Conditions & Treatments

Pelvic Organ Prolapse

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OVERVIEW

Pelvic organ prolapse (POP) is a medical condition that occurs when the pelvic organs, such as the uterus, bladder, rectum, or vaginal walls, drop from their normal position and bulge into or out of the vagina. This condition typically happens when the pelvic floor muscles and connective tissues become weakened or damaged, leading to a loss of support for these organs.

Pelvic organ prolapse can affect women of all ages but is more common in older women, particularly those who have given birth vaginally or undergone multiple childbirths.

At the University of Kansas Department of Urology, our dedication lies in delivering top-notch healthcare and utilizing cutting-edge therapies for our patients. We collaborate closely with each individual to craft a tailored treatment strategy, considering their distinct requirements and objectives.

Types of Pelvic Organ Prolapse

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

  • Cystocele: This occurs when the bladder drops into the front wall of the vagina. It’s one of the most common types of POP and can cause symptoms like urinary incontinence and a frequent need to urinate.
  • Rectocele: A rectocele happens when the rectum protrudes into the back wall of the vagina. This can lead to difficulty with bowel movements, constipation, and a sensation of incomplete emptying.
  • Uterine Prolapse: In uterine prolapse, the uterus descends into the vaginal canal. Women with uterine prolapse may experience pelvic pressure, a feeling of fullness in the lower abdomen, and sometimes pain during sexual intercourse.
  • Vaginal Vault Prolapse: This type occurs when the upper part of the vagina drops down into the vaginal canal or even protrudes outside the body. It often happens after a woman has had her uterus removed through a hysterectomy.
  • Enterocele: An enterocele occurs when the small intestine pushes into the space behind the uterus and into the vaginal wall, causing discomfort and pressure.

SYMPTOMS & CAUSES

Symptoms

The symptoms of pelvic organ prolapse (POP) can vary depending on the type and severity of the prolapse, but common symptoms include:

  • Pelvic Pressure: A feeling of heaviness or fullness in the pelvic region, often described as a sensation of “something coming down.”
  • Vaginal Bulge: Many women with POP notice a bulge or protrusion in the vaginal area that may be felt or seen.
  • Urinary Symptoms: These can include urinary incontinence (leaking urine), a frequent need to urinate, and difficulty fully emptying the bladder.
  • Bowel Symptoms: These may involve constipation, difficulty with bowel movements, or a feeling of incomplete emptying.
  • Pelvic Pain: Some women experience discomfort or pain in the pelvic area, lower back, or during sexual intercourse.

Causes

The causes of pelvic organ prolapse are multifactorial and can include:

  • Childbirth: Vaginal childbirth, especially with prolonged or difficult deliveries, can weaken the pelvic floor muscles and stretch connective tissues.
  • Aging: Natural aging processes can lead to a gradual weakening of pelvic tissues and muscles.
  • Hormonal Changes: Reduced estrogen levels after menopause can contribute to tissue laxity.
  • Chronic Straining: Conditions like chronic constipation, chronic coughing, or heavy lifting can strain the pelvic floor.
  • Obesity: Excess body weight can put increased pressure on the pelvic organs and supporting structures.
    Genetics: Some individuals may have a genetic predisposition to pelvic organ prolapse.

DIAGNOSIS & SCREENING

To diagnose pelvic organ prolapse, a healthcare provider typically performs a pelvic examination, which may include:

  • Physical Examination: The doctor will visually inspect the pelvic area and may ask you to bear down or cough to assess the extent of prolapse.
  • Pelvic Organ Prolapse Quantification (POP-Q) System: This is a standardized system used to measure the degree of prolapse and its severity.
  • Imaging: In some cases, imaging tests like ultrasound or MRI may be used to get a more detailed view of the pelvic anatomy.

Screening for POP is not typically done as a routine procedure but may be considered in specific cases, especially if a woman has a family history of pelvic organ prolapse or other risk factors.

TREATMENTS

The treatment for pelvic organ prolapse depends on the type and severity of the prolapse, as well as the individual’s overall health and preferences. Treatment options include:

  • Pelvic Floor Exercises (Kegel Exercises): These exercises can help strengthen the pelvic floor muscles and may be recommended for mild cases.
  • Lifestyle Modifications: These can include weight management, dietary changes to prevent constipation, and avoiding heavy lifting.
  • Pessaries: These are medical devices inserted into the vagina to provide support for the pelvic organs and relieve symptoms.
  • Physical Therapy: Pelvic floor physical therapy, often with the guidance of a specialized physical therapist, can help strengthen and rehabilitate pelvic muscles.
  • Medications: In some cases, estrogen therapy may be prescribed to help improve tissue health and alleviate symptoms, particularly for postmenopausal women.
  • Surgery: Surgical options range from minimally invasive procedures to more extensive surgeries, depending on the severity of the prolapse and the patient’s goals. Common surgical procedures include hysterectomy, sacrocolpopexy, and anterior or posterior repair.

The choice of treatment should be made in consultation with a healthcare provider who can provide personalized recommendations based on the individual’s specific condition and needs. It’s important to weigh the risks and benefits of each treatment option and consider the impact on overall quality of life.

OUTLOOK & PROGNOSIS

The outlook for individuals with pelvic organ prolapse (POP) depends on several factors, including the severity of the condition, the chosen treatment, and how well the individual responds to that treatment. In many cases, appropriate treatment can significantly improve or relieve the symptoms associated with POP. However, it’s essential to recognize that POP can be a chronic condition, and management strategies may be needed to maintain symptom relief.

Prognosis is generally favorable when treatment is tailored to the specific needs of the patient. Women who undergo surgery for severe cases of POP often experience significant improvement in their quality of life and a reduction in bothersome symptoms.

Prevention & Management

While not all cases of POP can be prevented, there are measures that can help reduce the risk and effectively manage the condition:

  • Pelvic Floor Exercises: Regularly performing pelvic floor exercises, such as Kegel exercises, can help strengthen the pelvic muscles, which may reduce the risk of POP and improve symptoms in mild cases.
  • Healthy Lifestyle: Maintaining a healthy weight, eating a high-fiber diet to prevent constipation, and avoiding heavy lifting can reduce the strain on the pelvic floor muscles.
  • Proper Lifting Technique: When lifting heavy objects, it’s important to use proper lifting techniques, including bending at the knees and not the waist.
  • Manage Chronic Conditions: If you have conditions like chronic cough or constipation, work with your healthcare provider to manage these conditions effectively to reduce strain on the pelvic floor.
  • Regular Check-ups: Routine gynecological examinations can help detect and address POP in its early stages, allowing for less invasive treatment options.
  • Pelvic Floor Physical Therapy: Consider pelvic floor physical therapy if you have mild to moderate POP. A trained physical therapist can provide exercises and techniques to strengthen the pelvic floor.
  • Pessaries: In some cases, a pessary may be used as a long-term management option to provide support and reduce symptoms.
  • Hormone Therapy: For postmenopausal women, hormone therapy may be considered to improve the health and elasticity of pelvic tissues.

CONCLUSION

Pelvic organ prolapse is a common condition, especially among women who have given birth or are postmenopausal. While it can cause bothersome symptoms and affect a person’s quality of life, there are effective treatment options available, ranging from lifestyle modifications and exercises to surgical procedures. Early diagnosis and personalized treatment plans are essential for managing the condition effectively.

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