Uterine Prolapse

Q:  I really need some advice from you. My mom, 76, has a prolapse problem which causes her bladder and part of her vaginal wall to come out. She doesn't want surgery. She went to see a urologist, who sent her to an OB-GYN. This doctor told her about pessaries and fitted her. The urine leakage stopped, but the pessary came out when she went to move her bowels.

The doc fitted her with another pessary and the same thing happened. With the third type of pesssary, the device does not slip out when she defecates, but this one leaks urine a lot.

Her female primary care doctor thinks mom should return to her urologist (even though he says it is an OB-GYN matter). I looked on the Internet and there are thirty-four different types of pessaries on the market. My question to you is: If one pessary prevents urine leakage and one type stays in place when she moves her bowels, why can't she get a pessary that will do both?

Help! Mom is very upset as she doesn't want to go through with an operation that is not always successful. Unfortunately, mom doesn't ask questions and is very shy in the presence of doctors. I feel she is getting the run around and I know you will be straight with me.

A:  One of the "benefits" of being a mother is pelvic floor relaxation as a result of pregnancy and childbirth, usually after a woman reaches menopause. The uterus or bladder wall may fall into the vagina and not only be uncomfortable but interfere with urination, bowel movements and sexual activity. Depending on how bad it is, surgery may be the best option, but since your mom is reluctant, a pessary is a good option. Pessaries actually date back hundreds of years and are devices placed in the vagina to hold the uterus in place. Modern-day pessaries are made of silicone, Lucite or some kind of plastic and come in a variety of shapes: ring, donut, cube, ball, etc. As you found on the Internet, there are over 20 kinds of pessaries, so there is a good possibility that one of these will work for your mother.

Your mom should ideally see a "uro-gynecologist," which is an OB-GYN who is specially trained in this area. There are at least three of these specialists in the Milwaukee area: Julianne Newcomer, MD, Assistant Professor of Obstetrics and Gynecology at the Medical College of Wisconsin, Katie Stevenson, MD, at Mt. Sinai, and Dennis Miller, MD, in Menomonee Falls.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.