June – Pelvic Organ Prolapse (POP) Awareness Month

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Pelvic Organ Prolapse

50% of women will have signs or symptoms of Pelvic Organ Prolapse over their lifetime? Many women will not seek care.

What is pelvic organ prolapse?

This condition refers to the bulging or herniation of one or more pelvic organs into or out of the vagina. The pelvic organs consist of the uterus, vagina, bowel and bladder. Pelvic organ prolapse occurs when the muscles and ligaments (a network of supporting tissue) that hold these organs in their correct positions become weakened. A prolapse may arise in the front wall of the vagina (anterior compartment), the back wall of the vagina (posterior compartment), the uterus and/or top of the vagina (apical compartment). Many women have a prolapse in more than one compartment at the same time.

What are the signs of prolapse?

There are a few symptoms that may suggest you have a prolapse, but they depend on the type of prolapse you have and its severity. Early on, if your prolapse is mild your doctor may notice it during a pelvic exam or pap smear, even if you are not aware of it. If you are not noticing any symptoms, no treatment is necessary.

When the prolapse is more severe, you may experience:

  • A heavy dragging feeling in the vagina or lower back.
  • A feeling of a lump in or outside the vagina.
  • Urinary symptoms such as slow urinary stream, a feeling of incomplete bladder emptying, urinary frequency or an urgent desire to pass urine, and/or urinary stress incontinence.
  • Bowel symptoms, such as difficulty moving the bowel or a feeling of not emptying properly, or needing to press on the vaginal wall to empty the bowel.
  • Discomfort during sexual intercourse.

What causes pelvic organs to prolapse?

The main cause is damage to the nerves, ligaments and muscles which support the pelvic organs and may result from the following:

▪ Pregnancy and childbirth are considered to be major factors leading to the weakening of the vagina and its supports. Prolapse affects about one in three women who have had one or more children. This is particularly true of women who had a large baby, needed forceps to deliver or had many babies. A prolapse may occur during or shortly after pregnancy or may take many years to develop. However, it is important to emphasize that only 1 out of 9 women (11%) will ever need surgery for prolapse in their lifetime.

▪ Aging and menopause may cause further weakening of the pelvic floor structures.

▪ Conditions that cause excessive pressure on the pelvic floor like obesity, chronic cough, chronic constipation, heavy lifting and straining.

▪ Some women may have an inherited risk for prolapse, while some diseases affect the strength of connective tissue e.g., Marfan syndrome and Ehlers-Danlos syndrome.

Diagnosis

To evaluate you for prolapsed, a specialist urogynecologist review your medical history and performs a pelvic exam. They suggest to further treatment according to the severity of prolapse.

What should you do?

If you believe you might be experiencing pelvic organ prolapse you are encouraged to talk to your healthcare provider. He or she may examine you to assess if you have a prolapse, what type of prolapse you have and offer treatment options that are tailored to your needs. You can try to prevent the prolapsed worsening by making lifestyle and behaviour changes. Avoid constipation, heavy weight lifting, maintain weight in the normal range and lose weight. Stop smoking, as tobacco doubles the risk of pelvic floor disorders.

Pelvic floor muscles exercises help strengthen the pelvic floor muscles and can improve mild prolapsed.

Prolapse surgery several different types of POP surgeries can improve pelvic floor anatomy sacrocolpopexy,

  • sacrospinous ligament fixation
  • Anterior vaginal prolapse repair
  • Posterior Vaginal Wall & Perineal Body Repair
  • Obliterative procedures
  • Uterine Preservation Surgery for Prolapse
  • Vaginal Hysterectomy for Prolapse
References
American College of Obstetricians and Gynecologists. Pelvic organ prolapse. Female Pelvic Medicine & Reconstructive Surgery. 2019 Nov 1;25(6):397-408.