Overview
Pelvic organ prolapse occurs when the muscles and ligaments supporting a woman's pelvic organs weaken, causing the organs to drop lower in the pelvis and create a bulge in the vagina. It is commonly associated with childbirth, hysterectomy, or menopause. Symptoms may include a feeling of pressure in the pelvic area.
Understanding the disease
Symptoms
The symptoms of pelvic organ prolapse may include:
- Feeling heaviness or pulling in the pelvis
- Feeling like the bladder doesn't empty all the way when you use the bathroom
- Problems with leaking urine, also called incontinence
- Trouble having a bowel movement and needing to press the vagina with your fingers to help have a bowel movement
- Feeling as if you're sitting on a small ball
- Feeling as if you have vaginal tissue rubbing on clothing
- Pressure or discomfort in the pelvis or low back
- Sexual concerns, such as feeling as though the vaginal tissue is loose It is important to consult a healthcare provider if these symptoms bother you and interfere with your daily activities.
Risk Factors
Risk factors for developing pelvic organ prolapse include:
- Age at first delivery (older women are at higher risk compared to younger women)
- Difficult labor and delivery or trauma during childbirth
- Delivery of a large baby
- Being overweight
- Lower estrogen level after menopause
- Chronic constipation or straining with bowel movements
- Chronic cough or bronchitis
- Repeated heavy lifting
- Genetics (weak connective tissue)
- Childbirth (vaginally delivered children, episiotomies, operative vaginal deliveries, and forceps delivery)
- Aging
- Obesity
- Prior pelvic surgery
- Family history of weak connective tissue
- Being Hispanic or white
- Chronic coughing (e.g., from smoking)
- Pregnancy and childbirth, including multiple pregnancies and C-section deliveries. It's important to note that even if you have one or more risk factors, it doesn't necessarily mean you will develop pelvic organ prolapse.
Development
The various pelvic organ prolapses develop when the muscles and ligaments supporting a woman's pelvic organs weaken, causing the organs to drop lower in the pelvis and create a bulge in the vagina. The most common causes are childbirth, hysterectomy, and menopause. Different types of pelvic organ prolapse can occur, such as uterine prolapse, anterior prolapse (cystocele), and posterior vaginal prolapse (rectocele). Risk factors for developing pelvic organ prolapse include having one or more vaginal births, being older at first delivery, giving birth to a large baby, aging, obesity, prior pelvic surgery, chronic constipation, and family history of weak connective tissue. Complications can arise from pelvic organ prolapse, and it's essential to consult a healthcare provider if symptoms such as pressure in the pelvic area are experienced.
Assessment and Diagnosis
Triage
You should see a healthcare provider if you experience symptoms of pelvic organ prolapse. Symptoms may include a feeling of pressure in the pelvic area, a bulge in the vagina, difficulty having a bowel movement, feeling pressure or fullness in the rectum, a feeling that the rectum has not completely emptied after a bowel movement, sexual concerns, and more. If you suspect you have a pelvic organ prolapse, it is important to consult with a healthcare provider to discuss treatment options.
Management and Treatment
Complications
Potential complications of pelvic organ prolapse may include:
- Urinary incontinence: Prolapse can put pressure on the bladder, leading to leakage when coughing, sneezing, or exercising.
- Fecal incontinence: Prolapse can cause difficulty in passing stools or leakage of feces.
- Sexual dysfunction: Prolapse can cause a loss of sexual sensation or make intercourse uncomfortable.
- Emotional distress: Women with prolapse may experience anxiety, depression, or a reduced quality of life due to the physical and emotional impact of the condition.
- Difficulty maintaining hygiene: Women with severe prolapse may find it difficult to maintain personal hygiene or clean the protruding tissues.
- Bowel obstruction or fecal impaction: In severe cases, the prolapse can obstruct the bowel or cause a fecal impaction, which may require medical intervention.
- Vaginal or bladder infections: Prolapse can cause difficulty in keeping the genital and urinary areas clean, increasing the risk of infections. It is essential to consult a healthcare provider if you experience any symptoms related to pelvic organ prolapse, as timely intervention and appropriate treatment can help manage these complications and improve your overall health.
Treatment
Treatments for pelvic organ prolapse depend on the severity of the condition and the symptoms experienced by the individual. Some treatment options include:
- Self-care measures: These can include exercises to strengthen the pelvic floor muscles, maintaining a healthy weight, wearing supportive undergarments, and practicing good bowel and bladder habits.
- Nonsurgical options: Depending on the type and severity of the prolapse, your healthcare provider may recommend pessaries (medical devices inserted into the vagina to support the pelvic organs), pelvic floor physical therapy, or surgery to reinforce the pelvic muscles.
- Surgery: Surgical options for prolapse include pelvic reconstructive surgery, which can involve reinforcing or repairing the damaged muscles and ligaments, or removing or supporting the pelvic organs in their correct position. The type of surgery recommended will depend on the individual's specific condition and symptoms. It is important to consult with a healthcare provider for a proper evaluation and to determine the most appropriate treatment plan based on your specific needs and circumstances.