Cystocele – what are the signs and symptoms?

Cystocele

Cystocele

Pelvic organ prolapse is bulging of one or more of the pelvic organs into the vagina.

These organs are the uterus, vagina, bowel and bladder.

Symptoms may include:

a sensation of a bulge or something coming down or out of the vagina, which sometimes needs to be pushed back

discomfort during sex

problems passing urine – such as slow stream, a feeling of not emptying the bladder fully, needing to urinate more often and leaking a small amount of urine when you cough, sneeze or exercise (stress incontinence)

Some women with a pelvic organ prolapse don’t have any symptoms and the condition is only discovered during an internal examination for another reason, such as a cervical screening.

When to see your GP

Pelvic organ prolapse isn’t life-threatening, but it can affect your quality of life.

See your GP if you have any of the symptoms of a prolapse, or if you notice a lump in or around your vagina.

Internal pelvic examination

Your doctor will need to carry out an internal pelvic examination. They’ll ask you to undress from the waist down and lie back on the examination bed, while they feel for any lumps in your pelvic area.

Some women may put off going to their GP if they’re embarrassed or worried about what the doctor may find. However, the examination is important, only takes a few minutes and is similar to having a smear test.

Further tests

If you have bladder symptoms, such as needing to rush to the toilet or leaking when you cough and sneeze, further tests may need to be carried out in hospital.

For example, a small tube (catheter) may be inserted into your bladder to examine your bladder function and identify any leakage problems. This test is known as urodynamics.

Your doctor will decide if further tests are needed before treating the prolapse.

Types of prolapse

If pelvic organ prolapse is confirmed, it will usually be staged to indicate how severe it is. Most often, a number system is used, ranging from one to four, with four indicating a severe prolapse.

Pelvic organ prolapse can affect the front, top or back of the vagina. The main types of prolapse are:

anterior prolapse (cystocele)  where the bladder bulges into the front wall of the vagina

prolapse of the uterus and cervix or top of the vagina  which can be the result of previous treatment to remove the womb (hysterectomy)

posterior wall prolapse (rectocoele or enterocoele)  when the bowel bulges forward into the back wall of the vagina

It’s possible to have more than one of these types of prolapse at the same time.

Why does prolapse happen?

Prolapse is caused by weakening of tissues that support the pelvic organs. Although there’s rarely a single cause, the risk of developing pelvic organ prolapse can be increased by:

your age – prolapse is more common as you get older

childbirth, particularly if you had a long or difficult labour, or gave birth to multiple babies or a large baby – up to half of all women who have had children are affected by some degree of prolapse

changes caused by the menopause – such as weakening of tissue and low levels of the hormone oestrogen

being overweight, obese or having large fibroids (non-cancerous tumours in or around the womb) or pelvic cysts – which creates extra pressure in the pelvic area

previous pelvic surgery – such as a hysterectomy or bladder repair

repeated heavy lifting and manual work

long-term coughing or sneezing – for example, if you smoke, have a lung condition or allergy

excessive straining when going to the toilet because of long-term constipation

Certain conditions can also cause the tissues in your body to become weak, making a prolapse more likely, including:

joint hypermobility syndrome – where your joints are very loose

Marfan syndrome – an inherited condition that affects the blood vessels, eyes and skeleton

Ehlers-Danlos syndrome – a group of inherited conditions that affect collagen proteins in the body

Can a prolapse be prevented?

There are several things you can do to reduce your risk of prolapse, including:

doing regular pelvic floor exercises

maintaining a healthy weight or losing weight if you’re overweight

eating a high-fibre diet with plenty of fresh fruit, vegetables, and wholegrain bread and cereal to avoid constipation and straining when going to the toilet

avoiding heavy lifting

If you smoke, stopping smoking may also help to reduce your risk of a prolapse.

How is prolapse treated?

Many women with prolapse don’t need treatment, as the problem doesn’t seriously interfere with their normal activities.

Lifestyle changes such as weight loss and pelvic floor exercises are usually recommended in mild cases.

If the symptoms require treatment, a prolapse may be treated effectively using a device inserted into the vagina, called a vaginal pessary. This helps to hold the prolapsed organ in place.

Surgery may also be an option for some women. This usually involves giving support to the prolapsed organ. In some cases, complete removal of the womb (hysterectomy) is required, especially if the womb has prolapsed out.

Most women experience a better quality of life after surgery, but there’s a risk of problems remaining or even getting worse.

Study links vegetarian diet in pregnancy to substance abuse in offspring

Study links vegetarian diet in pregnancy to substance abuse in offspring

Study links vegetarian diet in pregnancy to substance abuse in offspring

“Pregnant vegetarians are three times more likely to have kids who abuse drugs and alcohol,” reports the Mail Online. Researchers claim to have found a link between substance abuse at age 15, and diet of the child’s mother during pregnancy. But it is far from clear that avoiding meat in pregnancy “causes” substance abuse in teenagers.

The research was based on a long-running study in the UK. Researchers asked almost 10,000 teenagers about their use of alcohol, cannabis and tobacco, and about half responded. They then looked at the dietary records the teens’ mothers had filled out in pregnancy, to see if they could spot any relationships between the two.

The study found that children of women who ate most meat in pregnancy were less likely to be users of alcohol, cannabis or tobacco at age 15, compared to those who ate little or no meat. The researchers speculate this could be because women who don’t eat meat might have low levels of vitamin B12, which affects brain development.

However, we can’t know that diet in pregnancy was definitely the cause. Many factors are likely to be involved in something as complex as whether a teenager uses drugs or alcohol. This study cannot rule out that factors other than diet are responsible for the link seen.

That said, it’s important to be sure you get all the nutrients you need in pregnancy, including iron, vitamin B12 and calcium. You can do this without eating meat or dairy, though some women may need additional supplements.

Read more advice on vegetarian and vegan diet during pregnancy

Where did the story come from?

The researchers were from the University of Bristol in the UK, and the US National Institute on Alcohol Abuse and Alcoholism in Rockville, University of Illinois at Chicago and University of California, San Diego, all in the US. The research was published in the peer-reviewed journal Alcoholism: Clinical and Experimental Research.

The Mail Online’s headline is unnecessarily scaremongering. It quotes only the most extreme link found, and does not explain any of the limitations to the study in its article. It states that “most vegetarians have a B12 deficiency while pregnant”, and reports on the risks associated with vitamin B12 deficiency in pregnancy, but the study did not actually assess whether any of the women had a B12 deficiency.

This study alone cannot prove a definite link and other factors could be contributing to the findings.

 

What kind of research was this?

This was an analysis of data taken from a large, ongoing prospective cohort study called the Avon Longitudinal Study of Parents and Children (ALSPAC).

Cohort studies can identify patterns that may suggest risk factors for diseases or conditions such as substance abuse, but they can’t prove that one factor (in this case maternal diet) directly causes another (in this case substance abuse). This is because it is difficult to remove the impact of all other factors.

 

What did the research involve?

The new study came out of a long-running UK project, which has tracked what happened to almost 15,000 babies born to women in the Bristol area in 1991 to 1992.

In this study, just over 5,000 children in the group (about half of those invited) answered questions about their cannabis, alcohol and tobacco use. Researchers compared their answers to the dietary records taken from their mothers 15 years earlier, during their pregnancies. They checked whether children of women who reported eating little or no meat were more likely to report using alcohol, tobacco or cannabis.

The researchers made efforts to account for other possible causes for their findings (confounding factors). They adjusted their figures for these factors:

housing (owned, rented or social housing) and overcrowding

maternal education level

how many children were in the family

social class of the parents

occupation

ethnicity

the mother’s age when the child was born

family income after the child was born
parent/child relationships

Pregnant women who eat vegetarian diets may find it difficult to get enough vitamin B12 – one of the nutrients found in meat and important for brain development. The researchers thought that the mother’s levels of B12 could be responsible for their findings.

To test this, they also carried out a study in which they looked at women’s genetic variations, which may affect their ability to use vitamin B12. They looked separately at women with and without these specific genetic variants and whether there was a link between meat eating and children’s substance abuse.

 

What were the basic results?

Of the 9,979 teenagers invited to take part, 5,246 attended. About 10% of teenagers reported one of the following:

behavioural problems due to drinking alcohol (such as getting into fights because of drinking)

moderate use of cannabis (defined as using cannabis “at least occasionally”)

using tobacco on a weekly basis

The researchers carried out various analyses looking at different aspects of diet and these substance use outcomes. They found that teenagers born to mothers who had a “vegetarian” diet pattern had:

28% higher odds of having behavioural problems associated with alcohol (odds ratio (OR) 1.28, 95% confidence interval (CI) 1.17 to 1.41)

42% higher odds of using cannabis moderately (OR 1.42, 95% CI 1.30 to 1.55)

21% higher odds of using tobacco weekly (OR 1.21, 95% CI 1.10 to 1.33)

The study also found that the chances of having one of these substance abuse problems tended to lessen the more meat a woman reported eating.

The “three times more likely to have kids who abuse drugs or alcohol” figure quoted in the Mail Online’s headline seems to relate to the comparison of women who never ate meat compared to women who ate meat daily in pregnancy – the teens born to women who never ate meat had 2.7 times the odds of being moderate cannabis users (OR 2.7, 95% CI 1.89 to 4.00). The links with the other substance use outcomes were lower (OR for alcohol problems 1.75, and OR for weekly tobacco use 1.85).

In the genetic part of their study, the researchers found that the links between the mother’s meat intake and her child’s later substance abuse were stronger in women who had genetic variations that may allow the body to use vitamin B12 more efficiently. For women with a genetic variation that meant they couldn’t use B12 so well, their children’s risk of substance abuse was not linked to the amount of meat they ate.

That could be because eating more meat did not translate into more vitamin B12 for women with this genetic variation.

 

How did the researchers interpret the results?

The researchers said: “This study identifies low meat consumption in the prenatal period as [a] potentially modifiable risk factor for adolescent substance use.” They say that socioeconomic differences between women who did or did not eat meat were “unlikely to explain” their findings.

They say that vitamin B12 deficiency is “highly likely” to contribute to their findings, and suggest more fortification of foods with vegetarian sources of B12, and greater use of supplements.

 

Conclusion

While having too little vitamin B12 in your diet during pregnancy can affect a baby’s development, it remains to be proven whether a vegetarian diet in pregnancy can cause substance abuse problems in teenage offspring.

The findings do not mean that vegetarian pregnant women need to start eating meat. It is already recommended that vegetarian and vegan mums-to-be take special care to ensure they get enough of certain nutrients that are found in meat and fish, such as vitamin B12, vitamin D and iron. The study identifies a possible link between having little or no meat consumption in pregnancy (which may have led to vitamin B12 deficiency) and substance abuse in the offspring, 15 years later.

Substance abuse is a complicated problem, it is unlikely that one factor such as maternal diet in pregnancy could have caused it. However much the researchers tried to account for other potential confounding factors, it’s very difficult to untangle the mother’s diet in pregnancy from everything that happened between conception and the child’s 15th birthday.

More research is needed before we can come to more definitive conclusions.

The study has some limitations that may affect the reliability of the results:

  • Only half of the children invited to participate in the research at age 15 did so. We don’t know what happened to the other half, or why they dropped out of the study. We don’t know if their results would have supported or undermined the study findings.

    We don’t know whether the pregnant women were deficient in vitamin B12, because they weren’t tested for it. We have to rely on the questionnaires they filled in about their diet back in 1991 or 1992. We don’t know whether their diet changed during pregnancy, or whether they were deficient in other important nutrients.

    We don’t know how accurate the teenagers’ reports of substance abuse were, or whether they reflect long-term use of alcohol, cannabis or tobacco – the research gives us a “snapshot” view of one point in time.

    While the researchers tried to take into account a number of socioeconomic factors, and also some aspects of the parent-child relationship, the effects of these complex factors are unlikely to have been fully removed.

While the study doesn’t add much to what we already know about diet in pregnancy, it’s a reminder that pregnant women do need to ensure they get all the nutrients they and their growing baby need.

Know Your Normal – How Well Do We Know Our Bodies?

Know Your Normal – How Well Do We Know Our Bodies?

Know Your Normal – How Well Do We Know Our Bodies?

Everyone remembers sitting through biology lessons at school learning about the human body, but most of us don’t learn much more about our bodies after that, unless something goes wrong.  Our bodies are complex machines, with different parts working together to keep us healthy.  It’s easy not to think about changes to your body when things are going well, but it’s important to recognise what’s normal and what’s not – so that you have the confidence to talk about it and seek help when something does change.

That’s why Balance Activ have teamed up with Dr Sarah Jarvis to create a video that reminds women of the completely normal changes that will happen to their bodies over the decades.  These range from reaching peak bone mass in their 20’s to changes in intimate health – it’s important for women to ‘know your normal’, and many women don’t.

Research released today by Balance Activ, who surveyed 1,000 men and 1,000 women, reveals how well we really know our bodies (or not, as the case may be).  39 per cent of respondents didn’t know the difference between the kidneys and the liver – and a quarter couldn’t explain how veins and arteries differ.  Most people also don’t know the liver is the biggest internal organ – with 41 per cent under the impression that the lungs are.

Despite the huge changes women go through in their lifetime, including periods, pregnancy and menopause, over a third of women surveyed said they are not completely confident they know what their ovaries actually do and over half are not sure they know what happens during menopause.  As for men, more than seven in 10 questioned weren’t sure what a prostate does.

When asked about vaginal health, six in 10 women didn’t know what BV is, even though it is one of the most common conditions and is in fact twice as prevalent as thrush.  While around half of women have no idea what the potentially serious implications of leaving it untreated are, more than one in ten said they would use vaginal deodorants, washes or douches to relieve the symptoms – all of these things can actually cause BV rather than treat it.

Dr Jarvis said: “When it comes to intimate health specifically, it is interesting how many people spot that things have changed, or that something doesn’t feel quite right and yet often don’t seek medical advice for some time. This is often due to a lack of understanding about what is going on and confusion over symptoms which results in a lot of often unnecessary worry.  This can have a knock-on effect on our confidence, put pressure on relationships and generally cause a lot of anxiety when in fact it could be something very common and very easy to treat.

Knowledge is key in managing your health and well-being. This is why Balance Activ are working closely with the Intimate Health Taskforce, a panel of healthcare professionals and women that have experienced BV, to provide information and tools to help women understand more about their intimate health. The expert advice, women’s real stories and online symptom checker are designed to help reassure women and encourage them to talk openly about any worries they may have with either friends, partners, parents or healthcare professionals to seek further advice and effective treatment if needed.