As part of our Lunch & Learn series we were joined by Dr Surya Gupta-Wright of My Menopause Centre.
Are you aware of how prolapse and incontinence can impact your daily life and well-being? Do you know the best strategies to manage these conditions effectively, especially in a work environment? Dr Gupta-Wright gave her top tips and advice.
Henpicked: First of all, could you explain what prolapse is?
Dr Surya Gupta-Wright: Prolapse is when the organs in the pelvis, which are the bladder, bowel and womb (uterus) start to hang down into the vagina. Over time, the support which holds them up, the ligaments inside the pelvis and the pelvic floor can weaken.
Our pelvic floor, which is the sling of muscles at bottom of the pelvis, can be put under strain by a number of things. Pregnancy and childbirth is a big culprit, also long–term constipation and straining, a chronic cough and smoking, and carrying extra weight can put more pressure on your pelvic floor. Prolapse occurs when these organs hang down into the vagina and there may be bulges in the vaginal wall.
Henpicked: How does it feel – will we know we have it?
Dr Surya Gupta-Wright: You can’t always see it, but women describe a dragging sensation, or may feel a lump in their vagina, or protruding from the vagina. Some women may have a degree of prolapse but not really be bothered by it. Luckily, there are some simple things you can do to help to stop it from getting worse.
Henpicked: Do we need to get it checked out?
Dr Surya Gupta-Wright:
It’s always worth going to your GP in the first instance, especially if it’s something you’re worried about. If you’re struggling to see a GP then your local family planning clinic may be able to help. It won’t get better on its own, so it’s always best to get checked out.
It is really important to tell your GP if you experience changes in your bowels, bladder or get unexpected vaginal bleeding.
Henpicked: Can prolapse be caused by menopause?
Dr Surya Gupta-Wright: Around the time of the menopause, hormone levels start to drop and oestrogen is responsible for helping to maintain the elasticity of our body tissues, a prolapse may start to deteriorate at this time of life.
Henpicked: Is incontinence related to prolapse?
Dr Surya Gupta-Wright:
Yes, it can be. Essentially, incontinence is when you’re leaking urine (wee) or faeces (poo), and as weakness in the pelvic floor is one of the big factors for causing incontinence so there is definitely a link.
They are important symptoms to talk to your doctor about, and please don’t feel embarrassed, they should be able to offer you advice and possibly refer you to a local service (like the local bladder and bowel clinic) that can help you. Urinary incontinence takes two forms. Stress incontinence is related to the pelvic floor and the way the bladder is supported, and urge incontinence is caused by an irritability in the bladder walls.
Henpicked: What can we do to help ourselves?
Dr Surya Gupta-Wright: Pelvic floor exercises can make a significant difference. If you do them properly for about 16 weeks, around 80% of women will see an improvement. This seems like quite a manageable goal, especially if you use some strategies to help you remember and get into the habit of doing them regularly. The NHS Squeezy app is helpful and there is a useful page about pelvic floor exercises on the NHS website.
You could also book a couple of sessions with a physiotherapist that specialises in women’s health, just to get you started so you know that you are on the right lines and the exercises you are doing will be effective.
General exercise may not specifically target your pelvic floor, but it’s still a very positive thing to do for your overall health and wellbeing, and managing your weight. Some exercises like Pilates and yoga do help to strengthen the pelvic floor.
Also, as you go into perimenopause and menopause, vaginal oestrogen can help. Even those who can’t take HRT can generally use this, as it’s a tiny dose of oestrogen. But it can have a big impact on the elasticity of the vaginal tissues and can help make your bladder wall less irritable.
Henpicked: Are there any products that can help?
Dr Surya Gupta-Wright:
There are some really good incontinence pants on the market now which are much easier and more discreet than pads, and better for the environment. These can help to give you some flexibility and boost your confidence if you’re exercising. You can also try vaginal oestrogens.
There are ring pessaries, which are inserted into the vagina which can help to support a prolapse – you’ll need to speak to your doctor about these, as it needs to be professionally fitted. There are some new supplements for incontinence, some of which look interesting, but they may have been tested on relatively small numbers of women so far.
Henpicked: Can having a hysterectomy cause prolapse?
Dr Surya Gupta-Wright: It varies. For some women, it means the top of their vagina is less well supported so it could contribute. But for others, especially if they have a large womb with eg fibroids, a hysterectomy can relieve some prolapse symptoms.
Henpicked: Would prolapse be picked up during a smear test?
Dr Surya Gupta-Wright: Nurses may not point out a prolapse as a matter of course. But if you think you have signs of a prolapse you could mention it to them and they can check.
As ever, there were some great comments and tips from those watching the webinar:
“I’ve recently been referred to an incontinence team as I have been suffering recently with both urinary and bowel incontinence. 18-week wait! “
“Lots of clinicians in Primary Care don’t associate urinary incontinence with menopause. More training is still required.”
“I have been prescribed tablets whilst waiting for my appointment at the incontinence clinic. The tablets have helped but are not a long- term solution.”
“I had the vaginal mesh fitted in 2013 but I also have an overactive bladder which is my problem in terms of leakage. It seems worse the older I’m getting.”
“I’m a trained Pilates instructor and absolutely this type of exercise can help the pelvic floor.”
“Tea is a trigger for me for sure.”
“Alcohol and caffeine really trigger my bladder.”
“Switch to the delicious Rooibos (Red Bush) tea. It’s a plant that is naturally caffeine free and has a lovely tea taste.”
“There is a FB support group of other women with prolapses that might be helpful – FPOPS UK.
“Mine is improving as I’m eating less carbs and cutting back on fizzy drinks.”
“Pelvic floor, more intense orgasms! Keep doing them.”
Henpicked Menopause in the Workplace’s Deborah Garlick was joined by Dr Surya Gupta-Wright of My Menopause Centre.
Dr. Surya brings years of experience in Obstetrics and Gynaecology and holds Diplomas from the Royal College of Obstetrics and Gynaecology and the Faculty of Sexual and Reproductive Health. She is also a registered menopause specialist with the British Menopause Society. Dr. Surya’s expertise is further enriched by her work in a Menopause Research Unit in London, where she addressed complex menopause cases and contributed to important research projects.
