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Medical Edge Newspaper Column from Mayo Clinic

HYSTERECTOMY CAN LEAD TO VAGINAL PROLAPSE

DEAR MAYO CLINIC: I had a hysterectomy a year ago and thought I was home free after that surgery. Boy, was I wrong! Now I feel bloated and uncomfortable much of the time, like there’s something “down there.” Is this something I should have checked out, or is it a normal part of healing from a hysterectomy? — Fairfax, Va.

ANSWER: Yes, you should have this feeling of fullness evaluated by your physician — just as you would have any other persistently uncomfortable sensation evaluated. Early consultations offer the best results and peace of mind.

A thorough gynecological exam will help your physician determine if you have experienced prolapse of the vaginal vault. This is a condition in which the top of the vaginal lining starts to come down toward the vaginal opening. This is an extremely common occurrence following hysterectomy because the uterus acts as an anchor for the vaginal vault. When the uterus is removed, the vaginal tissue is unsupported.

In the United States, an estimated one in nine women will have a hysterectomy in her lifetime. Of those, roughly 10 to 30 percent will experience vaginal-vault prolapse. Think of a tube sock being turned inside out. The toe is the top, or “vault,” of the vagina. If you pull the toe down to turn the sock inside out, you get an image of what happens in vaginal-vault prolapse.

The degree of prolapse varies. In its severest form, the internal vaginal tissue falls and turns completely inside out. When this happens, patients complain of an uncomfortable feeling of vaginal fullness. The fallen lining protrudes into the vaginal canal and creates the discomfort they experience. Vaginal-vault prolapse can interfere with bladder function as well and can cause urinary incontinence, so be sure to discuss all of these issues with your physician.

Daniel Elliott, M.D., Urology; Mayo Clinic, Rochester, Minn.

Additional Resources:
Mayo Clinic Urology
To Make An Appointment in Urology

DEAR MAYO CLINIC: After about 10 years of numb hands and arms, and leg pains so bad I had to cut back on my work as an electrical contractor, doctors finally figured out what I have — but not what to do about it. They say it’s a liver thing called “familial amyloidosis,” and that there’s really nothing they or I can do. Do you know anything about this? Is there anything a person can do? Thanks. — New York

ANSWER: Yes to both questions. Familial amyloidosis is a rare hereditary disorder of protein production in the liver. It’s caused by a genetic defect. Its symptoms typically involve the nervous system, heart and gastrointestinal tract, and may include numbness, tingling and pain in the arms and legs, and chronic diarrhea.

Many possible gene mutations can cause this disorder. The disease is characterized by abnormal masses of protein — called “amyloid” — forming throughout the body. Eventually, amyloid builds up and leads to organ failure. The only current cure for familial amyloidosis is a liver transplant — transplantation removes the source of abnormal protein production. However, a liver transplant is only suitable for people who are young and healthy enough to undergo the procedure.

You don’t mention your age or family status, so I’ll outline several scenarios that may be pertinent.

If your doctor says you’re young and healthy enough to undergo a liver transplant, you may be put on a transplant waiting list. If a liver transplant is not an option, your doctor can prescribe medications that can generally help control the common symptoms of familial amyloidosis.

Because this disease is inherited, your children are also potential carriers of these gene defects. Patient support groups — your local doctor or medical center should be able to help you connect with one — can give you the names of advanced medical centers nearest you that may be capable of performing genetic tests to determine whether your children have inherited the disorder.

This information enables physicians to determine if your children are at risk of developing the disease — even before symptoms develop. This knowledge will allow them to plan for a liver transplant while they are still young enough to be eligible for the procedure.

Steven Zeldenrust, M.D., Ph.D., Hematology; Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Amyloidosis
Hematology Appointment Information
More Information
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.