Pelvic organ prolapse is a condition in which the organ of pelvis drops down from its normal anatomical location into the vaginal opening. It is one of the most discomforting conditions affecting woman. Normally the organs of pelvis namely bladder, uterus, rectum, and vagina are held in their respective place by muscles and tissues of pelvis. These groups of muscles and ligaments make up the pelvic floor.
When this group of muscles becomes weak either during childbirth or surgery or with age the organ located in pelvis can droop downwards and bulge out through the vaginal opening.
Treatment consists of training of pelvic floor muscles, mechanical support with use of pessary or in worst cases reconstructive surgery is the final option.
Types Of Pelvic Organ Prolapse
The type of prolapse is according to the organ involved. Prolapse refers to drooping of an organ. Pelvic organ prolapse is drooping of any organ located in the lower belly. This may include urinary bladder, rectum, uterus, vagina, small bowel.
- Cystocele: Protrusion of urinary bladder into the vagina.
- Rectocele: Prolapse of rectum through the anus or in the back side of vaginal wall.
- Uterine prolapse: Drooping of uterus through the vagina.
- Enterocele: It is prolapsed of small intestine.
What Can Cause Pelvic Organ Prolapse?
Pelvic organ prolapse occurs due to weak pelvic floor muscles. It is often linked with childbirth. Straining and stretching of muscles and connective tissue of pelvic region occur during childbirth. If the muscles do not recover after a period of time, they are unable to support the organs in pelvis as they used to do. This gradually results in prolapse of organ.
Sometimes the pudendal nerve may be injured during childbirth. Often removal of uterus also leads to prolapsed of bladder. Older women are at greater risk of pelvic organ prolapse as with time the muscles may become weak. Anything that increases pressure in the abdomen can worsen prolapse. For example, continuous coughing, being obese, constipation etc.
Symptoms Of Pelvic Organ Prolapse
The symptoms of pelvic organ prolapse are wide and varied. Some woman may not experience any symptoms at all, while in some the condition is extremely uncomfortable. Experiencing a bulge in the vaginal opening is one of the specific symptoms of prolapse. Other symptoms are as follows:
- Discomfort and bulge in vagina increases with extensive standing, coughing, lifting heavy object.
- Patient may have vaginal discharge if there is complete uterine prolapse.
- Constant feeling of fullness in lower abdomen.
- Patient may feel something will fall down from vagina.
- Low backache.
- Urinary problem such as frequent urge to pass urine. Involuntary urination especially while coughing, lifting or defecating.
- Sometimes patient may have to apply pressure in perineum region while defecating, especially if there is constipation.
- Vaginal bleeding or spotting.
- Pain during intercourse.
The symptoms depend on which organ in prolapsed. If bladder is prolapsed, patient may experience urinary problems. In case of rectal prolapsed, patient may develop constipation and painful intercourse. Backache, urinary leakage, difficulty in walking, vaginal discharge result from prolapsed of uterus.
Diagnosis And Treatment Of Pelvic Organ Prolapse
Routine pelvic examination and medical history will help the doctor to diagnose pelvic organ prolapse. Other tests include sonography of pelvis, X-ray of urinary tract (intravenous pyelography), CT scan of pelvis. Urodynamic studies may be useful for those suffering from urinary problem. Patients having problem in defecation may need a test called anal manometry or endoanal untrasonography.
There are multi factorial treatment plan for pelvic organ prolapse. At first the doctor recommends pelvic floor exercise which is also called Kegel Exercise. It involves systemic training of contracting muscles of pelvis either consciously or with electrical stimulation or through biofeedback training. This exercise helps to improve urinary problems caused by prolapse such as stress incontinence.
Treatment may also include use of pessary. It is a device made up of silicon. There are various shapes and sizes of pessaries. The pessary is inserted into the vagina to support the prolapsed organ. Pessary is often used when patient opts for non surgical treatment. Pessary is removable for cleaning.
Lastly reconstructive surgery is the only option in women who are not comfortable with pessary or there is severe form of prolapse. In case of uterus prolapse, hysterectomy (removal of uterus) is the surgical choice.