Pelvic Organ Prolapse

Understanding Pelvic Organ Prolapse
Pelvic organ prolapse (POP) is a fairly common health condition among women, particularly those who are older or have had children. While POP is rarely more than an inconvenience, there is a possibility that it could get worse over time and seriously affect one’s quality of life. If experiencing symptoms of POP, one should see a doctor to determine how severe it is and what the best options available are.

POP occurs when the muscles, ligaments and/or tissues that support a woman’s pelvic organs become weak, allowing those organs to slip out of place (or prolapse) and press up against the inside walls of the vagina. There are several types of POP, depending upon the specific problem. The organs that can be affected are:

• Rectum
• Bladder – the most common type of POP
• Uterus
• Urethra
• Small bowel

Most pelvic organ prolapse is caused, initially, by the damage caused to the pelvic ligaments and muscles due to childbirth or hysterectomy. Following both of these, estrogen levels in the body drop, which causes the muscles to weaken further. It can then trigger as a result of such things as a frequent or persistent cough, frequent constipation, pelvic organ tumors and certain spinal cord health problems. Other risk factors include obesity, advanced age and a family history of the condition.

The most common symptom of POP is a noticeable discomfort from the pelvic organs as they press against the vaginal wall. There can also be feelings of being full, pain in the lower back, a feeling of a stretched groin, painful intercourse, incontinence or frequent urination, constipation, spotting or bleeding or even the feeling that something is falling out of the vagina.

For minor symptoms, POP can often be dealt with at home by adopting some good practices and making a few lifestyle changes. Pelvic exercises will help to strengthen the muscles. One should also avoid caffeine, try to maintain a proper weight and avoid heavy lifting or activities which will put increased stress on the affected areas.

If preventative treatments do not work, then using a device called a pessary may solve the problem. A pessary is placed inside the vagina as added support to keep the organs in place. In more severe cases, a pessary will not provide enough support or may even fall out from the pressure. Medications to increase estrogen levels may be used for those suffering a decrease. Electrical stimulation to the muscles to contract and strengthen them is another option.

When the condition is too severe, all other options have proven ineffective or POP is seriously affecting one’s quality of life, surgery may be considered. This involves securing the connective tissues by either directly suturing the weakened areas, or by the use of a graft. Grafts can be made of either synthetic or biologic materials and have a greater long-term success rate than other forms of surgery. There are drawbacks to using grafts, however, including an increased risk of complications. Research is still being conducted on grafts to assess their safety and relative effectiveness.

Fixing pelvic organ prolapse is not a sure thing. There is a high risk of recurrence, and 3 out of 10 women typically need at least one more surgery to deal with complications or a new prolapse in a different weakened area. Luckily, POP is fairly easy to deal with and advances are being made to provide better and more reliable options to treat it.