All About Pelvic Organ Prolapse Repair

Introduction

POP, or Pelvic organ prolapse, is a condition that causes the pelvic floor's muscles, tissues, and ligaments that support the pelvic region's organs to become weak. Pelvic muscles provide firm support to the organs in the pelvic region, such as the uterus, vagina, bladder, and rectum. Thus, any prolapse or damage to the pelvic organ muscles causes these organs to shift or get displaced from their place. These organs usually do not get affected by mild prolapse; however, in the more severe cases, they tend to extend outside the vagina and create a bulge.

Pelvic organ prolapse is also a type of pelvic disorder, just like fecal or urinary incontinence, and all these can also occur together with pelvic organ prolapse.

What Are the Causes of Pelvic Organ Prolapse?

Weakening of the pelvic floor can occur for various reasons, and it increases the chances of organ prolapse.

The causes include:

• The common factor causing pelvic organ prolapse is vaginal birth. This happens mainly because multiple vaginal deliveries, carrying a larger-than-average fetus (fetal macrosomia), or having twins or triplets all increase the chances of pelvic floor muscles sustaining injuries and leading to prolapse.

• Increased body weight also increases the risk of pelvic organ prolapse. Researchers have found that clinically overweight or obese people are more likely to develop pelvic organ prolapse than those who fall in the normal weight range.

• The pelvic floor muscle also weakens due to long-term pressure in the abdominal cavity. This can happen due to chronic coughing, constipation, and frequent heavy lifting.

• The muscles of the pelvic floor also lose strength due to the aging process. This can be due to a decline in estrogen levels, especially during menopause, when the body produces less estrogen. This further weakens the connective tissues supporting the pelvic floor.

• Also, irregularities in the collagen can weaken the connective tissues in the pelvic floor, thus increasing the risk of pelvic organ prolapse. Moreover, individuals with connective tissue disorders, such as Ehlers-Danlos Syndrome (increased movement in the joints), are at a greater risk for developing pelvic organ prolapse.

• Additionally, having a family history of pelvic organ prolapse may also increase the chances of developing the condition. Further research is going on to learn more about the genetic components of pelvic organ prolapse. However, it is possible to inherit a weak pelvic floor.

What Are the Various Types of Pelvic Organ Prolapse?

Prolapses of the pelvic organs can be of the following types:

• Urethrocele: In this pelvic floor, muscle weakening causes drooping of the tube that carries urine from the bladder to the urethra (outside the body). A dropped bladder thus accompanies drooping of the urethra.

• Dropped Bladder or Anterior Vaginal Wall Prolapse: This is the most common type of pelvic floor muscle prolapse that causes weakening of the muscles above the vagina and can also cause the bladder to get displaced from its place and bulge onto the vagina. This kind of prolapse is also called cystocele.

• Enterocele: Weakening of the pelvic muscles can also cause the small intestine to bulge onto the top or back wall of the vagina.

• Dropped Rectum or Posterior Vaginal Wall Prolapse: Weakening of the pelvic floor muscles in between the vagina and rectum causes the rectum to bulge onto the vagina’s back wall. The condition is also called rectocele.

• Vaginal Vault Prolapse: Weakening of the pelvic floor muscles also causes the vaginal vault, or uppermost part of the vagina, to drop into the vaginal canal.

• Dropped Uterus or Uterine Prolapse: Weakening of the pelvic floor also causes the uterus to drop down into the vaginal canal.

What Are the Symptoms of Pelvic Organ Prolapse?

The feeling of a bulge inside the vagina is often the first and most common symptom of pelvic organ prolapse.

Additional symptoms include:

• Ache, fullness, and pressure in the pelvis.

• Ache, fullness, and pressure in the vagina.

• Worsening of the pressure and bulge over time.

• Dyspareunia or pain during intercourse and pressure.

• Vaginal spotting or bleeding.

• Worsening bulge or pressure while standing on feet for too long or while coughing.

• One also has to shift the protruding organs with their fingers to poop or pee.

If fecal stress or urge incontinence occurs along with pelvic organ prolapse, symptoms may include:

• Urge incontinence or increased frequency of urinating that cannot be controlled.

• Stress incontinence or urine leakage while coughing, exercising, or laughing.

• Fecal incontinence is the inability to control poop or constipation.

How Is Pelvic Organ Prolapse Diagnosed?

The diagnosis of pelvic organ prolapse is initially done by physical examination of the symptoms. The doctor may ask the patient to cough to see the degree of prolapse in relaxed and straining conditions. They also examined the patient while standing and lying down. In addition, the doctor may advise certain tests to diagnose the condition; these include:

• Imaging tests, including magnetic resonance imaging (MRI) and ultrasound, are used to view the pelvic cavity and analyze the extent of organ prolapse. Ingoing tests are mainly used to diagnose complex cases.

• Bladder function tests are also recommended to rule out the signs and symptoms of urinary problems associated with pelvic organ prolapse. The tests may include urodynamics to analyze how efficiently the bladder stores and releases urine, and a cystoscopy test is done to view the urethra and bladder.

How Is Pelvic Floor Prolapse Treated?

The first line of treatment for pelvic organ prolapse is a nonsurgical approach because of the complications and risks associated with surgical treatment methods. However, if the conservative treatment is ineffective in treating the condition, the doctor recommends surgical intervention.

Treatment includes:

Nonsurgical Treatment

• The doctor advises Kegel or pelvic floor strengthening exercises, and they provide the person with a personal physical therapist to test the individual's muscle strength and guide them with targeted exercises to train weak muscles.

• A silicon device, or vaginal pessary, is inserted inside the vagina to support the sagging pelvic organs. The vaginal pessary is a removable device.

• In addition, the doctor suggests lifestyle changes, such as weight loss if a person is overweight, avoiding heavy weight lifting, and incorporating a high-fiber diet if one has constipation issues.

Surgical Treatment

Surgical treatment is opted for when all other options are ineffective in treating the condition. Surgeries are mainly of two types; reconstructive surgery (repairs the weakened parts of the pelvic region) and obliterative surgery (the vaginal walls are sewed to prevent organ displacement).

The surgical methods include:

• Anterior or posterior wall vaginal wall prolapse is treated with colporrhaphy, which involves surgery through the vagina to prevent cystocele and rectocele or dropping of bladder and rectum and provide them support with dissolvable sutures.

• Other surgical procedures are sacrocolpopexy and sacrohysteropexy, which involve correcting the prolapse in the middle region of the pelvic floor, such as the womb or uterus, if it has dropped down. The former involves attaching the uppermost part of the vagina to the sacrum or tailbone with the help of a synthetic mesh, and the latter involves attaching the cervix. The uterus is not removed.

• Sacrospinous ligament fixation is another surgical method and an alternative to treating pelvic organ relapse in the middle part of the pelvic cavity. In this procedure, the vaginal back is attached to the ligament in the pelvic floor to lift its back.

How Can Pelvic Organ Prolapse Be Prevented?

Pelvic organ prolapse can be prevented in the following ways:

• One must maintain a healthy body weight.

• Regular pelvic floor exercises must be done to strengthen the muscles and provide support to the organs.

• Avoid smoking, as it causes coughing and, in turn, puts pressure on the abdominal cavity and pelvic floor.

• Eating a high-fiber diet helps avoid constipation and puts strain and pressure on the pelvic floor.

• Avoid lifting heavy objects, and if one is involved in lifting weights, ensure correct posture to prevent injury to the pelvic floor and lower back.

Conclusion

To conclude, pelvic organ relapse can be treated with timely intervention; however, if there is a delay in availing of treatment, the condition can become severe and affect one's quality of life. There are various conventional treatment options for pelvic organ relapse and surgical methods to treat more severe conditions, depending on the type and location of the prolapse. In addition, the prognosis also depends on the severity and location of the prolapse and whether one wishes to have penetrating sex, children, or less invasive treatment options. Therefore, one must consult the doctor and discuss their condition without hesitation to find a better outcome.