Pelvic Organ Prolapse

Pelvic Organ Prolapse Q & A

Q1. What is pelvic organ prolapse?

The meaning of prolapse is drooping or descending of organs. Pelvic organ prolapse is a condition in which there is drooping or prolapse of any of the organs located in the pelvic floor from their normal anatomical position. These organs include bladder, uterus, small bowel, rectum and vagina. During prolapse, these organs descend or droop into or out of the anus or vaginal canal. The female prolapse of different organs is referred to in the following ways:

• Cystocele: It is the prolapse of the urinary bladder into your vagina. Cystocele, also called anterior prolapse occurs due to the weakening and stretching of the supportive tissue present between your vaginal wall and bladder. This allows the urinary bladder to protrude into your vagina. Cystocele is also referred to as a prolapsed bladder.
• Urethrocele: Urethral prolapse is called urethrocele. It happens when the urethra protrudes into your vaginal canal. During urethral prolapse, the urethra may also come out of your urethral opening. The urethra is a small tube, which transports urine present in the urinary bladder to the outside of your body. Urethral prolapse occurs when the tissues, muscles, and ligaments supporting the urethra weaken. In many women, cystocele can also occur with urethrocele. The condition is then known as cystourethrocele.
• Uterine prolapse: A uterine prolapse occurs when your uterus drops into your vagina. It happens due to the weakening of the ligaments and muscles of the pelvic floor. In certain cases, the uterus may come out from the opening of the vagina. Risk factors for developing a prolapsed uterus are obesity, pregnancy, childbirth, and entering menopause.
• Vaginal vault prolapse: It is the prolapse of your vagina. In this condition, the normal shape of the upper part of the vagina is lost and it drops down into your vaginal canal or even outside the vagina. Vaginal vault prolapse may occur along with a prolapsed uterus or after you have undergone a hysterectomy. It occurs due to the weakness of the vaginal and pelvic tissues and may occur in association with cystocele, urethrocele, Rectocele, and Enterocele.
• Enterocele: It is the prolapse of the small bowel. Enterocele happens when the small bowel moves downwards into the lower part of the pelvic cavity, pushing the top of the vagina and creates a bulge. It is caused by weakening of the ligaments and muscles of the pelvic floor by processes, which put pressure on them.
• Rectocele: It is the prolapse of the rectum. Also known as posterior prolapse, Rectocele happens when there is a weakening of the wall that separates the vagina from the rectum. A posterior prolapse produces bulging of the vaginal wall; if large, the bulge may protrude outside the opening of the vagina.

In females, the prolapse generally happens when there is a collapse of the pelvic floor after treatment of the gynecological cancers, heavy lifting or childbirth.

Q2. What are the causes of pelvic organ prolapse?

Anything, which increases the abdominal pressure, can result in pelvic organ prolapse. Some of the common causes of female prolapse are:

• Pregnancy, labor, and delivery of the baby
• Obesity
• Constipation
• Respiratory problems that are associated with long-term, chronic cough
• Cancers of the pelvic organs
• Hysterectomy (removing the uterus surgically)
• Repeated heavy lifting

Genetics also has a role to play in the occurrence of pelvic organ prolapse. Some women may have weaker connective tissues, which increase their risk of developing female prolapse.

Q3. What are pelvic organ prolapse symptoms?

In some females, no prolapse symptoms may be present, but in others the following organ prolapse symptoms are present:

• A feeling of fullness or pressure in the area of the pelvis
• Backache in the lower area of the back
• Constipation
• Pain while having sex
• A feeling of something falling outside the vagina
• Vaginal bleeding or spotting
• Urinary problems including chronic urgency for urination or leakage of urine (incontinence)
• A sensation of fullness or pressure in the rectum
• Difficulty in passing stool

Prolapse symptoms also depend on the organ that is prolapsed. The symptoms of dropped bladder are leakage of urine (urinary incontinence). The symptoms of rectum prolapse are uncomfortable intercourse and constipation. The small intestine and uterine prolapse symptoms are uncomfortable intercourse and backache.

Q4. How does your doctor diagnose pelvic organ prolapse?

Your doctor can find out about a pelvic organ prolapse while doing a routine pelvic examination. This exam can be done during your routine check-up or when you are getting your Pap test. They can recommend a variety of other tests including:

• X-ray of the urinary tract (intravenous pyelography)
• Ultrasound (US) of the pelvis
• CT scan of the pelvic cavity
• MRI scan of the pelvic cavity

Q5. What is the treatment of pelvic organ prolapse?

Pelvic organ prolapse treatment depends on the severity of your prolapse symptoms. Prolapse treatment may include various therapies that include:

• Behavioral treatments like doing Kegel exercises help in strengthening the muscles of your pelvic floor.
• Mechanical treatments like inserting a pessary for bladder prolapse into your vagina helps in supporting your drooping organs.
• Surgical treatment, which includes repairing the affected organ or tissue (for instance; cystocele repair, Rectocele repair or Enterocele repair) or removing the organ (for instance; hysterectomy for uterine prolapse).

Q6. Can you prevent pelvic organ prolapse?

Many of the risk factors and causes of pelvic organ prolapse are not under your control. Some of these are:

• A family history of pelvic organ prolapse
• Increasing age
• Genetic predisposition to develop female prolapse
• Having a complicated vaginal delivery
• History of hysterectomy

But you may decrease your risk of developing pelvic organ prolapse by following the below-mentioned steps:

• Perform Kegel exercises on a daily basis to maintain the strength of the muscles of the pelvic floor.
• Maintain an optimum and healthy weight recommended for your age and height.
• Take steps to avoid constipation. Some of these include drinking lots of water, increasing the fiber intake in your diet by including plenty of fresh vegetables and fruits and whole grains and doing a regular aerobic activity such as brisk walking.
• If you are a smoker, then quit smoking as smoking may affect tissues. Furthermore, the chronic cough that is often present in smokers makes them prone to develop pelvic organ prolapse.