What is Pelvic Floor Prolapse?
Pelvic organ prolapse (POP) or vaginal relaxation syndrome is a condition that occurs when the supportive muscles and ligaments of the pelvic floor weaken, causing the pelvic organs to sag and press into the wall of the vagina.
The organs within a woman’s pelvis, such as the bladder, rectum, and uterus, are usually held in place by ligaments, facias, and muscles. When these support structures are weakened, the pelvic organs can bulge from their natural position into the vagina, resulting in POP. Sometimes, a prolapse may be large enough to protrude outside the vagina.
Causes of Pelvic Organ Prolapse
Various reasons can cause pelvic organ prolapse, which includes:
- Pregnancy and childbirth are the most common causes of weakening of the pelvic floor muscles and ligaments.
- Aging, particularly after menopause and lack of hormones, also contribute to the development of pelvic organ prolapse.
- Being overweight or experiencing significant weight loss can weaken the pelvic floor.
- Conditions that accompany increased intra-abdominal pressure, such as constipation, persistent coughing, or prolonged heavy lifting, can cause pelvic organ prolapse.
- Being genetically predisposed to having loose connective tissue can increase the risk of prolapse.
Symptoms of Pelvic Organ Prolapse
The symptoms of pelvic organ prolapse can vary based on the type and severity of the prolapse. Common symptoms of POP include:
- A mass sensation in the vagina that feels like something is “coming down.”
- Backache, heaviness, or a dragging discomfort inside the vagina.
- Protrusion from the vagina; If the bladder has prolapsed into the vagina, it may cause a frequent urge to urinate or leakage of urine when coughing, sneezing, or exercising.
- If the bowel is affected, there may be low back pain, constipation, or incomplete bowel emptying. In some cases, pushing back the prolapse may be necessary to allow stools to pass.
- Uncomfortable or painful sex.
Types of Pelvic Organ Prolapse
There are different types of prolapse depending on which organ is bulging into the vagina. The uterus, bladder, or rectum may be involved. It is common to have more than one type of prolapse at the same time. The most common types of POP include:
- Anterior wall prolapse (cystocele) – when the bladder bulges into the front wall of the vagina.
- Posterior wall prolapse (rectocele) – when the rectum bulges into the back wall of the vagina.
- Uterine prolapse – when the uterus hangs down into the vagina. Eventually, the uterus may protrude outside the body. This is called a procidentia or third-degree prolapse.
- Vault prolapse – after a hysterectomy, the top (or vault) of the vagina may bulge down. This is called a vault prolapse. This happens to one in ten women who have had a hysterectomy to treat their original prolapse.
Treatments for Pelvic Organ Prolapse
The treatment for POP depends on the severity of the condition and the symptoms.
A. Non-Surgical Treatments
For mild cases, the following nonsurgical treatments may ease symptoms and prevent further worsening of the prolapse:
- Lifestyle changes, such as losing weight if overweight, managing a chronic cough, avoiding constipation, heavy lifting, and high-impact exercise.
- Pelvic floor exercises can also be beneficial, as well as vaginal hormone treatment with estrogen for mild cases of postmenopausal prolapse.
- Another option is the use of a pessary, a plastic or silicone device that fits into the vagina to support the pelvic organs and hold up the uterus. Pessaries come in various types and sizes, and fitting the correct size is important. They should be removed, cleaned, and reinserted regularly, and estrogen cream may be used during changes to prevent soreness. Although sex is possible with some types of pessary, unexpected bleeding should be reported to a doctor.
- Finally, laser treatment can relieve incontinence symptoms and rejuvenate the vaginal wall by stimulating collagen. This treatment is painless, has no downtime, and is suitable for mild to moderate cases of prolapse and urinary incontinence.
B. Surgical Treatments
If non-surgical treatments do not provide relief, there are various surgical options available to treat vaginal relaxation. The type of operation recommended will depend on the type of prolapse, the severity of symptoms, the patient’s age and general health, and their desire for sexual intercourse or to have children in the future.
Your gynecologist in Dubai can advise on which operation is best for you and the pros and cons of each. Surgical options include:
- Pelvic Floor Repair: this involves tightening the walls of the vagina to support the pelvic organs.
- Sacrocolpopexy or sacrospinous fixation: which lifts the uterus or vagina to a bone towards the bottom of the spine or a ligament within the pelvis. A vaginal hysterectomy may also be performed for uterine prolapse, sometimes in combination with a pelvic floor repair.
In severe cases where previous surgeries have been unsuccessful, closing the vagina (colpocleisis) may be considered, but only if the patient is in poor medical health.
Related Q&A
Q1. Can pelvic organ prolapse be prevented?
While certain factors for pelvic organ prolapse cannot be controlled, such as aging or genetics, there are steps that can be taken to reduce the risk or slow its progression. These include maintaining a healthy weight, practicing pelvic floor exercises, avoiding heavy lifting, managing chronic coughing, and practicing proper lifting techniques during childbirth.
Q2. How is pelvic organ prolapse diagnosed?
Pelvic organ prolapse is usually diagnosed through a combination of medical history assessment, physical examination, and possibly additional tests such as pelvic organ prolapse quantification (POP-Q) exam, urodynamic testing, or imaging studies.
Q3. Can pelvic organ prolapse be cured?
Although there is no definitive cure for pelvic organ prolapse, you can use the effective treatment methods mentioned above.
Q4. When should I seek medical advice?
It’s advisable to seek medical attention when you start experiencing symptoms of pelvic organ prolapse, like vaginal bulging, pelvic pressure, or bowel problems.
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