder leakage, constipation, spotting, and other regional delights. Thankfully, POP doesn’t hurt, except for some women during intercourse.
Unsexy topics like this get scant coverage to begin with, unsexy topics about women over 40 get even less.
As I semi-obsessively began to research the condition, I wondered why, after decades of writing and editing stories about women’s health, I’d never heard more than a passing reference to this condition. It’s incredibly common: Estimates vary, but it appears that over a quarter of women across all ages have some degree of pelvic organ prolapse, according to a study the Journal of the American Medical Association.
Then I sighed. Of course. While admittedly unsexy topics like this get scant coverage to begin with, unsexy topics about women over 40 get even less. Guess what? The rate of POP shoots up after that age, and having given birth increases your odds dramatically, since the weight of a fetus and the surrounding fluid, as well as the pushing involved in vaginal delivery, can stretch out your connective tissues. Obesity doubles your risk, and POP is also more common after menopause, because women’s pelvic floor muscles and ligaments get looser with time and hormonal changes.
Dialing Down My Panic
I spent the next three months dialing down my panic. I am an anxious person, and my frequent feeling of “falling apart”—being so overwhelmed with kids and work and love and the moral decay of the universe that I can’t contain my life—seemed to be literally, physically manifesting itself in my body.
I also seriously wondered, could something really and truly dramatically FALL OUT.
I kept imagining a Disney movie in which the wicked witch cut a bargain with a barren young farm wife: “You will bear a child, fair maid,” she’d cackle. “But in exchange, your REPRODUCTIVE ORGANS WILL SOMEDAY TUMBLE OUT OF YOUR VAGINA!” And when my friends and I gathered for our frequent feminist vent-fests, we laughed until we leaked at the thought of the cohort of men who turn into toddlers when they have a head cold. Imagine if they had to deal with this shit!
I also seriously wondered, could something really and truly dramatically FALL OUT, like a pregnant woman’s water breaking, say, as I ponder new product offerings at Trader Joe’s? There was an image online of a woman’s bladder sitting on an exam table, entirely outside her body, that I fervently wish I could unsee. What about running? Might my footfall rattle something loose? And sex—my boyfriend worried about doing more damage until I assured him that the doctor said intercourse was fine, as long as it didn’t hurt for me. In fact, the second and third medical opinions I got assured me that—despite my outsized fears—nothing was going to wind up suddenly external, although high impact exercise could, over time, make things worse.
Solving Pelvic Organ Prolapse
I considered my options carefully. If you have a mild case, exercises that strengthen your pelvic floor muscles can improve the situation, and my doctor explained that many women, even with later stage POP like mine, choose to use a pessary, a solid plastic disc that you can insert to hold things up where they belong. A pessary can also alleviate the feelings of pressure. The other main option is surgical repair, which 300,000 women have each year, according to the National Institutes of Health. Many, many more decide that their POP is something they can live with or manage through nonsurgical means.
Mostly, I wasn’t quite ready for a constant, literally pressing, reminder that the body falling apart is inevitable.
I ultimately decided to have surgery, which in my case involved knitting my muscles back together under general anesthesia. Once I’m all healed, I’ll likely have physical therapy to further strengthen my pelvic floor. Depending on which organs are prolapsed and whether you have bladder leakage, the surgery may be more involved. My thinking was that I’m relatively young and fit, and so I would likely heal well; I’m sexually active and don’t want to deal with a pessary; and, most important, I have health care coverage, but who knows for how long?
But my deciding factor was psychological. At 50, I felt I had a choice: To fix something that was distracting me from enjoyment during sex and making me uncomfortable, thus renewing my contract with my vagina, or to live with the new normal, and make peace, Zen-like, with the impermanence of everything. (I’ve been meditating like a madwoman, yet that level of enlightenment eludes me.) Mostly, I wasn’t quite ready for a constant, literally pressing, reminder that the body falling apart is inevitable. I have my 81-year-old dad for that! But there’s no right answer—every woman with POP needs to balance the discomfort and severity of her condition against the risk and cost of surgery.
I’m almost healed, but I milked my recovery for all it was worth, having my teenagers lift things for me until I can do it without risking popping a stitch. “It’s not as if any of this is your fault, really…” I told them, my feet up on cushions. “I mean, just because carrying twins overtaxed my pelvic floor, you shouldn’t, like, feel guilty, or anything. Could you bring me some more tea?” Nope, they won’t need any therapy at all.
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I was not aware that without strong pelvic muscles, your organs such as bladder, cervix, and uterus start heading southward. My husband’s sister was diagnosed with POP, and we are looking for advice about what it is and how to help her. I will let him know about your article to help him understand more about her sister’s condition.
Thank you for your article! I discovered my POP at age 34 and chose the surgical option. No more periods, no more discomfort! It’s one of the best choices I have ever made for myself.
Thank you for publishing on this topic! It’s so important to educate! I love that this article not only shared an experience of an ignored topic, but also prompted the sharing of so many options. As a Lactation Consultant, I’m often the first person to ask how mom’s bottom is doing. Seems an odd question for someone dealing with breastfeeding, but if mom has to sit to feed her baby 8-12x a day, and it’s painful, or it hurts to get up and down from sitting, then how can she be expected to do her “job”? More often than not, just asking the question can elicit a wealth of sharing from mom, about incontinence, painful intercourse, etc. And then my job is to refer her to professionals who can assess and treat, so that mom can be comfortable “on the job”. And regardless of breastfeeding/sitting comfort, every mother needs to be educated on pelvic floor health. Education and options are amazing in all areas of health (including birthing positions!)
I’ve had surgery for a vaginal prolapse and bladder repair. Tried Kegels to no avail. I hated the pessiary, and I refuse to wear pantilners or pads the rest of my life. I just had a bladder mesh surgery and so far it’s good. Of course there’s always the risk of it not working. I have a great gyneurologist who has been understanding and caring.
Good to hear. Hope it holds
I just had “suspension work” done and was surprised yo find out how normal/average this condition is.
When my surgeon repaired the prolapse, she also repaired EVERYTHING…. I now look & feel pre-pubescent. It’s uncomfortable for a few weeks after but totally worth it. I feel better than ever.
I had repair 25 years ago and last year all the work got scar tissue and the clips sort of moved out of place and everything in my bladder started backing up into my kidneys called Hydro Nephrosis it had to be released with another surgery so back to square one
Betty McKnight Davis was there another option you could have taken 25 years ago?
I had “suspension work” done too about 8 years ago. Everything was wonderful for about 3 years and unfortunately, the daily physical chores of farm life sent everything downhill again. This time I think it’s worse than the first. I’ll have to wait until we move off farm to have surgery again. Sucks feeling like a 90 year old in your 40s.
I love my concerning potential medical issue articles delivered with great humor and graphic descriptions. So thank you very much. This was a great read and very informative.
If women were encouraged to squat while giving birth like nature intended, this problem would not be so prevalent.
My husband, who has traveled all around the world, encouraged me to squat while I was in labor. Helped so much.
It can happen no matter what position you give birth in. I’m in a group for younger women with prolapse and many of them had natural births, squatting, in water, minimal pushing and still it happened. Sometimes this stuff will happen no matter what you do or how much you prepare.
Thanks so much for sharing your experience. You help other women by opening up and we sure appreciate it.
I am truly sorry that POP happened to you. I am also very sorry you either weren’t a good candidate or didn’t consider the wealth of other non surgical options available to women these days. Your article seems very disheartening to women who exist along the spectrum of mild issues w/ easy fixes to truly no option but surgery. I often help women with these issues in my office. Women who want further info on non surgical possibilities should research Katy Bowman, Nuitritious Movement, Isa Herrera, and talk to a physical therapist that specializes in pelvic floor issues. If you take action before things actually fall out you stand an even better chance. Pelvic floor yoga is another good option. There are many. Start now before more symptoms develop! Don’t wait for total prolapse.
Thank you for sharing your knowledge. I’m sure your points will be very helpful to lots of readers.
Not everyone has the option of non surgical options. Some experience stage 3 or 4 pelvic organ prolapse as part of the birthing process immediately right after the baby comes out.
True. And unfortunate. Hopefully surgery provides relief. Surgery is not always optional. I just hate to see people try surgical solutions because they didn’t know there were other options. Also because unfortunately the surgeries don’t always work. But yes, sometimes surgery is the only option. Pelvic yoga, physical therapy, Visceral Manipulation, Mayan Abdominal Massage, Chi Ne Tsang, Acupressure, Shiatsu, Acupunture, Katy Bowman’s Pelvic Wellness, Isa Herrera’s Ending Female Pelvic Pain & Female Pelvic Alchemy – any of these is a good starting place. Isa has an online assessment to help you figure out more precisely what your issues are. Best wishes to all of us, men included, suffering w/ pelvic pain.
Really witty and well written!!
Mary Faichney , thank you! I am blogging soon (my first) on this & other health topics. Thanks for the encouragement.
Like a lot of things, each woman should decide for herself what things will be best for her quality of life. But I strongly urge each woman to do a good amount of research, and get second opinions to help that research. From my personal experience, a good physical therapist who specializes in POP is a superb place to start.