Pelvic organ prolapse (POP) refers to the prolapse or descent of pelvic organs such as the bowel, bladder, rectum, or uterus from their normal positions. This condition arises when the muscles, ligaments, and tissues that support these organs become too weak to hold them in place.
Being overweight, a history of hysterectomy, undergoing menopause, multiple vaginal childbirths (especially with twins or triplets), chronic abdominal pressure from conditions like chronic coughing or constipation, heavy weight lifting, family history of POP, and collagen irregularities such as Ehlers-Danlos syndrome are all risk factors for pelvic organ prolapse
The type of prolapse depends on which pelvic floor muscles are weak and which organs are affected:
Anterior Vaginal Wall Prolapse (Cystocele): This occurs when weak pelvic floor muscles cause the bladder to slip out of its place and bulge into the vagina. It is the most common type of POP.
Uterine Prolapse: This happens when the pelvic floor muscles weaken, causing the uterus to descend into the vaginal canal.
Posterior Vaginal Wall Prolapse (Rectocele): This is due to weak muscles between the vagina and rectum, leading to the rectum bulging into the back wall of the vagina.
Vaginal Vault Prolapse: Typically occurring post-hysterectomy, this involves the top part of the vagina dropping into the vaginal canal.
Enterocele: This type of prolapse is caused by the small intestine bulging into the top of the vagina due to weakened pelvic muscles.
Uterine prolapse is particularly common after childbirth. The symptoms are:
Feeling of heaviness in the pelvis
Tissue bulging out of the vagina
Uncontrolled urinary leakage (incontinence)
Discomfort in the pelvis or lower back
Sexual concerns, such as a sensation of looseness in the vaginal tissue
Persistent urge to urinate even when the bladder is empty
Diagnosing POP involves a thorough medical history and examination of the pelvic organs to determine the type and extent of the prolapse. Specific tests include:
Pelvic Examination: This involves testing the strength of the pelvic floor and sphincter muscles during a pelvic examination. For urinary incontinence, the patient may need to be examined with a full bladder and asked to cough or strain, with urine leakage indicating a positive stress provocation test.
Pelvic Floor Strength Test
Bladder Function Test: This measures how well the bladder empties and whether it leaks when held in place during the examination.
Prolapse is graded based on the extent of descent:
First Degree: The lowest part of the prolapse is above the introitus (vaginal opening).
Second Degree: The lowest part extends to the level of the introitus on straining.
Third Degree: The lowest part extends through the introitus and lies outside the vagina.
Bathla emphasized that treatment includes both conservative and surgical options:
Pelvic Floor Exercises: To strengthen and retrain the pelvic floor muscles.
Dietary Adjustments: Drinking plenty of fluids and consuming high-fiber foods to prevent constipation.
Weight Management: Maintaining a healthy weight through diet and lifestyle.
Avoid Heavy Lifting: Proper posture and movement techniques to avoid strain on the pelvic floor.
Quit Smoking: To prevent chronic coughing.
Posture Movement: Advice on correct posture and movement to prevent strain.
Bowel Movement Retraining: Techniques for passing motions without straining.
Low-Impact Exercises: Activities like Pilates, yoga, swimming, walking, and cycling.
Vaginal Pessary: A device to support the pelvic organs.
Abdominal Massage: To improve bowel movement.
Holding On Technique: For those with fecal urgency.
Mesh Repair: Used in severe cases to enhance support to the pelvic floor.
Pelvic Floor Repair: Strengthening with sutures if the urethra, bladder, rectum, or intestines protrude through the vaginal wall.
Vaginal Hysterectomy: Removal of the uterus if it protrudes through the vaginal opening.
Sacrospinous Ligament Fixation: Reduces the chance of prolapse recurrence in severe cases.
POP can significantly affect a woman's quality of life, leading to:
Anxiety and depression
Isolation in relationships
Disturbed sleep patterns
Increased stress and low self-esteem
Fear of social embarrassment due to incontinence
Restriction of activities and travel due to anxiety over toilet accessibility
Understanding and addressing pelvic organ prolapse through a combination of lifestyle changes, conservative treatments, and surgical options can significantly improve the quality of life for those affected by this condition.
(Input From Various Sources)
(Rehash/Dr. Pragati Priya/MSM)