Table of Contents
TABLE OF CONTENTS
ACKNOWLEDGEMENTS i
FOREWORD BY ROGER DMOCHOWSKI, MD, MMHC, FACS v
INTRODUCTION: THE VAGINA, THE MOST STIGMATIZED HEALTH FRONTIER vii
1. PELVIC ORGAN PROLAPSE: THE BASICS 1
2. CAUSES OF PELVIC ORGAN PROLAPSE 7
Childbirth 8
Menopause and Age-Related Muscle Loss 9
Genetics 10
Chronic Constipation 11
Chronic Coughing 12
Heavy Lifting 12
Obesity 13
Hysterectomy 13
Compounding Health Conditions 15
Adhesions and Tissue Damage 15
Diastatis Rectus Abdominus 16
Fitness Activities 16
3. TYPES OF PELVIC ORGAN PROLAPSE 19
Cystocele 20
Rectocele 20
Uterine 20
Vaginal Vault 21
Enterocele 21
4. SYMPTOMS OF PELVIC ORGAN PROLAPSE 25
Vaginal Tissue Bulge 27
Urinary Incontinence 28
Urine Retention 29
Chronic Constipation 29
Vaginal and/or Rectal Pressure 30
Vaginal and/or Rectal Pain 30
Back or Pelvic Pain 30
Inability to Retain a Tampon 31
Fecal Incontinence 31
Coital Incontinence 31
Painful Intercourse 32
Reduced Intimate Sensation 32
5. WHEN TO SEEK MEDICAL TREATMENT 35
6. MEDICAL EVALUATION: WHAT TO EXPECT 39
The Standing Screen 40
Urodynamic Study 42
Pelvic MRI/Pelvic Ultrasound 43
Hormone Level Testing 43
Cystoscopy 44
Defecography 44
7. NON-SURGICAL TREATMENT OPTIONS 45
Kegel Exercises 47
Kegel Assist Devices 48
Pessary 50
Incostress 51
Impressa 51
Hormone Replacement Therapy 51
Electrical Stimulation 52
Biofeedback 53
Tibial Nerve Stimulation 53
Myofascial Release Therapy 54
Pelvic Floor and Core Exercise Programs 57
Urethral Bulking Agents 58
Support Garments 59
Laser and Radio-Frequency Vaginal Tissue
Restoration Therapy 60
Vaginal Restoration for POP: Round One 66
8. THE PESSARY 71
9. SURGERY 79
10. CHOOSING A HEALTHCARE PROVIDER 87
11. WHAT TO ASK YOUR PHYSICIAN PRIOR
TO SURGERY 89
12. WHAT TO EXPECT WITH POP SURGERY 93
13. WHAT TO HAVE ON HAND PRIOR TO
SURGERY 101
14. IMPACT TO INTIMACY 107
15. THE MESH AGENDA: MISTAKES MADE
AND NEXT STEPS 111
Mesh Presentation to the FDA 117
16. PREVENTION AND MAINTENANCE 121
17. MY POP EXPERIENCE 125
18. HEALTHCARE TUNNEL VISION 133
APPENDIX A: TIPS AND TOOLS 138
APPENDIX B: RESOURCES 142
APPENDIX C: POP-RFQ 144
GLOSSARY 146
BIBLIOGRAPHY 152
INDEX 161
ABOUT APOPS
LETTER FROM APOPS FOUNDER
ABOUT THE AUTHOR