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Incontinence & Overactive Bladder Health Center

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The Scariest Article You'll Ever Read About Your Ladyparts

"Why does it feel like my insides are falling out?"

If you have the sensation that you're sitting on a ball (but you're not!), you may have uterine prolapse, in which the uterus drops into the vagina as a result of weakened pelvic muscles and tissue. Rebbekah White, 35, of Sylvania, OH, began suffering from prolapse after the birth of her second child. "It felt like I had a bowling ball between my legs," she says. In addition to this bulging feeling, many women experience pressure with a pulling sensation in the pelvis, lower backache, and painful intercourse. In severe cases, the uterus can fall so far south that it protrudes from the vaginal opening. (The vagina, bladder, and rectum can drop too.) Eventually, whenever Rebbekah went to the bathroom or had intercourse, she could see and feel her uterus. "It was depressing, and so uncomfortable," she says. Rebbekah's clues were obvious; in mild cases of prolapse, however, there are often no clear signs, says Peter Rosenblatt, M.D., the director of urogynecology at Mount Auburn Hospital in Cambridge, MA. Up to 50 percent of women who've had children have some degree of prolapse, but only 10 to 20 percent show symptoms.

Blame it on: Multiple vaginal deliveries, especially if your babies were 8 pounds or heavier and forceps were used, Rosenblatt says. (Rebbekah's second child weighed 12 pounds at birth and had to be delivered by forceps.) Still, just because you haven't given birth doesn't mean you're in the clear. "I've seen prolapse in nuns," says Erika Banks, M.D., an ob/gyn at Albert Einstein College of Medicine in New York City. Other triggers include age, obesity, and anything that puts pressure on the abdomen — say, if you're a nurse who lifts patients.

The fix: A pessary — a removable vaginal device that helps prop up the uterus. "I've used one for four years now and it's no big deal," says Sarah Kelsey, 34, a mom of three in Bethel, CT. "I don't even know that it's in there. I was pregnant when my uterus prolapsed — talk about pain! I wouldn't be able to urinate without a pessary. I can't walk distances or do anything physical like jumping rope without it. It saved me from surgery."

For severe prolapse there's sacrocolpopexy, a minimally invasive procedure that supports the uterus by suspending the walls of the vagina from the back of the pelvis. (The chance of a woman having surgery for prolapse in her lifetime is 11 percent, Rosenblatt says.) Five years ago, after having her third child, Rebbekah had a hysterectomy, once a popular — and far more intrusive — prolapse treatment. These days, however, most doctors recommend that the uterus be resuspended. (See "What every woman must know about hysterectomies," above.)

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