Nancy Poe had a problem with leakage and bowel movements, so in the fall of 2010 she sought help.

“My friend referred me to Dr. Sprock,” says the retired public school cafeteria manager.

Marja Sprock, MD, FACOG, is a board-certified obstetrician and gynecologist with fellowship training in urogynecology. Her practice is in Rockledge, in the Melbourne area.

“I found her to be very friendly, direct, and informative,” remembers Nancy. “She’s not in any rush. I wanted help, and she talked to me and answered all of my questions.”

In a healthy vagina, a network of muscles, ligaments, and skin act as a complex support structure for the uterus, rectum, urethra, small bowel, and bladder,” describes Dr. Sprock: “When various parts of this support system weaken, these structures, or even the vagina itself, may prolapse, or fall, out of their normal positions. Without medical attention, these structures may continue to fall into the vagina and might eventually emerge through its opening. Visually, it can look like when you reach into a sock and pull it inside out until the toe of the sock rises through its cuff. Symptoms of vaginal prolapse may include pelvic pressure, can affect sexual activity, and may disturb functions including urination and defecation, although some women do not experience any obvious symptoms.”

Women who develop vaginal prolapse are typically over 40 years old and have likely experienced childbirth, menopause, or a hysterectomy. Other causes are genetics, chronic constipation, and obesity. Also, careers that require heavy lifting, such as Nancy’s, can contribute to the condition, adds the doctor.

Treatment options

 Some women, due to embarrassment or for other reasons, fail to seek medical advice. However, for those who do, different treatment options are available.

“Following diagnosis, some patients choose to do nothing,” observes Dr. Sprock, “but this may not be the wisest choice. Depending on what has prolapsed [see special box: Types of Vaginal Prolapse ], there can be consequences to ignoring the condition. If the bladder has prolapsed through the vagina opening, urination can be difficult. Retention of urine can have repercussions. It can cause bladder infections, or if the pressure elevates significantly, it can cause kidney damage.

“On the other hand, if it is the uterus that has prolapsed, the condition may just be annoying to the patient.”

Dr. Sprock says that a second option for patients is a vaginal pessary: “This is a removable device which is placed into the vagina. There are different types, some made of rubber, plastic, or silicone-based material. They are designed to hold the pelvic organs in position. Pessaries are used as a nonsurgical approach and have their pros and cons. They are not permanent, and do not work well for rectocele, where the back wall of the vagina weakens, pushing against the vaginal wall and allowing the front wall of the rectum to bulge into the vagina.

“A third option is surgery, which can be performed vaginally or laparoscopically,” continues Dr. Sprock.

Nancy chose to have surgery, which was performed in October 2010.

“For Nancy, we reinforced the front, top, and back of her vagina with Polypropylene screen cloth, or mesh, which offers great strength and stability,” elaborates Dr. Sprock. “By attaching the mesh to a ligament, it strengthens and supports weak tissue. One of the elements that make it a good choice is that this particular mesh lasts forever. Rather than dissolving, the patient’s own tissue will use it as a lattice, growing into and incorporating it.”

 Dr. Sprock mentions that previously, different meshes came with potential problems, but that the fibers used to make the meshes of today have smaller diameters and the mesh offers more flexibility and larger pores: “One of my patients described it as feeling so soft that she compared it to the lace she uses for sewing.”

Along with pointing out the importance of good mesh, the doctor also cautions that this procedure is highly technique sensitive: “Several studies on numerous different surgical interventions and procedures have shown that surgeons who perform a certain surgery more often, known as high-volume surgeons, tend to have better outcomes and fewer complications.”

Before having her surgery, Nancy worked with Central Florida Urogynecology to strengthen her pelvic floor muscles.

“We have everything set up here in the clinic to enable our patients to see on the computer how well they contract,” says the doctor. “We train them and also use passive stimulation for their muscles, so it really helps them.

Excellent result

“I’m very pleased with my surgery,” assures Nancy. “It didn’t take very long at all, and I came home the same day.”

“I try to do these surgeries on an outpatient basis whenever possible,” explains Dr. Sprock. “There are several advantages for our patients. They can stay active in their own environments, avoid hospital infections, and have a lower chance of blood clots.

“Our patients are actually up walking a couple of hours after surgery. We caution them not to do anything the first couple of days that will require them to strain, and initially bending over is not a good thing because it puts a lot of pressure on the pelvis. But in general, I am more pro activity like walking.”

“They encouraged me to walk, and I did,” notes Nancy. “I wasn’t in any pain or anything.

“I did wait several weeks before bowling again, but I’m back to that, as well.

“Dr. Sprock is a very caring person, and she knows what she’s doing. She certainly knew how to help me.” 

FHCN – Kris Kline