Amy Turpin, a Harwood resident, is unusual in some ways. At 50 years old, this grandmother of four is exceptionally fit, working as a strength and conditioning coach, and competing in marathons and triathlons. “I’m physical all day long, and then running or cycling is what I choose to do for fun,” she says.
But there is one way in which Amy is not unusual. Just like almost a quarter of American women, she experienced a pelvic floor disorder.
Pelvic floor disorders occur when the muscles or connective tissues that support a woman’s pelvic organs weaken or are injured. This is commonly a result of pregnancy and childbirth. But obesity, smoking and genetic predisposition are also risk factors.
The most common problems are incontinence and pelvic organ prolapse. In prolapse, organs such as the uterus, bladder or bowel collapse into the vagina.
Briana Walton, MD, director of female pelvic medicine and reconstructive surgery at Anne Arundel Medical Center’s Women’s Center for Pelvic Health, explains prolapse like this: “If you think about the vagina as a room, and you walk into that room, the ceiling keeps the bladder out, the floor is where the rectum would be, and the wall in front of you is where the uterus is,” she says. “Prolapse causes either the ceiling to drop, the floor to bulge or the wall to lean toward the entrance.”
For many women with prolapse, there are no symptoms, other than some pressure or a vague feeling that something is different, until an organ begins to protrude out of the vagina.
Physical and Mental Changes
“For me, the changes were fairly subtle over a period of time,” says Amy. She began to feel pelvic pressure while jumping rope. On long runs she would feel the same pressure, plus numbness in her legs.
Then, one day, the change became dramatic. “I was out for a run, and I just felt like, literally, the bottom fell out.”
At this point, Amy had to change her training routine and avoid some activities she enjoyed. “It affected every aspect of my life physically,” she says. “Then there’s the mental pain when you can’t do the things that you’re used to doing.”
Dr. Walton says it’s common for women to wait until this point to see her. “This is a quality of life issue,” she says. “When it starts to interfere with a woman’s ability to do things that are meaningful to her, then she’s ready to do something about it.”
Studies suggest that a woman has an 11 to 19 percent chance of needing surgery for pelvic organ prolapse in her lifetime. While lifestyle changes or pelvic floor exercises (called Kegels) can help some women with early prolapse, often the degree of muscle damage or tissue relaxation requires other treatments.
Dr. Walton often begins by trying a pessary—an insertable device that supports the pelvic organs. But Amy’s active lifestyle demanded a more permanent solution.
“For me, surgery was a very clear answer, because I just couldn’t perform at the level that I was used to performing,” she says.
“We talked a lot about the approach,” says Dr. Walton. “We knew Amy was going to go back to being very active. So we ended up doing a minimally-invasive robotic procedure.”
This involved making small incisions in her abdomen “no wider than your pinky,” says Dr. Walton. She then controlled robotic arms that worked through the incisions to move Amy’s pelvic organs back into place and secure them. She also inserted a mesh sling under the urethra, the tube through which urine comes out, to prevent urine leakage.
Back to Full Speed
“With the great technology that we have, you don’t end up with huge scars, but that doesn’t mean the surgery should be minimized,” says Amy. After her surgery in May 2015, she was careful to follow instructions to avoid stairs and not drive or bend over for at least two weeks, then begin returning to regular activities slowly. Recovery time is typically about six weeks.
“I think being compliant and not moving around as much as I’m used to was the most challenging part,” she says.
But meeting that challenge paid off. “Her results are beautiful, and she’s happy,” says Dr. Walton.
“I feel amazing. I got my life back,” says Amy. “In fact, I recently did a triathlon.”
Through her work, Amy meets a lot of women.
“I know I’m not unusual,” she says. So she made a conscious decision to be open about the personal nature of her surgery, and she often hears, “Oh my goodness, I have the same thing.”
Her advice to the millions of women experiencing a pelvic floor disorder is, “We can’t be quite so proud. If you have symptoms, you need to find out what your options are, because you don’t have to live that way.”