PELVIC ORGAN PROLAPSE

The muscles, ligaments, fascia and connective tissue generally support pelvic organs, collectively; these are referred to as the pelvic floor. If the structures that support the pelvic organs become damaged or weakened, they are able to slip down. This condition is referred to as pelvic organ prolapse or female genital prolapse.

For the most part, it is adult women who experience pelvic organ prolapse. Many women who have pelvic organ prolapse do not have any symptoms. However, those who do experience symptoms state that the most bothersome symptom is the feeling that something is falling down into their vagina. This feeling occurs because pelvic organs (bladder, uterus or rectum) slip down and either press against the vaginal wall or protrude into the vagina. Pelvic organ prolapse may occur with only one organ protruding, or several organs.

While this condition can occur in younger women or those who have never had a child, women who have had children, are postmenopausal or have had a hysterectomy usually experience it.

Estimations indicate that at least half of the women who have birthed more than one baby have some kind of genital prolapse.

Symptoms

  • Painful intercourse
  • Pelvic pressure
  • Feeling as if something is falling out of your vagina
  • A stretching or pulling sensation in your groin
  • Low back pain
  • Vaginal bleeding or spotting
  • Difficulty moving your bowels
  • Urinary incontinence, urgency or frequency (especially during the night)

These symptoms worsen when you stand, jump or lift. Generally, you can relieve these symptoms by lying down.

Types of pelvic organ prolapse

Vaginal vault prolapse – the top of a woman’s vagina descends, this occurs in women who have undergone a hysterectomy.

Uterine prolapse – is when the uterus and cervix descends the vaginal canal because of damaged or weak support structures.

Cystocele (bladder prolapse) – the tissues that support the wall between the vagina and bladder weaken, which allows a portion of the bladder to move down putting pressure on the vaginal wall.

Urethrocele – this condition occurs when the tube that leads from the bladder to the outside of the body (urethra) descends, pressing on the vaginal wall. Usually this condition is accompanied by a cystocele.

Rectocele – When the tissues that support the wall between the rectum and vagina become weak, the rectum can descend, pressing into the vaginal wall.

Enterocele – this condition is similar to the rectocele except that it involves the area between the rectum and the uterus descending and then pressing into the vaginal wall.

Causes

Usually, women experience this condition following pregnancy, labor and childbirth. Diseases that increase the pressure in the abdomen can also cause pelvic organ prolapse.

These diseases include:

  • Respiratory issues with chronic cough
  • Obesity
  • Pelvic organ cancers
  • Constipation

A hysterectomy can also cause pelvic organ prolapse. The following factors may contribute towards the occurrence of pelvic organ prolapse:

Aging/menopause – The hormone estrogen plays an enormous part in maintaining the pelvic floor’s strength. When a woman goes through menopause, her estrogen levels fall and her pelvic floor weakens. This lack of estrogen only exacerbates the damage that has already occurred due to childbirth or other factors. The natural aging process also causes pelvic support structures to relax.

Pregnancy and Childbirth – Carrying a child and then giving birth are two of the most significant factors in suffering prolapse. During a woman’s pregnancy, the added weight of the baby, hormonal changes and pressure can cause the pelvic floor to weaken. Vaginal deliveries, especially those that include a vacuum extraction, a large baby or the use of forceps, can also stretch or tear the supporting pelvic structures. Many times the damage that occurs during a woman’s pregnancy and while giving birth go unnoticed until her symptoms develop later in life, usually following menopause.

Genetics – Some women have a higher risk of developing prolapse because they were born with already weakened pelvic floor muscles. Congenital weakness is the reason that some women who have never given birth or are young develop a prolapse.

Abdomen pressure – Other factors that can cause a woman to suffer a prolapse relate to pressure on the abdomen. These factors include chronic coughing, obesity, straining during bowel movements, lifting heavy objects and pelvic masses. All of these conditions place pressure on the abdomen. If this pressure remains for a long time, it can weaken a woman’s pelvic floor, thus causing a prolapse.

Pelvic surgery – Any woman who has already had surgery for a pelvic organ prolapse may have an increased risk of developing other kinds of prolapses.

Treatments

Once your doctor has determined that you are suffering from pelvic organ prolapse, he will discuss your treatment options with you. The most appropriate treatment depends on the kind of prolapse you have, the severity of your prolapse, your age, your health and your plans in relation to having children.

There are three main types of treatments. These treatments are conservative, mechanical and surgical. Usually the conservative and mechanical treatments are considered for women with a mild prolapse, those who are not a good candidate for surgery (elderly) and those who are interested in having children.

1. Conservative

Pelvic floor exercises / kegel exercises – These exercises strengthen your pelvic floor muscles. You actively tighten and lift these muscles at intervals. You can perform these exercises while standing, sitting or lying down.

Lifestyle – There are some simple measures that you can take which include treating your constipation or chronic cough, losing weight and stop lifting heavy objects.

2. Mechanical

Vaginal pessaries – seen as an effective alternative to surgery, these are devices inserted into the vagina to provide mechanical support against the various forms of pelvic organ prolapse.

Biofeedback – This treatment uses a sensor to measure your pelvic floor muscle contractions. It also helps women perform these exercises.

Electrical stimulation – If your muscles are extremely weak, electrical stimulation with the use of small electrodes can be done.

3. Surgical

If the non-surgical treatments do not provide relief, surgical repair may be recommended. Usually, the pelvic organ prolapse surgery aims to repair and then reconstruct the pelvic support structures restoring the pelvic organs to their normal positions. Other key factors include restoring and maintaining a woman’s bowel, bladder and ability to function sexually.

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