What is pelvic organ prolapse?

Pelvic organ prolapse (POP) is a condition where one or more pelvic organs, such as the uterus, bladder or rectum, prolapse into the vagina due to weakened muscles and tissues of the pelvic floor. This can cause discomfort or pain during sexual intercourse, urinary or faecal incontinence and a feeling of weight or pressure in the pelvic area. Risk factors for pelvic organ prolapse include pregnancy and childbirth, menopause, aging, obesity and chronic coughing. Treatment options include pelvic floor muscle exercises, pessaries, hormone therapy or surgery.

What are the types of pelvic organ prolapse?

There are different types of pelvic organ prolapse depending on which pelvic organ prolapses into the vaginal wall. These types include:

→ Cystocele: It is a prolapse of the bladder on the anterior vaginal wall.

→ Orthocele: It is a prolapse of the rectum on the posterior vaginal wall.

→ Uterine prolapse: It is a prolapse of the uterus in the vaginal canal.

→ Prolapse of vaginal stump: This occurs when the upper part of the vagina protrudes into the vaginal canal after removal of the uterus.

→ Enterocele: It is a prolapse of the small intestine into the vaginal wall.

→ Pelvic floor dysfunction: This refers to general weakness or laxity of the pelvic floor muscles and can lead to prolapse of multiple pelvic organs.

The type and severity of pelvic organ prolapse can be determined through clinical examination and diagnostic tests. Treatment options depend on the type and severity of the prolapse, as well as the general health and preferences of the patient.

What are the most common symptoms caused by pelvic organ prolapse?

Symptoms of pelvic organ prolapse can vary depending on the type and severity of the prolapse, but some of the most common symptoms include:

• Feeling of pressure or weight in the pelvic area
• Lump protruding from the vagina
• Discomfort or pain during sexual intercourse
• Difficulty emptying the bladder or bowel or feeling of incomplete emptying
• Urinary incontinence or an urgent need to urinate and frequent urination
• Stool incontinence or difficulty controlling bowel movements
• Back pain
• Vaginal bleeding or discharge

These symptoms can worsen over time and may affect your quality of life. It is important to seek medical help if you experience any of these symptoms, as early diagnosis and treatment can help prevent complications and improve outcomes.

What are the causes and risk factors for the development of organ prolapse?

Pelvic organ prolapse occurs when the tissues and muscles that support the pelvic organs become weakened, stretched or destroyed, leading to the descent of one or more organs into the vaginal canal. The causes and risk factors for developing pelvic organ prolapse include:

• Pregnancy and childbirth: The physical strain of carrying a baby and giving birth can weaken the pelvic floor muscles and lead to prolapse.
• Menopause: The decrease in estrogen levels during menopause can weaken the pelvic floor muscles and lead to pelvic organ prolapse.
• Aging: As a person ages, the tissues and muscles that support the pelvic organs may weaken and stretch, leading to pelvic organ prolapse.
• Obesity: Excess weight can put pressure on the pelvic floor muscles, causing them to weaken and increasing the risk of prolapse.
• Chronic cough: Activities that put pressure on the pelvic floor, such as chronic coughing can lead to prolapse.
• Family history: There may be a genetic component to pelvic organ prolapse and a family history of the condition may increase the risk of developing it.
• Hysterectomy: Surgical removal of the uterus can weaken the support structures of the pelvic organs and increase the risk of pelvic organ prolapse.
• Lifting heavy weights: Regular heavy lifting or intense physical activity can put pressure on the pelvic floor muscles and increase the risk of pelvic organ prolapse.

It is important to note that not all people with these risk factors will develop pelvic organ prolapse and other factors may be involved in the development of the condition. Maintaining a healthy weight, pelvic floor exercises and avoiding activities that put pressure on the pelvic floor can help reduce the risk of developing pelvic floor prolapse.

How can we diagnose organ prolapse?

Pelvic organ prolapse (POP) can be diagnosed through physical examination, medical history and diagnostic tests. Here are some of the diagnostic methods used to identify POP:

Pelvic examination: A physical examination of the pelvic area can help identify the location and severity of the prolapse. The doctor may ask the patient to slow down or do other maneuvers to help identify the prolapse.

Imaging tests: Imaging tests such as MRI or ultrasound can be used to provide more detailed images of the pelvic area and diagnose prolapse.

Urodynamic tests: These tests measure the pressure and function of the bladder and urethra and can help diagnose urinary incontinence associated with pelvic organ prolapse.

Cystoscopy: It involves the use of a thin camera to examine the inside of the bladder and can help diagnose bladder prolapse.

Evaluation of the pelvic floor muscles: This may include the use of biofeedback techniques to assess the strength and coordination of the pelvic floor muscles.

The diagnosis of pelvic organ prolapse can sometimes be complex and certainly requires expertise. Early diagnosis and treatment can help prevent complications and improve outcomes.

How is pelvic organ prolapse treated?

Treatment of pelvic organ prolapse depends on the severity of the condition, the specific organs involved and the general health and preferences of the patient. Here are some common treatment options:

Pelvic floor exercises: These exercises, also known as Kegel exercises, can help strengthen the pelvic floor muscles and improve pelvic organ support.

Pessus: A pessary is a device that is inserted into the vagina to provide support for organs that have prolapse. There are different types of pessaries and the appropriate one for each patient depends on the specific type and severity of the prolapse.

Hormonal therapy: In some cases, estrogen therapy can be used to strengthen the tissues and muscles that support the pelvic organs.

Surgery: In cases where non-surgical options are not effective or appropriate, surgery may be recommended. The type of surgery will depend on the type and severity of the prolapse, as well as the general health and preferences of the patient.

Lifestyle changes: Lifestyle changes such as losing weight, stopping smoking, avoiding heavy weights and practicing good bowel and bladder habits can help reduce the risk of pelvic organ prolapse and improve symptoms.

It is important to discuss all treatment options with a healthcare provider to determine the best course of action. If left untreated, pelvic organ prolapse can lead to complications such as recurrent infections, urinary incontinence and difficulty with bowel movements.

What does pelvic organ prolapse surgery involve?

Surgery for pelvic organ prolapse involves repairing or removing the weakened or damaged tissues and muscles that support the pelvic organs. The specific surgical procedure will depend on the type and severity of the prolapse, as well as the patient's overall health and preferences. Here are some common surgical procedures for pelvic organ prolapse:

Vaginal mesh: A synthetic mesh is inserted through the vagina to support the organs that have prolapse. This procedure is usually used for severe cases and carries a risk of complications such as mesh erosion.

Hysterectomy: This surgery involves the removal of the uterus and may be recommended for women with uterine prolapse.

Sacrilege: It involves the use of mesh or other materials to support prolapsed organs and is usually used for severe cases of pelvic organ prolapse.

Catch: This involves partial or complete closure of the vagina and may be recommended for older women who no longer wish to be sexually active.

Surgery for pelvic organ prolapse carries risks such as bleeding, infection and damage to surrounding organs. Recovery time varies depending on the specific procedure and the overall health of the patient. It is important to discuss the risks and benefits of surgery with your doctor to determine the best treatment strategy.