Pelvic Organ Prolapse- Causes, Symptoms and Treatment

What is Pelvic organ prolapse?

Pelvic organ prolapse, also known as POP, is a medical condition that occurs when the tissues and muscles supporting the pelvic organs become weak, and as a result, leads to a prolapse of the pelvic organs from their usual position. Examples of pelvic organs include bladder, uterus, vagina, cervix, urethra and rectum.

The pelvic muscles support the pelvic organs like a hammock. When prolapse happens, one of the pelvic organs will drop down and push out of the vagina. In the later stages, the bulge will be literally protruding out of the vagina and can be visibly witnessed.

Prolapse usually is seen in women years after childbirth, after menopause, or after a hysterectomy.  

Pelvic organ prolapse is not a serious issue and can be cured when timely treatment is considered. 

How is it caused?

Some of the common causes of a pelvic organ prolapse are:

• Aging – This usually happens to aged women above 60  as the muscles and tissues of older women are getting weaker and are not able to hold the pelvic organs in place
• Vaginal birth – during labor,  relaxation and contraction of pelvic muscles happen, which will increase the chances of getting a prolapse years after childbirth. However, prolapse with women who have had a c-section delivery
• Putting more pressure on the abdomen – this can be due to obesity, straining during a bowel movement, or intense coughing
• Giving birth to a child that weighs over 8.5 pounds
• Genetic or family history 
• Changes in hormones during menopause. During or after menopause, most women will have a loss of estrogen which can increase the risk of pelvic organ prolapse.

What are the different types of pelvic organ prolapse?

Depending on the type of pelvic organ and the extent of how much it has prolapsed, this medical condition is categorized into the following types:

1. Urethrocele: This refers to the prolapse of the urethra
2. Cystocele: This type refers to the prolapse of a patient’s bladder into the vagina
3. Vaginal vault prolapse: This refers to the prolapse of the vagina
4. Enterocele: This type refers to the prolapse of the small bowel
5. Rectocele: This type refers to the prolapse of the rectum

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What are the symptoms?

The common symptom that women with pelvic organ prolapse experience are discomfort during physical activity or sexual intercourse. 

The other usual symptoms are:

• Bulging structure  seen or felt in the vagina
• Ache or discomfort in the pelvis
• Problems with bowel movement or urine leakage
• Unusual discomfort during periods (while inserting tampons or placing napkins)
• Pain or pressure in the pelvis during coughing, walking, standing, or sitting. 

How is pelvic organ prolpase diagnosed?

Patients who suspect pelvic organ prolapse need to get themselves checked by a physician. For diagnosing this condition, the following tests are available to detect if any organ has slipped or moved out of its original place:

• Bladder function tests
• CT scan tests
• MRI and ultrasound of the pelvis
• Urinary tract X-ray (intravenous pyelography)

Can pelvic organ prolapse be prevented?

Pelvic organ prolapse can be prevented by a combination of healthy lifestyle habits and exercises that focus on strengthening the pelvic muscles. These include the following:

• Performing Kegel exercises on a daily basis
• Take extra care when lifting weights, ensure the leg muscles are used and avoid straining the back muscles
• Avoid sedentary lifestyle habits, like sitting for a prolonged period
• Quit smoking 

What measures can be taken to help with the symptoms?

The basic treatment for pelvic organ prolapse is to strengthen the pelvic floor muscles in order for it to support and keep the pelvic organs firm and intact. 

Below are some of the measures that can be followed to help with the symptoms of pelvic organ prolapse. 

• Prevent constipation – constipation is one of the causes of pelvic organ prolapse. While straining, there are high chances of having a prolapse. Hence, it is good to avoid constipation . Fiber-rich foods help with relieving the condition. Some of the practices that may help with clearing constipation are:
  • Drinking plenty of fluids
  • Consuming lots of fruits and vegetables
  • Eating high fiber foods like whole grains, beans, carrots, etc.,
  • Avoid oily and junk foods that can contribute to constipation
  • Do not strain much while passing stools .
• Following exercises – doing exercises that focus on the pelvic floor muscles, helps to improve and strengthen the muscles and ligaments that hold the pelvic organs in place. Doctors advise women  follow Kegel exercises. It is found to give good results when followed consistently. As a beginner you can try  holding back and tightening the muscles for 5 seconds and releasing for 5 seconds, and repeating the process 5 times helps. Gradually the duration can be increased to 10 seconds and repeated 10 times at a stretch after getting used to this motion.
• Avoid putting pressure in the pelvic area . This can be done by avoiding lifting heavy weights, straining, walking or standing for a long period of time, sitting  by crossing the legs tightly together, etc.,
• Quit smoking – smoking causes innumerous damages to the health. The habit may weaken the tissues around the pelvic region making the symptoms worse. Smoking will also lead to chronic coughing and ultimately puts pressure on the pelvic muscles. Hence, it is normally advised to quit smoking when a woman has this ailment.
• Losing excess weight – being obese may again put pressure on the lower part of the body, which in turn affects the pelvic floor muscles, leading to prolapse. Hence, maintaining weight is essential to prevent the occurrence of pelvic organ prolapse. 

What are the treatment options for a pelvic organ prolapse?

A prolapsed pelvic organ can be treated in two ways – surgical or non-surgical methods:

Non-surgical treatment options

For patients suffering from mild forms of pelvic organ prolapses, physicians will first suggest non-surgical treatment options. Non-surgical options include physical therapy that focusses on strengthening the pelvic muscles, such as Kegel exercises. Patients who do not undergo physical therapy to strengthen their pelvic muscles are at risk of requiring surgery. 

Surgical options

For treating severe cases, patients may be required to undergo surgery to repair weakened or affected tissues, or to completely remove a pelvic organ. Hysterectomy is an example of this treatment option, as it involves the surgical removal of a uterus.