Pelvic Organ Prolapse.

Pelvic organ prolapse is the term used to describe the descent, or “drop” of your pelvic organs from their usual position. Your pelvic organs (for women, the bladder, uterus and bowel) are usually held in place by a network of connective tissues called fascia and ligaments. The pelvic floor muscles also provide some support for these organs from below.

When the support for your pelvic organs fails, these organs may start to descend into the pelvis. You may have a prolapse of any one of the bladder, uterus or bowel, or you may have a prolapse of any 2 or all of these organs. After a hysterectomy, it is still possible for the top of the vagina (the ‘vault’) to prolapse as well.

Common symptoms of pelvic organ prolapse include a feeling of heaviness, dragging or a bulge or ‘lump’ in the vagina. Some women can see or feel a lump when they wipe themselves or when washing. Other symptoms include difficulty with fully emptying your bladder or bowels, discomfort with intercourse, and pressure or pain in the lower back or pelvis. Prolapse symptoms are often worse at the end of the day or after being on your feet for a long time.

What Causes Pelvic Organ Prolapse?

The ultimate cause of pelvic organ prolapse is failure of the connective tissues supporting the pelvic organs. Weak pelvic floor muscles can contribute, as this may mean greater strain is placed on the connective tissues. However, weak pelvic floor muscles will not cause prolapse alone if the connective tissues remain strong.

The supporting connective tissues of the pelvic organs may fail for a number of reasons:

  • Childbirth trauma – this is the most common cause of prolapse. You are at greater risk if you have had a forceps delivery, a prolonged 2nd stage of labour, or your baby weighed more than 4kg at birth
  • Ageing – our connective tissues become less elastic and more likely to fail as we age
  • Chronic coughing or constipation
  • Obesity
  • Repetitive high impact exercise or heavy lifting

These last 3 factors all place downward strain on the supportive connective tissues and the pelvic floor muscles, making them more likely to fail.

Treatment Options

There are a number of simple, conservative measures you can take to help improve your pelvic organ prolapse symptoms.

Lifestyle factors: Changing some of the factors contributing to your prolapse can make a big difference.

  • Losing weight, changing to low impact exercise and avoiding heavy lifting can all help.
  • See your doctor to better manage chronic respiratory problems, or to help quit smoking, to reduce coughing and sneezing.
  • Address chronic constipation by adopting better toileting habits and positions, and making some modifications to your diet and fluid intake.

Pelvic floor muscle training: There is good evidence that regular pelvic floor muscle training can improve these symptoms and even reduce the extent of the prolapse. You have a better chance of improvement if your prolapse is of a milder degree – so it is best to start sooner rather than later! It is advisable to see a Continence and Women’s Health Physiotherapist to ensure you are doing these exercises correctly, and to guide you as to how and when to do these exercises.

Support pessaries: These are silicon devices that are fitted in the vagina to splint the vaginal walls up and outward, helping to hold the pelvic organs in a better place and prevent them descending. You can be measured and fitted with a support pessary by a Continence and Women’s Health Physiotherapist or your Gynecologist.

Support pessaries formerly were only used for women who were unable to have surgery. However, we now know they can be a good option to prevent the need for surgery, yet still relieve POP symptoms, for many women. There is evidence that support pessaries, in combination with pelvic floor muscle training, is more effective in managing this condition than treatment alone.

Surgery: Prolapse repair surgery is an option if your pelvic organ prolapse is of a greater degree, and if conservative measures have failed. This is now commonly performed through the vagina, but is sometimes still performed through the abdomen. Often after surgery, you will be asked to change your lifestyle, as mentioned above, and start pelvic floor muscle exercises – so it’s useful if you are already familiar with these things.

Unfortunately, like all prolapse treatments, surgery is not always successful. One in three women who have had a prolapse repair will have recurrence of prolapse afterwards.

Advice

It is useful to seek advice from a number of different health care professional regarding your pelvic organ prolapse.

  • Your GP is a good first point of call. They can refer you to a gynaecologist, and help with managing chronic respiratory issues and obesity.
  • A Continence and Women’s Health Physiotherapist can assess you, teach you how to perform pelvic floor muscle exercises and fit you with a support pessary if required. They can also advise on how to modify your daily tasks and exercise, and manage your bowels to prevent constipation.
  • A Dietician may help you to lose weight, if this is an issue.
  • A Gynaecologist can also assess you, fit you with a support pessary, and advise on surgical options if this is needed.

Note that surgical mesh was previously commonly used in prolapse repair surgery. There have been large class action lawsuits worldwide regarding the use of mesh, as it has been shown to cause severe and chronic pain for some women. Ensure you thoroughly discuss surgical options with your Gynaecologist, as many no longer use mesh, but some still do.

Need More Information?

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