Bladder prolapse causes discomfort in 68-year-old woman
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DEAR DR. ROACH: I am a 68-year-old female who’s in great health, except for cholesterol levels that are a tad high. In January, I was diagnosed with a prolapsed bladder. My gynecologist said it was stage 1, and therapy will be able to help. I’ve been through physical therapy and done pelvic floor exercises, but they don’t seem to be helping.
Is a bladder prolapse uncommon? I don’t have any other female friends who’ve experienced this. I’m more often than not very uncomfortable with the discomfort and “bulge.” I’m a very active person with gardening and house chores, and I’m having a hard time doing the things that I’ve enjoyed in the past. What’s your opinion on treatment options? What do you think of a pessary? — T.M.W.
ANSWER: Pelvic organ prolapse (POP) is a very common issue when you look for it — 40% to 50% of postmenopausal women have this condition after undergoing a pelvic exam. However, roughly 3% of women will report having this condition, reflecting the large number of asymptomatic cases. Age is a significant risk factor, but the number of babies that a woman has delivered vaginally is also a big risk factor for POP.
I completely agree with the decision to try pelvic-floor physical therapy as an initial treatment. I also recommend topical estrogen, such as a cream or a vaginal pill, as it’s used by many experts to help keep the lining of the vagina healthy, especially if a pessary is considered.
A pessary is a removable device that’s placed in the vagina to mechanically support the vaginal walls and pelvic organs. They are typically made of silicone, plastic or latex. A ring-shaped pessary is often the first one that’s tried. The gynecologist will find a properly fitting pessary, and most women learn to place and remove it themselves.
About 92% of women can be properly fit with a pessary, which means that they are able to urinate and have sexual relations but not feel the device. The vast majority of women with stage 1 POP who don’t get adequate relief from pelvic-floor physical therapy will do well with a pessary. If a pessary is ineffective, or a woman doesn’t want it, there are surgical options. A gynecologist is the expert in managing POP.
DEAR DR. ROACH: Do xanthomas go away with cholesterol treatment that includes a statin? — V.P.
ANSWER: Xanthomas are yellow areas of the skin that are found in some people with very high cholesterol. Very high LDL or triglyceride levels may cause them. They are often on the elbows, knees, hands or face.
People with xanthomas generally have very high cholesterol levels that need aggressive treatment — usually some combination of a statin, a PCSK9 inhibitor, and ezetimibe. With aggressive treatment, xanthomas do go away, but it may take five years or more.
The issue in this case isn’t as much the cosmetic appearance of the skin lesion as it is the fact that xanthomas occur in people whose cholesterol levels put them at a very high risk for heart attacks and strokes. Effective therapy reduces the risk of these conditions and helps get rid of them.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.