On the move again

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Coleen Venema, 71, climbed down from the ladder in her living room to share her story.

She had spent the day painting the ceiling and making various renovations around the house. On any given day, it’s nearly impossible to catch her standing still.

This alone makes it plain to see how prolapse had been such an inconvenience in her otherwise active life.

“We usually have five or six beef cattle on our Sheridan farm and lots of chickens,” Venema said. “With 139 acres, there is always something that needs to be done.”

But for about two years, health issues forced Venema to slow down.

She hated every dragged-out minute of it.

Her prolapse, with part of her bladder and vagina pushing down and out, had been similar to a hernia. It made her nearly immobile.

“I was miserable,” she recalled. “I could hardly walk and I was always tired.”

Along with the discomfort of the prolapse, she felt a constant pressure on her bladder, as though she had to run to the bathroom for relief that would never come.

Desperately seeking solutions

Nima Shah, MD, a urogynecologist with Spectrum Health Medical Group, said pelvic organ prolapse involves organs within the pelvic area—bladder, cervix, intestines, rectum, urethra, uterus, vagina—dropping down lower than they should.

When the muscles and tissues that hold these organs in place become weak or torn or stretched, it can lead to prolapse.

Sometimes this is mild enough that the person doesn’t feel any symptoms. For others, like Venema, it can cause debilitating discomfort.

“In Coleen’s case, her bladder and part of her vagina were pushing down and that caused a lot of pressure,” Dr. Shah said. “She also had problems with leakage.

“When Coleen’s obstetrician-gynecologist referred her to me, we discussed our options,” the doctor said.

By the time Venema met with Dr. Shah, she could recount several options she’d already been through.

Her trouble began as a young woman, when she hoped to get pregnant. “I found out then that I had endometriosis,” Venema said.

Endometriosis causes a layer of tissue that normally grows inside the uterus to instead grow on its outside. It can prevent pregnancy.

“I had to have a hysterectomy and later we adopted our two children,” Venema said. “By the time I saw Dr. Shah, I had had five incisions and I had also tried a pessary. That was horrific.”

A pessary is a soft, removable device inserted in the vagina to help control leakage while supporting weakened tissues that can cause a prolapse.

Venema, however, had trouble removing the device.

“Even my doctor had trouble removing it,” she said. “It didn’t work for me. Then my doctor talked about trying surgery and putting a mesh in to hold the organs in place.”

But surgery entailing the placement of mesh wouldn’t work.

“A mesh to lift the vagina can be inserted using laparoscopy, making a small incision through the belly button,” Dr. Shah said. “But when Coleen’s previous doctor tried that, she encountered a lot of scar tissue from the endometriosis and hysterectomy—and the surgery was not successful.

“We talked about surgery done through the vagina instead,” Dr. Shah said.

Venema liked the plan. And she trusted Dr. Shah immediately.

“She was upfront with me and she told me right away what she could and could not do,” she said. “So I knew I could trust her.”

Wrapping it up

In March 2018, Dr. Shah performed surgery through the vagina, making an incision at its top wall.

“I could find strong muscle and tissue support there that I could use,” Dr. Shah said. “Basically, it’s like using strong stitches to put things back together where they should be. I used longer-acting sutures but also relied on scar tissue to hold them in place.”

While researchers continue to study the progress of people who have undergone this procedure, it’s currently estimated that about 15 to 20 percent of patients have a recurrence of prolapse after this type of surgery.

These surgeries can provide relief for up to 25 years, Dr. Shah says.

“It was about a 2 1/2 hour surgery and Coleen was able to go home the same day,” Dr. Shah said. “In about two weeks she had no more pain, normal urination and great relief.”

Venema attested to this.

“Oh, I felt relief immediately,” she said. “I can go half a day now without visiting the bathroom. I can walk, I can work, I can teach, I can be myself again.”

She laughed as she climbed back up the ladder in her house, paintbrush in hand. Since the procedure, she has again found pleasure in renovating her home.

Her new favorite project: sprucing up the bathroom.

Call it closure.

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