Everything You Need to Know

Pelvic organ prolapse (POP) is a condition that affects many women, particularly as they age or after childbirth. It occurs when the muscles and tissues that support the pelvic organs weaken, causing one or more organs (such as the bladder, uterus, or rectum) to slip out of their normal position and press against or descend into the vaginal canal. This can lead to discomfort, pain, and even affect daily activities or sexual function.

Fortunately, there are treatments available for pelvic organ prolapse that can help restore normal function, relieve symptoms, and improve quality of life.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse happens when the pelvic floor muscles and ligaments become too weak to support the organs in the pelvis. The pelvic organs include the bladder, uterus, rectum, and sometimes the small intestine. When the support structure weakens, one or more of these organs can drop (prolapse) into or out of the vagina.

The severity of pelvic organ prolapse can vary, ranging from mild cases where there are no noticeable symptoms to more severe cases where the organ visibly protrudes from the vaginal opening.

Types of Pelvic Organ Prolapse

There are different types of pelvic organ prolapse, depending on which organ is affected:

1. Cystocele (Bladder Prolapse)
   When the bladder drops into the front wall of the vagina, it’s called a cystocele or bladder prolapse. This can lead to urinary incontinence or difficulty emptying the bladder.
2. Rectocele (Rectal Prolapse)
   Rectocele occurs when the rectum bulges into the back wall of the vagina. This can cause difficulty with bowel movements and feelings of incomplete evacuation.
3. Uterine Prolapse
   Uterine prolapse occurs when the uterus slips down into or outside of the vaginal canal. This is more common in women who have had multiple vaginal deliveries.
4. Enterocele (Small Bowel Prolapse)
   Enterocele involves the small intestine dropping into the upper part of the vaginal wall. This usually occurs after a hysterectomy.
5. Vaginal Vault Prolapse
   This occurs when the top of the vaginal wall sags after a hysterectomy. It can also affect the surrounding pelvic organs.

Symptoms of Pelvic Organ Prolapse

The symptoms of pelvic organ prolapse can vary depending on the type and severity, but common signs include:

• A feeling of heaviness or pressure in the pelvic area
• A bulge or protrusion from the vaginal opening
• Difficulty with urination or bowel movements
• Lower back pain
• Pain or discomfort during intercourse
• Feeling like something is falling out of the vagina
• Frequent urinary tract infections

Many women with mild prolapse may not experience symptoms, but as the condition progresses, these symptoms can become more noticeable and bothersome.

Causes of Pelvic Organ Prolapse

Several factors can contribute to the weakening of the pelvic floor muscles and lead to prolapse:

• Childbirth
  Vaginal deliveries, particularly of large babies or multiple births, can stretch and weaken the pelvic muscles.
• Aging
  As women age, their pelvic muscles naturally lose strength, increasing the risk of prolapse.
• Menopause
  The drop in estrogen levels during menopause can cause tissues to become weaker and less elastic.
• Chronic Straining
  Chronic coughing, constipation, or heavy lifting can put stress on the pelvic floor muscles, leading to prolapse over time.
• Obesity
  Excess weight adds pressure to the pelvic organs and can contribute to prolapse.

Treatment Options for Pelvic Organ Prolapse

Treatment for pelvic organ prolapse depends on the severity of the condition, symptoms, and individual preferences. Options include both non-surgical and surgical treatments.

1. Pelvic Floor Exercises (Kegels)

For mild cases, pelvic floor exercises (Kegels) can help strengthen the muscles that support the pelvic organs. These exercises can improve symptoms and prevent further prolapse from occurring.

2. Pessary

A pessary is a medical device inserted into the vagina to help support the pelvic organs. Pessaries come in different shapes and sizes, and they can relieve symptoms without the need for surgery. They are especially useful for women who want to avoid surgery or are not surgical candidates.

3. Lifestyle Modifications

Making changes such as losing weight, avoiding heavy lifting, treating chronic coughs, or managing constipation can help reduce the strain on the pelvic floor and alleviate symptoms.

4. Hormone Replacement Therapy (HRT)

For postmenopausal women, hormone replacement therapy can help strengthen vaginal tissues by improving collagen production, reducing the likelihood of prolapse progression.

5. Surgical Options

For more severe cases of pelvic organ prolapse, surgery may be necessary to repair or support the affected organ. There are various surgical approaches, including:

• Anterior or Posterior Repair
  This surgery involves tightening the tissues that support the bladder (anterior repair) or the rectum (posterior repair).
• Vaginal Vault Suspension
  This surgery is done to correct vaginal vault prolapse and involves supporting the top of the vagina with surgical sutures or mesh.
• Hysterectomy
  In some cases, removing the uterus (hysterectomy) may be part of the treatment plan if uterine prolapse is severe.
• Sacrocolpopexy
  This procedure involves attaching the vagina or cervix to the sacrum (a bone in the lower spine) to hold the pelvic organs in place. It’s often used for more severe prolapse cases and can be done using minimally invasive techniques.

Who Is a Candidate for Pelvic Organ Prolapse Treatment?

Women experiencing any of the following symptoms may be candidates for treatment:

• A feeling of heaviness or pressure in the pelvis
• A noticeable bulge in or around the vaginal area
• Difficulty with urination or bowel movements
• Pain or discomfort during sex
• Chronic pelvic pain

It’s important to consult with a healthcare provider who specializes in pelvic floor disorders to determine the best course of treatment.

The Pelvic Organ Prolapse Treatment Process: What to Expect

The treatment process for pelvic organ prolapse will depend on the chosen approach, but here’s a general outline:

1. Consultation

The first step is meeting with a pelvic floor specialist or gynecologist. During this consultation, the doctor will perform a physical exam, review your symptoms, and discuss your treatment options.

2. Treatment

Non-surgical treatments like pelvic floor exercises or pessaries can be done in an outpatient setting. Surgical treatments are typically performed in a hospital, and depending on the procedure, they may be minimally invasive.

3. Recovery

Non-surgical treatments require little to no downtime, while surgical treatments will involve a recovery period that varies based on the procedure. Minimally invasive surgeries typically have shorter recovery times, while more extensive surgeries may require several weeks of rest and limited activity.

4. Follow-Up

After treatment, follow-up appointments will be scheduled to monitor progress and ensure healing. For surgical treatments, physical therapy may be recommended to strengthen the pelvic floor muscles and prevent future prolapse.