Pelvic organ prolapse is a pelvic floor disorder that occurs when the ligaments and muscles which support the pelvic organs, become loose or week. This is not a life-threatening condition but causes enough pain and discomfort in the pelvis and lower back that prompt treatment is required.
- Degrees of prolapse
- Risk factors
- Home remedies
- When to consult a doctor?
Symptoms of pelvic organ prolapse
Pelvic organ prolapse can cause a number of symptoms depending upon the organ involved. Sometimes a prolapse is asymptomatic and is discovered during a pap smear. Some common symptoms are:
- Something coming out of the vagina
- A feeling of pressure and discomfort in the pelvis
- Pressure symptoms worsening upon standing, coughing, or over the day
- Urinary incontinence
- Leakage of urine upon sneezing or coughing
- Dyspareunia; pain during intercourse
- Loss of bowel control and fecal incontinence
- Intermenstrual bleeding
- Pain in the lower back
- The problem in inserting tampons
Types of pelvic organ prolapse
Types of pelvic organ prolapse are categorized on the basis of the organ involved, most common types are:
- Uterine prolapse: When the uterus drops into or out of the vaginal canal
- Cystocele: As the bladder prolapses into the vagina, this is the most common type of pelvic organ prolapse
- Rectocele: Prolapse of the rectum into the vagina
- Enterocele: Small bowel prolapse into or out of the vagina
- Urethrocele: Urethral prolapse
- Vaginal vault prolapse: Prolapse of the vagina, common in females who undergo a hysterectomy
Degrees of prolapse
Degrees of prolapse are used to describe the extent of uterine prolapse. The four degrees are:
- First-degree- uterus lies in the upper half of the vagina
- Second degree- uterus lies in the lower half and near the opening of the vagina
- Third-degree- uterus bulges out of the vagina
- Forth degree- uterus lies completely outside the vagina
Causes of pelvic organ prolapse
Pelvic organ prolapse takes place when the ligaments and muscles, that support the pelvic organs and structures, become weak and are not strong enough to support the pelvic organs. This can take place due to a number of reasons, some of which are:
- Old age: Pelvic floor disorders are more prevalent in females, older than 60 years. As the muscles and ligaments become loose with growing age and fail to support the pelvic organs.
- Vaginal delivery: Although, the vaginal canal is stretchable multiple vaginal deliveries can strain the pelvic floor muscles and ligaments, increasing the risks for pelvic organ prolapse.
- Chronic cough: Chronic cough can put pressure on your abdomen thus weakening the pelvic muscles over time.
- Genetics: Genetics plays an important role in prolapse.
- Delivering an over-weight baby (macrosomia): Baby, weighing more than 8 and a half pounds can exert long-term pressure on the pelvic floor, causing it to become weak.
- Hormonal changes: Females in their menopause, experience loss of estrogen levels that are known to affect the strength of the pelvic floor.
- Hysterectomy: Females who undergo a hysterectomy are also likely to develop prolapse.
Direct surgical failure often results in a vaginal prolapse recurrence, the second repair is difficult, messy, and uncomfortable for the patient. Thus, females who have prolapse surgery are advised to follow a pelvic floor strengthening routine to avoid recurrence.
Some women are at higher risk of developing pelvic organ prolapse than others, some of the risk factors are:
- Age more than 60 years
- Females with chronic straining conditions like constipation, cough
- Marfan’s Syndrome
Complications of pelvic organ prolapse
Some of the complications of pelvic prolapse are:
- Vaginal sores are caused by constant rubbing of vaginal tissue that bulges outside against the clothes or upon sitting
- Infections as the vaginal tissue are more exposed
- Urinary retention can lead to obstruction of kidneys
- Chronic constipation
- Painful intercourse
Diagnosis is made by taking a detailed history of the patient who comes with the complaint of “something coming out of vagina”, this is followed by a pelvic examination. However, some tests are conducted to rule out other causes of the associated symptoms:
- Urinary and culture for infection
- Ultrasound of the pelvis
- Intravenous pyelography
- CT scan pelvis
- MRI pelvis
How to prevent pelvic organ prolapse?
Pelvic organ prolapse can be prevented by taking a few measures that contribute to the risk factors. Some of the ways are:
- Lose weight, if you are obese
- Avoid smoking, as it can cause cough
- Consume foods with higher fiber content, if you have chronic constipation
- Do pelvic floor exercises to strengthen the muscles throughout the pregnancy
Treatment of pelvic organ prolapse
Treatment of pelvic organ prolapse is dependent upon the degree of prolapse, the severity of symptoms, and the age of the patient. The treatment modalities most commonly employed are:
- Pelvic floor exercises are advised by a physiotherapist to females who do not have severe symptoms
- Vaginal pessaries are small plastic devices that provide mechanical support to pelvic organs
- Surgery for prolapse, surgically a synthetic mesh is used to repair the pelvic floor and build the support. This can be done by abdominal approach as well as vaginal
- Colpocleisis, this method involves closing the vaginal opening surgically and is employed in females who no longer have vaginal intercourse
Lifestyle changes and home remedies
- Take a high-fiber diet to avoid getting constipation
- Do pelvic floor exercises, Kegel’s exercises, to strengthen your pelvic floor even after surgical repair to avoid recurrence
- Avoid lifting heavy objects
- Take vitamin C supplements, that help build the collagen in the body
When to consult a doctor?
Although prolapse is not a life-threatening condition if your symptoms are increasing in severity and causing more pain and discomfort than usual, you should consult a doctor for proper management and treatment.
Can you push a prolapse back into place?
Depending upon the degree of prolapse, yes, you can push it back into place often.
Does a prolapse get worse over time?
Yes, almost always the pelvic prolapse gets worse over time but it is gradual. But prolapses that are new and occur after a vaginal delivery, often get better within a year.
How effective are pelvic floor exercises?
Pelvic floor exercises or Kegel’s exercises can improve the symptoms from 1st to 3rd-degree prolapse and are effective enough to prevent the prolapse from getting worse over time.