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There are nearly 14 million American women who suffer from urinary incontinence or the involuntary loss of urine. One of the most common causes is a dropped bladder. Dropped bladder is a general term to describe a condition known as Pelvic Organ Prolapse (POP). POP means that one of the pelvic organs - the bladder, the uterus, the intestines or the rectum has fallen down into the vagina. POP ranges in severity from very mild (i.e. prolapse that can only be felt by your doctor on examination) to severe where one or more of the pelvic organs actually protrude through the vaginal opening and can be easily felt by the woman on self examination. When the POP is severe you can actually see it; it looks like a red ball protruding from the vagina.

Causes of POP?
POP is caused by a weakening of the muscles that normally hold the pelvic organs in place. Childbirth (labor and delivery) is the most common cause of weakening of these muscles. The aging process itself, particularly in women who do a lot of heavy lifting, may be another cause. Excessive weight and chronic coughing are also causes of POP.

What are the Symptoms of POP?
The most common symptom of POP is a feeling of pressure or fullness in the lower abdomen, vaginal or rectal area accompanied by urinary incontinence. In severe cases you may actually see the POP protruding from the vagina and, if so, it may get irritated and cause a discharge or even bleeding. With more severe degrees of POP it may be difficult to urinate, causing you to have to push or strain. Rarely the POP can block the kidneys causing kidney failure. Fortunately, when the POP is repaired the kidneys usually return to normal, provided that the condition is caught early enough.

Treatment for POP
For the overwhelming majority of patients with POP treatment is completely elective-meaning that if your symptoms bothersome enough, you will want to have it fixed. At the present time there are only two treatment options: a pessary or surgery.

A pessary is a device that is usually made out of a plastic and is usually in the shape of a donut or ring. It is placed in the vagina, like a tampon, to hold the pelvic organs in place. Pessaries come in many different sizes and shapes and need to be fitted by your doctor to the size and shape of your vagina. Pessaries are quite safe, although in some patients they seem to be associated with recurring bladder infections. If a pessary works for you, and it is comfortable, it can be a lifetime treatment. It can be left in place for several months at a time and may be changed by doctor or a nurse. They are not, however, effective in all patients.

If a pessary is not effective, then surgery is the other option. There are operations that are done through the vagina and operations that are done through the abdomen. There are now procedures that can be done on one-day stay or outpatient basis under a local anesthetic where a tape or sling is placed below the urethra that elevates the urethra and the base of the bladder which immediately corrects the incontinence. Most patients can return to all of their activities in 1-2 days after the procedure. They cannot do heavy lifting, have intercourse, or use douches for 4-6 weeks after the surgery.

So if you are considering surgery, be sure that you do your homework and learn a lot about the different surgical possibilities, and the potential risks and benefits of the procedure. If you think you have a dropped bladder contact your urologist or gynecologist for an evaluation and to learn what treatment options are available to you. Remember help is available and you don't have to depend on Depends!

Dr. Neil Baum is a urologist and can be reached at 504.891.8454 or at www.neilbaum.com

More information about pelvic organ prolapse, also known as vaginal prolapse >>