Female Urology
Pelvic Floor Disorders
Pelvic Organ Prolapse
Definition
Pelvic organ prolapse occurs when a pelvic organ-such as the bladder-drops (prolapses) from its normal spot in the lower belly and pushes against the walls of the vagina.
This can happen when the muscles that hold the pelvic organs in place get weak or stretched from childbirth or surgery. Many women will have some kind of pelvic organ prolapse. It can be uncomfortable or painful. But it isn't usually a big health problem. It doesn't always get worse. And in some women, it can get better with time.
More than one pelvic organ can prolapse at the same time. Organs that can be involved in a pelvic prolapse include:-
- Bladder. This is the most common kind of pelvic organ prolapse.
- Urethra
- Uterus
- Vagina
- Small bowel
- Rectum
Causes of pelvic organ prolapse
Pelvic organ prolapse is most often linked to strain during childbirth. Normally the pelvic organs are kept in place by the muscles and tissues in the lower abdomen. During childbirth these muscles can get weak or stretched. If they don't recover, they are unable to support the pelvic organs.
Pelvic organ prolapse can also occur after surgery to remove the uterus (hysterectomy). Removing the uterus can sometimes leave other organs in the pelvis with less support.
Pelvic organ prolapse can be made worse by anything that puts pressure the lower abdomen such as:
- Being very overweight (obesity).
- A long-lasting cough.
- Frequent constipation.
- Pelvic organ tumors.
Older women are more likely to have pelvic organ prolapse. It also tends to run in families.
Warning signs / symptoms
- Feeling pressure from pelvic organs pressing against the vaginal wall.
- Feeling very full in the lower abdomen.
- Feeling as if something is falling out of the vagina.
- Feeling a pull or stretch in the groin area or pain in the lower back.
- Releasing urine without meaning to (incontinence),
- Frequent urination
- Having pain in the vagina during sex.
- Having problems with the bowels, such as constipation.
Diagnosis
- History- enquiring about symptoms, pregnancies, health problems
- Physical exam including a pelvic exam
Treatment Options
Decisions about treatment will be based on which pelvic organs have prolapsed and how bad the patient symptoms are.
If your symptoms are mild:-
- Kegel exercises that make the pelvic muscles stronger.
- Reach and stay at a healthy weight.
- Cut back on caffeine, which acts as a diuretic
- Avoid lifting heavy things that put stress on pelvic muscles.
For more severe symptoms: -
- Fitting a pessary – a device to help with the pain and pressure of pelvic organ prolapse. It is a removable device that fits in the vagina. It helps hold the pelvic organs in place.
- Surgery is another treatment option for serious symptoms of pelvic organ prolapse and should be considered if the patient has: -
- A lot of pain because of the prolapsed organ.
- Problems with bladder and bowels.
- The prolapse makes it hard to enjoy sex.
Types of surgery for pelvic organ prolapse include:
- Surgery to repair the tissue that supports a prolapsed organ.
- Surgery to repair the tissue around the vagina.
- Surgery to close the opening of the vagina.
- Surgery to remove the uterus (hysterectomy).
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