Which is the best way to fix my pelvic prolapse problem?

AFTER I was diagnosed with a prolapse problem, my doctor prescribed a hormone cream and I’ve been fitted with a vaginal pessary. I’ve tried to get used to it, and sometimes I forget it’s there, but at other times I find it uncomfortable. How successful are these devices, and is there any alternative?

WITHIN the pelvis is a ‘hammock’ of muscles and ligaments called the pelvic floor which, in women, supports the womb, bladder and rectum. If these muscles are weak, as they can be due to ageing, obesity and after pregnancies, they don’t hold everything in place as well as they should, so there can be some shift downwards.

This is what doctors call a prolapse, and it’s a common problem. The term prolapse actually encompasses a wide range of issues depending on which organ is affected, and to what degree it is ‘dropping’.

In a significant prolapse, the womb may bulge noticeably out of the vagina. The type and extent of prolapse will affect the symptoms, which can include heaviness, a dragging sensation, feeling a lump, bladder symptoms, incontinence and painful intercourse.

A vaginal ring is one way of supporting a prolapse for people who don’t want surgery. It is usually a plastic doughnut-shaped device that sits at the top of the vagina holding everything up.

It needs to be fitted by a doctor and often takes a few goes to get the right size. Oestrogencontaining hormone replacement therapy creams are used alongside, to keep the tissues comfortable and healthy.

Gynaecologists recommend pelvic-floor exercises to help strengthen the pelvic floor muscles, and these are even more effective if a trained pelvic physiotherapist is involved in the process.

Weight loss and avoiding constipation are also important.

There are many surgical options for prolapse, depending on symptoms and general health, and this is a discussion to have with a gynaecologist.

The notorious vaginal mesh operations were performed for prolapse but are now performed only as part of research, due to complications they caused. Other surgical options are available, and new techniques are being developed all the time.

FOR the past four weeks I’ve suffered very loose, floating bowel movements. They’re also more frequent than I’m used to, and sometimes I find I’ve leaked, which is distressing. I am not in pain, but this is not normal for me. Should I pluck up the courage to see a GP in case there is something serious going on?

A SIGNIFICANT change in bowel habits like this is absolutely cause to see a doctor. The worry is that there is something wrong with the pancreas, a gland in the abdomen that produces enzymes that break down food.

One of these enzymes is the one we need to digest fat. Without it, fat we consume stays in the gut, and ends up in the stools.

The medical term for this problem is called steatorrhoea and it can be a sign of pancreatic cancer. It can also be a sign of pancreatitis, where the pancreas is inflamed, sometimes from gallstones.

Steatorrhoea is also a sign of coeliac disease, which is an inflammatory gut condition and can be something that happens to people with cystic fibrosis, a genetic disease that affects the function of many organs.

To find out the cause, urgent testing needs to be carried out to screen for all these things. The best sort of scan to look at the pancreas is a CT scan, but usually a GP would start with an ultrasound, as it is easier to get.

AFTER eating a meal, I find I sweat profusely – all over my body – for about an hour.

My GP did some tests which indicated I have high blood sugar. He knows I don’t like taking pills, so suggested a diet. Do you think that will sort it?

SWEATING after eating, known as gustatory sweating, is normal after eating hot and

spicy foods. But if it happens regularly, it could be a sign of an unusual condition associated with nerve damage – and in particular damage to the nerves in the mouth. This can occur after surgery or an injury, and it can also be a side effect of some medicines.

We do also see nerve problems in cancer, when a tumour presses on a nerve.

It is associated with Vitamin B12 deficiency and also in heavy drinkers. And, yes, it can also be the result of diabetes, which is in fact the most common cause of problems with autonomic nerves – the nerves that control involuntary movements such as breathing, heart rate, and sweating.

In order to assess this type of issue, nerve-function tests need to be arranged. These are usually done in the hospital. An unusual symptom like this warrants more

testing than a blood test, particularly when it is new and persistent. Depending on the results of the nerve-testing, scans may also be needed. If all sinister causes are ruled out, medication or treatment may be worth considering, if it is very distressing.

This would be under specialist guidance with a referral to hospital. Specific treatments may involve a cream or tablet that blocks the nerves to the sweat glands, or injections of Botox, which are shown to reduce sweating in the area where they are administered.