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In mid September, Lee had surgery to repair the damage from a condition known as buy cod online tramadol organ prolapse, the loss of support to one or more of the buy cod online tramadol organs — the bladder, vagina, uterus and rectum. It's long been an unmentionable condition. When Lee, 36, told co workers at a Tomball elementary school that she was having a surgical repair and would be off work for about a month, three women confessed that they, too, had the condition. One waited 35 years to have surgery. "She said, 'I was embarrassed.' " And despite today's tell all culture, Dr. Bart Putterman said secrecy remains common. "I think people are still very, very embarrassed," he said, perhaps because the condition frequently causes incontinence. Doctors should bring up the topic so patients don't have to, said Putterman, an obstetrician/gynecologist at The Methodist Hospital's Center for Restorative Pelvic Medicine. He was one of three surgeons involved in Lee's case, which included removing the uterus and repositioning her vagina, bladder and rectum. Pelvic prolapse is often thought to affect only older women — as many as 40 percent of women between 50 and 70 may have symptoms — but younger women can have it, too. Lee's first symptoms appeared after the birth of her second child 12 years ago. Symptoms vary, but Putterman said they include buy cod online tramadol pressure and urinary or fecal incontinence. Lee had lower back pain and pain in her thighs. It got so bad she couldn't run or jump on a trampoline — important activities for a woman whose youngest child is in kindergarten. Pregnancy is the primary risk factor for buy cod online tramadol prolapse, and giving birth to a large baby increases the risk, Putterman said. Other risk factors include obesity, a family history of the condition and chronic constipation. The loss of estrogen after menopause can also weaken muscles and ligaments that hold buy cod online tramadol organs in place. Avoiding weight gain, heavy lifting and straining are important for prevention, said Putterman, who is also a clinical associate professor at Baylor College of Medicine. Using topical estrogen can keep tissues stronger after menopause. Once a problem develops, losing weight and Kegel exercises may help; some women find relief from a pessary, a device that is inserted in the vagina to provide support. Surgical repairs vary, depending upon a woman's specific needs, although Putterman said that in many cases, simply removing the uterus without doing other needed procedures may provide only short lived relief. The surgery itself has changed in recent years, just as other surgical procedures have: It's less invasive, for one thing, making recovery times shorter and reducing scarring. But it's not foolproof. Putterman said the lifetime failure rate is about 25 percent, meaning some women are likely to need a second repair at some point. "Unfortunately, we have nothing that's absolutely perfect," Putterman said. "Our goal with surgery is to improve people's quality of life so they're not having the symptoms. ... buy cod online tramadol