Pelvic Organ Prolapse

Doctor using a smart board to examine an xray

What Is Pelvic Organ Prolapse and How Does It Affect Your Life?

Pelvic organ prolapse is one of the most common disorders affecting women. Also known as a genital prolapse, it occurs when one or more pelvic organs, such as the uterus, bladder, or bowel, slip out of place and bulge into the vagina. This condition is not life threatening, but it may cause severe discomfort and affect your quality life.

Each year, more than 200,000 surgeries are done in the U.S. to correct pelvic organ prolapse. However, surgery is only required in severe cases. Some women have mild symptoms or no symptoms at all.

Understanding Pelvic Organ Prolapse

This health condition affects about half of women over 40 years old. Younger women can develop this condition too. It typically occurs because of heavy lifting, injuries, or childbirth. When the pelvic muscles become weakened, they can not longer hold the genital organs in their correct position. The vaginal wall collapses, which leads to the descent of the pelvic organs into or out of the vagina. Patients may experience pain, bladder incontinence, general discomfort, and problems with bowel movements. In severe cases, they can see or feel their pelvic organs bulging outside of the body.

Most women are too embarrassed to see a doctor or talk about their symptoms. For this reason, it is hard to estimate the global relevance of pelvic organ prolapse. This condition affects a woman's physical, emotional, social, and sexual health. Its symptoms vary from mild to severe. Most times, it is caused by strain during childbirth. The main types of pelvic organ prolapse are:

  • Cystocele (bladder prolapse)
  • Urethrocele (urethra prolapse)
  • Rectocele (rectal prolapse)
  • Enterocele (small bowel prolapse)
  • Vaginal vault prolapse
  • Uterine prolapse

More than one organ can prolapse at the same time. Treatment depends on the severity of symptoms, and may include physical therapy, surgery, or lifestyle changes.

Causes and Risk Factors

Pelvic organ prolapse can have a variety of cases, from aging to neurological injuries. Vaginal delivery appears to be the single major factor leading to the onset of this condition. Some women develop pelvic organ prolapse during pregnancy because of the increase in intra-abdominal pressure.

Another common cause is aging. As you age, your collagen levels decrease. This leads to weakening of the fascia and connective tissues. Many patients develop pelvic organ prolapse after hysterectomy, which involves surgical removal of the uterus. Other risk factors include pelvic organ tumors, frequent constipation, obesity, menopause, and genetics.

This condition tends to run in families, which explains why some women are born with weaker connective tissues. Studies have also found that Caucasian women have a higher risk of pelvic organ prolapse compared to African American women. Intense repetitive activity, weight lifting, nerve, muscle disorders, chronic coughing, and smoking increase the risk too.

Pelvic Organ Prolapse Symptoms

Many women suffering from this disorder have nonspecific symptoms, such as constipation, abdominal pain, back pain, frequent urination, and vaginal bleeding. Some experience discomfort in the low back, pelvis, and abdomen, problems passing urine, pain during intercourse, incontinence, or fullness in the lower abdomen. Others feel as if something is falling out of their vagina.

In general, uterine prolapse is characterized by painful intercourse and low back pain. Rectocele causes constipation and changes in bowel habits. Urine leakage is associated with cystocele. However, symptoms may not correlate with the severity or location of the prolapsed organ. Research indicates that most women have some type of pelvic organ prolapse without being aware of it.

This condition affects a woman's mental and emotional well-being too, causing psychological stress, embarrassment, depression, and social anxiety. Some patients are afraid to leave the house or go to work because of urinary and fecal incontinence. Others report a lack of sexual sensation, which affects their relationship.

Diagnosis and Treatment

Pelvic organ prolapse is often detected during routine pelvic exams. The most widely used diagnostic procedures include:

  • Cystourethroscopy
  • Pelvic floor strength tests
  • Pelvic MRI
  • Pelvic ultrasound
  • Digital rectal exam
  • Urodynamic tests
  • Computed tomography scan
  • Intravenous pyelogram (IVP)
  • Urinary tract X-rays
  • Bladder function tests
  • Cotton swab tests

After making a diagnosis, the doctor will determine the severity of prolapse using a classification system. Treatment options depend on the patient's age, overall health, and symptoms. Most women will require a vaginal pessary. This device is placed into the vagina to hold the pelvic organs in place. It can be made of plastic, rubber, or silicone, and does not cause any discomfort. Pessaries are typically recommended to young women who develop uterine prolapse during pregnancy. Although these devices don't fix the prolapse, they slow its progress and reduce its symptoms.

Some women are able to relieve pain and pressure through lifestyle changes, such as losing weight, avoiding heavy lifting, and eating more fiber. Kegels have shown to be effective too. These exercises strengthen the pelvic floor muscles, restore their function, and help control urine loss. They are particularly beneficial for women with bladder incontinence. To fully reap the benefits, do your Kegels daily.

Surgery is recommended when the symptoms are severe and affect your daily life. It may involve the closure of the vagina, hysterectomy, or repair of the prolapsed organs. About 25 out of 100 women who have surgery will develop another prolapse at some point in their lives. Non-surgical options include biofeedback therapy, hormone replacement therapy, pelvic floor muscle training.