QA Womens HealthFor Pelvic Organ Prolapse Awareness Month during June, we asked Gena Dunivan, M.D., FACOG, FACS, professor and division director for the UAB Division of Urogynecology and Pelvic Reconstructive Surgery, some important questions about pelvic organ prolapse, the importance of awareness, what makes UAB’s Division of Urogynecology and Pelvic Reconstructive Surgery special in this area, and more.

Dunivan also serves as vice chair for mentorship and faculty development for the UAB Department of Obstetrics & Gynecology (OB/GYN).

What is pelvic organ prolapse (POP)? What are the symptoms?

Pelvic organ prolapse occurs when one or more of the pelvic organs drop from their normal position and can bulge into the vagina. This can happen when the pelvic floor, which includes muscles and ligaments, weakens.

One common symptom is pressure or heaviness in the vagina. Depending on what is prolapsed, women may also experience urinary symptoms such as incontinence or difficulty emptying their bladder as well as difficulty with bowel movements. However, some cases are mild and may not have any symptoms.

Why is it important to bring awareness to POP?

Pelvic organ prolapse is relatively common in women, making it an extremely important issue. Given the range of symptoms and age being a risk factor, it is hard to know exactly how many women it occurs in, but it is estimated that about one-third of women will experience pelvic organ prolapse. Even more important - many women do not seek care because they are embarrassed or ashamed to talk about it with their provider. Many also incorrectly believe that it is a normal part of aging and that nothing can be done to help.

What research is being done regarding POP, and how is UAB OB/GYN involved? 

There is a lot of important research going on regarding pelvic organ prolapse. The UAB Division of Urogynecology and Pelvic Reconstructive Surgery is part of the Pelvic Floor Disorders Network. This network is a nationwide collection of medical centers, funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, that studies pelvic floor disorders, which includes pelvic organ prolapse.

The Division has been a part of pivotal studies in the field, including comparing native tissue repairs for apical prolapse, comparing pelvic organ prolapse surgery outcomes with and without a hysterectomy, and exploring the patient perspectives of adverse surgical outcomes.

As physicians, what can we do bring additional awareness to POP? 

It is important for physicians to normalize talking about pelvic organ prolapse so patients will not be embarrassed. Most importantly, it is important to ask patients if they are experiencing symptoms. This is particularly true in OB/GYN and primary care.

It is important for patients to understand there are many treatment options available, both surgical and non-surgical, and especially that they are not alone! The postpartum period is also an excellent time to talk to women about their pelvic floor and any symptoms they may be experiencing.

What education and training do we provide our residents to care for POP patients?

All of our OB/GYN residents rotate on the urogynecology service. They learn how to assess and work up pelvic organ prolapse and gain exposure to all of the treatment options.

UAB also has the only three-year fellowship training program in the state. These are physicians who have completed an OB/GYN or urology residency and choose to do an additional three years of training to become experts in the care of pelvic floor disorders.

What makes the UAB Division of Urogynecology and Pelvic Reconstructive Surgery special/experts when it comes to POP?

The Division of Urogynecology and Pelvic Reconstructive Surgery is so special as it is truly team-based care that is individualized for each patient and their unique needs.

The Division has four (soon to be five) fellowship trained urogynecologists that are experts in both the surgical and nonsurgical treatment options for pelvic organ prolapse, as well as pelvic floor problems that can occur with pelvic organ prolapse, including urinary and fecal incontinence.

Additionally, our team includes dedicated and highly trained advanced practice providers (APPs), nurses, and physical therapists, which allows us to tailor the care plan for each patient.