Pelvic organ prolapse (POP) is a common condition that roughly half of all women experience it to some degree. In this condition, the muscles and connective tissues of the pelvic floor weaken and allow the organs they usually hold in place — like the bladder and uterus — to shift downward and press against the vaginal wall.

POP is usually a result of pregnancy, childbirth or menopause and typically results in pelvic pressure and the feeling of tissue bulging from the vagina.

If that weren’t “uncomfortable” enough, POP presents a double whammy when it comes to urinary tract infection…

UTI and POP: A problem before and after

During prolapse, pressure on the bladder can keep it from emptying completely, causing urine stagnation and bacterial growth. This is why women experiencing prolapse are known to get frequent urinary tract infections (UTIs).

If a woman’s quality of life is impacted enough by pain and bowel and bladder problems, surgery may be required to put pelvic organs back in place. More than 12 percent of American women will have POP surgery in their lifetime.

But for some, even if other symptoms are alleviated by surgery, post-surgical UTIs and other complications can present a double whammy of trouble…

Researchers at Mayo Clinic looking to head off these post-surgical complications analyzed vaginal microbiome samples from postmenopausal women undergoing a vaginal hysterectomy with pelvic reconstruction.

The samples were collected at five stages, including before surgery, immediately after and during recovery. They then used advanced sequencing techniques to map the genetic material of the microbes and identify changes in the microbial communities.

They made some fascinating discoveries…

Key bacteria involved in disruption

Women with lower levels of the protective bacterial species Lactobacillus in the vaginal microbiome were more likely to develop a UTI post-POP surgery.

In addition, higher levels of the bacteria types Prevotella and Gardnerella — both linked to inflammation and infection — were associated with a greater risk of postoperative UTI.

Then, samples taken after surgery showed lower microbial diversity in both the vaginal and urinary microbiomes. It’s a known fact that the diversity of bacterial strains is essential for healthy microbiomes. The researchers suggest that preoperative antibiotics (which can contribute to dysbiosis) and vaginal cleansing before surgery, and the surgery itself, could be to blame for the imbalanced microbiomes.

By identifying these patterns, the researchers hope they have found a way to potentially predict who will develop a post-surgical UTI before surgery even begins.

“Our ability to detect these microbiome patterns provides a potential opportunity to personalize treatment strategies and improve outcomes,” says Dr. Marina Walther-Antonio, a microbiome researcher at Mayo Clinic.

“Understanding the microbiome’s role in post-surgical infections gives us a unique opportunity to possibly prevent these complications altogether,” says Dr. John Occhino, a Mayo Clinic urogynecologic surgeon.

It’s all about diversity

UTIs can be especially challenging for women, with or without POP. Staying ahead of the game by supporting your microbiomes with probiotics is a simple and effective way to reduce your risks of these annoying infections.

Probiotic suppositories that can be vaginally inserted are on the market, though the research has not quite caught up with how effective they are. However, I did come across a study where women who took oral Lactobacillus saw a significant increase in the numbers of their vaginal lactobacilli.

If you can build up a healthy microbiome before surgery, it may be possible to not only avoid UTI before but following surgery as well.

Here are more supplements known to help reduce the risk of UTI…

• D-mannose: This glucose-related sugar can prevent certain bacteria from sticking to the walls of the urinary tract. It has been found in at least one study to be more effective than antibiotics at getting rid of recurrent UTIs.
• Cranberry extract: Research has shown that consuming cranberry products in juice, tablet or capsule form was strongly associated with reduced risk of UTI in women with recurrent infections. Other studies indicate that proanthocyanidins (a type of polyphenol) could keep E. coli, the bacteria behind most UTIs, from sticking to the urinary tract lining.

If you plan to undergo POP, you may want to talk to your doctor leading up to surgery for best practices to avoid post-surgical UTI, and be sure he is aware of any supplements you’re taking in case he wants you to stop for a brief period before surgery.

Sources:

Vaginal microbiome may predict post-surgery urinary tract infections — Mayo Clinic

Preoperative vaginal microbiome as a predictor of postoperative urinary tract infection — Scientific Reports

Pelvic organ prolapse — Mayo Clinic

Demystifying pelvic organ prolapse — UChicagoMedicine

Are My Recurrent Urinary Tract Infections Caused by Prolapse? — Austin Urogynecology

Vaginal microbiome following orally administered probiotic — Journal of Pathology, Microbiology and Immunology