Debbie GonzalezDoctor's Corner, Pelvic Health Leave a Comment

My doc said I have stage 3 prolapse & to continue work out. Should I get a 2nd opinion?

Question: “One week ago, my gynecologist told me I have stage three uterine prolapse. She also said for me to continue to exercise (as in to keep running, rowing, and lifting weights). She said it was more important for me to be healthy. Should I get a second opinion regarding this? She also said that I have overactive bladder syndrome. I have to pee many times at night, such as five to ten times.”

Answer from Dr. Daniel Gruber, urogynecologist from Sibley Memorial Hospital in Washington D.C., part of John Hopkins medicine.

Let’s start by addressing the first issue, regarding your prolapse. Stage three typically means that some part of the vagina falls out, whether that’s the front wall, the back wall, or the top of the vagina where the cervix is. It can be one part, or any combination (including all of them) that can be dropping out. Typically stage three means something it coming out. 

The real concern is how much it bothers you, and that’s a really subjective thing. Some people with a stage three prolapse are not bothered very much, while others are very bothered by it. 

You definitely can continue to exercise. Lifting heavy weights might make it slightly worse over time, but I totally agree that it’s important to remain healthy. If it impacts your ability to exercise because it’s falling out or causing you some issues, then treatment might be a good thing. 

 Treatment really depends on how much it bothers you. It’s not going to change the treatments regardless of what stage you’re at. For example, you can use a pessary, like I mentioned before, or even discuss surgery options. 

As far as your overactive bladder is concerned, waking up many times a night, from five to ten times, is completely ridiculous. It’s obviously disrupting your sleep and to get up that much, there’s many factors that can go into it. 

For example, if somebody’s drinking way too much, then urine might be building up over the day, so they have to urinate many times at night. Decreasing fluid intake in that instance might be a good idea. Usually, we recommend not drinking within a couple hours of bedtime in order to help minimize this. 

We also know that eliminating some foods can help as part of the behavioral changes. Some people might have bladder irritants that they’re in-taking that can make things worse, and it would be helpful to eliminate them. 

There are lots of different treatments as well that we can do beyond the behavioral ones that I just mentioned or mentioned before. There are medications, electrical stimulation, and both internal and external options like implants, for example. We do bladder Botox as well, where we inject Botox into the bladder. That can help people for six to nine months at a time, and we can repeat it.

Note that there can be other hormonal issues going on if, as you get older, your hormones change. That can be influencing things, so there’s a lot of variability.  

So there’s lots of different options and some people need more than one of those to help them. It’s definitely a long road for overactive bladder. That’s why it’s important that you go see your gynecologist as soon as possible to get on the road of recovery. I can imagine waking up five to ten times at night is disrupting your sleep, and therefore also disrupting your day. It’s a big deal. 

I definitely would recommend seeking care.

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