Dr. Gott: Surgery declined for senior

DEAR DR. GOTT: I have reached my 79th birthday and have been diagnosed with pelvic prolapse, affecting mostly my bladder. However, my OB-GYN describes it as bladder, bowel and cervix. Owing to my heart skipping occasionally, I went through an EKG and all stress tests and blood testing preparing me for surgery. I was given approval for the surgery until my OB-GYN told me that she would not perform the necessary surgery as it would be a long procedure and she didn’t want to put my body through that much stress.

A pessary was ruled out because it did not work for me. So, for the time being, I have decided to live with the situation but am now asking your advice on whether I should get a second opinion or do nothing? What problems do you think I would encounter later on? It is not that easy to talk about, but in doing so, I find it is not all that uncommon.

DEAR READER: Pelvic prolapse is a weakening of the muscles and ligaments of the pelvic organs with the end result being that the organs slip downward out of their normal position. As you have determined, this is a rather common condition that affects almost 50 percent of all women who have had children.

Symptoms include loss of bladder and bowel control, an increased sensation of urgency to urinate with a sensation of being unable to fully empty the bladder, repeat infections and excessive vaginal discharge.

To document the diagnosis, there are bladder-function tests plus pelvic floor strength tests, ultrasound, MRI or cystoscopy.

Because there are several types of prolapse, I will explain them briefly. If the anterior vaginal wall and bladder fall, the condition is known as a cystocele. If the posterior vaginal wall and rectum fall, the condition is known as a rectocele. If the uterus falls, a person has uterine prolapse. Small bowel protrusion through an area between the vagina and rectum is an enterocele.

Initial treatment might begin with medication. For example, menopause causes a decrease in estrogen levels in a woman’s body that results in a weakening of vaginal muscles. Estrogen-replacement therapy can restrengthen those muscles; however, this therapy is not appropriate for all women. That decision must be left to each patient’s primary-care physician or gynecologist.

The next step might be physical therapy to include either biofeedback or electrical stimulation – then surgery. The procedure depends on what specific type of prolapse a person has.

I don’t know your full medical history and can only suggest you return to your surgeon with a list of questions. Bring a trusted family member with you who might have a different perspective on the situation. Ask why the doctor has chosen not to perform the procedure after all your testing. Perhaps she found something in the test results that she failed to share with you.

Then, if you remain dissatisfied, ask for a referral to another specialist for a second opinion. Bring all your test results when you go. He or she will either agree with the first doctor or will feel your quality of life is compromised enough that the procedure should be performed.