Pelvic Organ Prolapse - Types, Causes, Symptoms, and Treatment

Introduction:

Pelvic organ prolapse is a disorder causing the pelvic floor's tissues and muscles to become loose and weak, resulting in drooping of the pelvic organs (cervix, uterus, vagina, bladder, urethra, and rectum). The bladder is not involved in pelvic organ prolapse. Pelvic floor disorder can occur after childbirth, causing complications like stretching and torn muscles or aging.

The most common pelvic floor disorders are:

• Leaking of urine (urine incontinence).

• Leaking of stools (fecal incontinence).

• Pelvic organ prolapse (weakening of the supporting tissues and muscles of the pelvic organs).

What Are the Causes of Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the muscles and the tissues of the pelvic floor do not work correctly because of the following:

• Vaginal birth causes stretching and straining of the pelvic floor muscles. Prolonged, difficult childbirth or delivering large or multiple babies can also cause pelvic floor prolapse.

• Due to constipation, long-term pressure in the abdominal region may occur due to chronic cough, obesity, or straining during bowel movements.

• Hysterectomy (surgical removal of the uterus).

• Changes in the female hormone estrogen during and after menopause can cause pelvic organ prolapse. However, the exact cause is unknown.

• Pelvic floor disorders are more common in elderly women.

• Family history.

• Women in jobs that require lifting heavy objects.

What Are the Types of Pelvic Organ Prolapse?

There are five main types of pelvic organ prolapse.

• Cystocele (Dropped Bladder) - It is a common type of pelvic organ prolapse. It occurs when the bladder drops into or out of the vagina.

• Rectocele (Dropped Rectum) - This occurs when the rectum bulges into or out of the vagina.

• Uterine Prolapse (Dropped Uterus) - It occurs when the uterus bulges into or out of the vagina.

• Enterocele - An enterocele occurs when the small intestine or small bowel bulges into the vagina.

• Vaginal Vault Prolapse - This occurs when there is prolapse of the vagina.

What Are the Signs and Symptoms of Pelvic Organ Prolapse?

The symptoms vary in each individual, and some women may have no symptoms. The common symptoms include,

• Pain and dragging discomfort inside the vagina.

• A feeling of something coming out of the vagina often feels like sitting on a ball.

• A feeling of heaviness around the lower belly area and genitals.

• Seeing or feeling a lump coming out of the vagina.

• Pain, discomfort, or numbness during sex.

• Problems during peeing include feeling like going to the toilet more often or leaking a small amount of pee when you sneeze, cough or exercise.

• Loss of bowel control or constipation.

• Spotting or bleeding from the vagina.

• Problems while using tampons.

Is Pelvic Organ Prolapse Preventable?

By controlling the following risk factors, pelvic organ prolapse can be prevented.

• Maintain Average Weight - Women with overweight or obese have an increased chance of pelvic organ prolapse.

• Prevent Constipation - Food rich in fiber can prevent constipation and strain during bowel movements.

• Do not smoke, as smoking can affect tissues and cause a chronic cough.

• Doing Kegel exercise can maintain good muscle strength in the pelvic area.

• Avoid Heavy Lifting - In case of heavy lifting, use your legs and not your back or abs.

Some risk factors cannot be controlled. They are:

• Pelvic organ prolapse is associated with aging.

• Family history of pelvic organ prolapse.

• A complicated vaginal birth.

• Surgical history of hysterectomy.

How Is Pelvic Organ Prolapse Diagnosed?

The doctor will take a medical history and examine the pelvic organs to check the strength of the pelvic floor muscles. If the physician suspects pelvic organ prolapse, and if more than one organ has moved out of place, also if the patient has other related conditions, then a few tests are to be done to prevent the severity of the prolapse. The tests might include:

• Intravenous pyelography (X-ray of the urinary tract) is used to view the kidney, bladder, and uterus and its working.

• A bladder function test is carried out to check the working of the bladder and associated structures.

• Cystourethrogram helps to check the bladder before and after urinating and analyze the condition of the ureter and bladder.

• CT (computerized tomography) of the pelvis.

• Ultrasound of the pelvic region shows the image of pelvic organs and their position.

What Is the Treatment for Pelvic Organ Prolapse?

According to the medical history and physical examination, the physician will recommend the treatment options. It may be non-surgical or surgical.

Non-Surgical Treatment:

• Pelvic Floor Exercise - This exercise is also called Kegel exercise, which helps to strengthen the pelvic muscles by contracting and relaxing the muscles surrounding the opening of the vagina, urethra, and rectum.

• The Pessary - It is a removable device inserted into the vagina to support the prolapsed pelvic organs. Certain types of pessary can treat both pelvic organ prolapse and urinary incontinence.

• Dietary Changes - Doctors may recommend eating foods with fiber for people with bowel problems. The fiber in food helps prevent constipation and straining during bowel movements.

Surgical Treatment:

Surgery is not often recommended for patients with pelvic organ prolapse. It is recommended for women with severe pain and discomfort, affecting their day-to-day lives. Surgery is carried out depending on the following factors.

• Age.

• The severity of prolapse.

• The severity of symptoms.

• Sexual activity.

• The desire for future children.

• The organ has prolapsed.

Surgery is done to restore the normal position of the vagina, repair the tissue around the vagina and permanently close the vaginal canal with or without removing the uterus (colpocleisis). Surgery of pelvic organ prolapse can be done either through the abdomen or vagina, using stitches, or with the addition of surgical mesh. Some women with pelvic organ prolapse may experience problems with urine leakage. During surgery, a procedure is done to prevent or decrease urine leakage.

Conclusion:

Pelvic organ prolapse is not a life-threatening disorder. It occurs because pelvic floor tissues become weak and result in prolapse of pelvic organs. The symptoms are not severe. There will only be slight discomfort and pain recorded in most cases. There are non-surgical and surgical treatment options. Only in rare instances, surgical treatments are performed.