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Understanding Pelvic Organ Prolapse
This article provided by Ethicon Women’s Health & Urology
Division of Ethicon, Inc.

Aging may cause a woman’s pelvic organs to shift. Obesity, pregnancy and childbirth can cause stretching and may weaken muscles that support your pelvic organs. Because of this shifting, it can become difficult to have a bowel movement or hold urine.

Have you experienced some loss of bladder control lately? Have you felt a pressure in your pelvic area that won't go away? Do you have pain or discomfort during sexual intercourse? Does it constantly feel like you are wearing a tampon, and it's falling out?

If so, you may be suffering from pelvic organ prolapse (POP), a common but rarely discussed condition in which organs in the pelvic region shift out of their normal position, or prolapse.

Pelvic organ prolapse, sometimes known as "dropped bladder," can be uncomfortable both physically and emotionally. Women with this condition tend to limit their daily activities and avoid sex because of pelvic pain and the need to urinate frequently.

If you suffer from this condition, you are not alone and you can find help. Click here to assess your symptoms and learn about treatment options that may be right for you.

Causes of Pelvic Organ Prolapse

The organs in your pelvic area — uterus, vagina, bladder and rectum — are held in place by a web of muscles and connective tissues that act like a hammock. When this web becomes weakened or damaged, one or more pelvic organs shift out of normal position and literally "fall," or prolapse, into the vagina.

As a result, organs may press against the vaginal wall and produce a hernia-like bulge, causing discomfort and limiting physical and sexual activity.

The major risk factor for pelvic organ prolapse is having delivered a baby vaginally. Other risk factors include:

• Obesity
• Menopause
• Loss of muscle tone with aging
• Hysterectomy
• Genetics
   

Types of Pelvic Organ Prolapse

There are several different types of pelvic organ prolapse, defined by which organs are involved. It’s also possible to have more than one type of prolapse.

Please use this diagram as a reference to compare the position of the organs for the different types of prolapse

Organs that are commonly involved in pelvic organ prolapse include the:

Bladder

(Cystocele): The most common type of pelvic organ prolapse is cystocele (pronounced sis-tuh-seel) and is often called “dropped bladder.” As the front wall (or roof) of the vagina stretches or loses its attachment to the pelvis, it drops into the vaginal opening. The bladder, which rests on this area of the vagina, similarly “drops” out of position.

Uterus

(Uterine Prolapse): Prolapse of the uterus (and cervix) into the vagina is called uterine prolapse.

Other organs that may also be involved in pelvic organ prolapse include the:

• Intestine/small bowel (Enterocele): Prolapse of the small bowel pushes the vagina towards the opening. This is called an enterocele (pronounced en-tro-seel).
• Vagina (Vaginal Vault Prolapse): For women who have had a hysterectomy and no longer have a uterus, the top of the vagina pushes into the lower vagina. This is called vaginal vault prolapse.

Maybe you’ve been too embarrassed or confused by how you feel to seek medical help. You may even have wondered if your symptoms would just go away.

But pelvic organ prolapse is a real, common and treatable problem. Consider this:

• About 4 out of 10 women over age 50 in the US have some form of prolapse¹
• One in 10 women undergo surgery for pelvic organ prolapse by age 80.²

You don’t have to accept the limits that pelvic organ prolapse can put on your lifestyle. Click here for questions to ask your doctor about pelvic organ prolapse.

Treatments for Pelvic Organ Prolapse

Pelvic organ prolapse (POP) can be treated with a variety of methods, including nonsurgical and surgical procedures, depending on the severity of the prolapse and the associated symptoms.

Nonsurgical Treatment

• Behavioral/Muscle Therapy: If symptoms are mild, therapy often starts with Kegel exercises to help strengthen the pelvic floor muscles.
• Pessary: This device can be inserted into the vagina to support the pelvic area and help relieve mild symptoms of pelvic organ prolapse, including incontinence. Your doctor may recommend using vaginal estrogen along with the pessary. In some instances, a pessary may make urinary incontinence worse; if this happens, see your doctor to discuss other treatment options.
• Biofeedback: In this method, the patient exercises the pelvic floor muscles while connected to an electrical sensing device. The device provides “feedback” to help you learn how to better control these muscles. Over time, biofeedback can help you use your pelvic muscles to decrease sudden urges to urinate and lessen certain types of pelvic pain.

Surgical Options

For women whose symptoms don’t respond to nonsurgical methods, your doctor may recommend pelvic reconstructive surgery. Your doctor may choose to perform one of several types of procedures. It is important for you to be familiar with each type of repair and to understand your choices.

·         Graft Augmented Repair: During this procedure, the surgeon repositions the prolapsed organs and secures them to surrounding tissues and ligaments using a soft synthetic mesh or biologic tissue graft. This surgery may be performed in one of three ways:

o   Through tiny incisions in the vagina. Click here to learn more about this procedure

o   Through an incision below the bikini line

o   Through several small incisions in the abdomen together with a small camera called a laparoscope (pronounced lap’-a-rō-skōp) inserted through the belly button. This type of surgery is called laparoscopy (pronounced lap-a-rah’- skōp-pee).

·         Native Tissue Repair: This procedure, also referred to as Posterior and Anterior Colporrhaphy (pronounced kol-por’e-fee) is performed through incisions in the vagina. It involves folding and then suturing, or stitching, the back (posterior) or front (anterior) wall of the vagina to support prolapsed organs.

·         Hysterectomy: A hysterectomy may be done in combination with other pelvic floor repair procedures, depending on the type of pelvic organ prolapse. Click here to explore your hysterectomy options.

All surgeries present risks. For more information about treatment options, please consult your doctor

If you’ve been told that pelvic organ prolapse is an inevitable part of getting older, you should know that you don’t have to cope with it – treatment may help. Click here to find a doctor to discuss treatment options that may be right for you.

References:

1. Hendrix S, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002: 1160-1166.
2. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501-506.

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Keywords: pelvic prolapse symptoms and treatments, causes of pelvic prolapse, how to treat pelvic prolapse, pelvic prolapse symptoms, symptoms of pelvic prolapse.

 

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