What is a pelvic organ prolapse?

A prolapse refers to the displacement or dropping of an organ from its normal position, often occurring in the pelvic region. In the context of pelvic organ prolapse, this typically involves one of the pelvic organs (bladder, uterus, rectum, or small bowel) sagging or bulging into the vaginal canal due to weakened or stretched supporting tissues.

Types of Pelvic Organ Prolapse:

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

• Cystocele:

• This is the prolapse of the bladder into the vaginal wall. It occurs when the tissue between the bladder and the vaginal wall weakens, causing a bulge. This can lead to urinary symptoms like incontinence, frequent urination, or a feeling of incomplete bladder emptying.

• Rectocele:

• This is the prolapse of the rectum into the vaginal wall. It happens when the tissue between the rectum and vaginal wall weakens, causing a bulge. Symptoms might include difficulty with bowel movements, feeling of pressure, or a sensation of something "falling out."

• Uterine Prolapse:

• This occurs when the uterus drops down into the vaginal canal. It can happen when the pelvic floor muscles and ligaments that support the uterus become weakened, often as a result of childbirth, aging, or hormonal changes. Symptoms can include pelvic pressure, lower back pain, urinary problems, and in some cases, a visible bulge.

• Enterocele:

• This is the prolapse of the small intestine into the vaginal wall, causing a bulge. It’s less common than cystocele or rectocele, but it can occur when the supportive tissues of the pelvic floor are weakened.

Causes of Pelvic Organ Prolapse:

• Childbirth: Vaginal delivery, especially with multiple children or a large baby, can stretch or tear the pelvic floor muscles and ligaments, leading to prolapse.

• Aging: As a woman ages, the pelvic floor muscles naturally lose strength and elasticity, especially after menopause when estrogen levels decrease.

• Chronic constipation or straining: Chronic constipation can cause repeated straining, which puts pressure on the pelvic organs.

• Obesity: Excess weight increases pressure on the pelvic floor, which can weaken its supporting structures.

• Heavy lifting: Repeated heavy lifting or strenuous physical activity can strain the pelvic floor muscles.

• Genetics: Some women may have a genetic predisposition to weaker connective tissues.

Symptoms of Prolapse:

The symptoms can vary depending on the severity of the prolapse and which organ is affected. Common signs and symptoms include:

• A feeling of pressure, heaviness, or fullness in the pelvic area.

• A bulge or protrusion in the vaginal area (you may feel or see it).

• Difficulty urinating, including a weak stream or incomplete emptying of the bladder.

• Urinary incontinence (leaking urine when coughing, sneezing, or laughing).

• Difficulty with bowel movements or a sensation of not being able to fully empty the bowel.

• Lower back pain or pelvic discomfort.

• In severe cases, the prolapsed organ may be visible at the vaginal opening.

Treatment Options:

Treatment for pelvic organ prolapse depends on the severity of the condition, the specific organ involved, and whether symptoms are present. Options include:

• Conservative Management:

• Pelvic floor exercises (Kegels): Strengthening the pelvic floor muscles can help support the pelvic organs and alleviate symptoms.

• Pessary: A device inserted into the vagina to support the prolapsed organ. It can be a good option for women who don’t want surgery.

• Lifestyle changes: Maintaining a healthy weight, managing constipation, and avoiding heavy lifting can help prevent worsening of prolapse.

• Surgical Options:

• Surgery may be considered if the prolapse causes significant symptoms that interfere with daily life. The goal is to repair the pelvic floor and reposition the prolapsed organ. This can be done through vaginal or abdominal surgery, depending on the case.

• Hormone Therapy:

• In some cases, hormone therapy (such as estrogen) may be recommended, especially after menopause, to help strengthen the pelvic tissues.

Preventing Prolapse:

While not all cases of prolapse can be prevented, there are steps that can reduce the risk or minimize its severity:

• Pelvic floor exercises: Regularly practicing pelvic floor strengthening exercises (e.g., Kegel exercises) can help support the pelvic organs.

• Manage your weight: Maintaining a healthy weight reduces the strain on the pelvic floor.

• Prevent constipation: Avoid straining during bowel movements by eating a high-fiber diet and staying hydrated.

• Avoid heavy lifting: Use proper techniques when lifting heavy objects to reduce pressure on the pelvic floor.

If you think you might have a prolapse, it's important to consult with a healthcare provider, such as a gynecologist or a pelvic health physiotherapist, for diagnosis and treatment options tailored to your situation.