What Is Pelvic Organ Prolapse in Women & How to Treat It

Do you ever feel a bulge or pressure in your vagina? Or maybe you have trouble emptying your bladder completely? These could be signs of pelvic organ prolapse, a common condition that occurs when the muscles and tissues supporting the pelvic organs weaken.

Whether you're experiencing symptoms or want to learn more, this blog will provide valuable insights into pelvic organ prolapse and empower you to take control of your pelvic health.

Pelvic organ prolapse (POP) is a common, benign condition that occurs when the pelvic floor muscles and tissue weaken, causing a descent of one or more parts of the vagina and uterus. There can be descent of the apical compartment, the anterior vaginal compartment, or the posterior vaginal compartment.

The anterior vaginal wall supports your bladder, so the vaginal anatomy change that occurs during POP impacts the bladder, sometimes leading to urinary symptoms (urinary incontinence).

Based on the severity / stage of prolapse, your symptoms can range from urinary urgency and frequency to inability to urinate.

There are a few different types of prolapse. There is anterior wall prolapse, posterior wall prolapse, and apical prolapse. Apical prolapse can be prolapse of the cervix / uterus or of the vaginal cuff if the patient has had a hysterectomy. 

Another thing to consider about prolapse is that, in general, it's due to overall weakness / dysfunction of the pelvic floor.

One of the first things to consider is whether prolapse is symptomatic. There is a very big difference between the people who have prolapse on exam (up to 50% of people), and the percentage that are symptomatic (<5%). 

When we think about risk factors, think more about risk factors for symptomatic prolapse, which are:

• Deliveries
• Vaginal deliveries.
• Age (increases with age).
• Obesity
• Connective tissue disorders.
• Menopause
• Chronic constipation.
• Downward pressure on the pelvic floor.

In general, having a child does increase the risk of POP, and vaginal delivery increases the risk as well. This is due to the weakening and stressing of the pelvic floor musculature. This can be by stretch, tearing, or a combination of the two.

There is also increased abdominal pressure during pregnancy, which puts pressure on the pelvic floor. Operative deliveries, like using forceps, also increase the risk of pelvic floor disorders, including prolapse. 

Common symptoms for many people with POP include:

• Vaginal bulge / pressure.
• Urinary symptoms, like urgency, frequency, and difficulty emptying (urinary incontinence).
• Defecatory dysfunction.
• Sexual dysfunction.

Your stage of prolapse can impact your overall symptoms. Some people may have to splint, which means pushing into the vagina or on the perineum to assist with voiding or having a bowel movement. If you have more advanced or severe prolapse, it may impact how your bladder functions.

Sometimes, as prolapse progresses, urinary symptoms actually improve because instead of frequency, the tube that empties the bladder (urethra) is kinked off, so those symptoms get better. 

The initial evaluation for POP typically includes a thorough history, assessment of symptoms,  and physical exam by your healthcare provider. It's also essential to assess the goals of your treatment.

The most important part of the evaluation is figuring out which symptoms you're having. Part of the evaluation also typically involves assessing how you're emptying your bladder. 

It is essential to assess the severity of your symptoms and how they are impacting your activities. The next step is to consider how you want to address your POP.

Surgery for pelvic organ prolapse is an option, and there are a few types that may improve symptoms.

• Hysteropexy: This means a suspension of the apex without removal of the uterus.
• Hysterectomy: Removal of the uterus.
• Native tissue repair: Your own ligaments or tissue are used to suspend the apex.
• Sacralcolpopexy: A piece of Y mesh used to suspend the anterior and posterior walls of the vagina (with or without the cervix).

If you don't want surgery, you can try using a pessary or pelvic floor physical therapy.

• Vaginal pessary: A removable device that supports the pelvic organs. More than 90% of people with prolapse can be fit with a pessary. Ring pessaries and Gellhorn pessaries are the two most common pessaries used. Ring pessaries are used in earlier prolapse, and Gellhorn pessaries are used in more advanced stages.
• Pelvic floor physical therapy: This is a highly specialized and trained medical therapy that focuses on improving pelvic floor muscle function. Data shows that pelvic floor physical therapy can reduce the stage of prolapse. 

All surgeries have risks, and they should be discussed with your surgeon. In general, risk factors include:

• Bleeding
• Infection
• Damage to surrounding structures (bladder, bowel, blood vessels, nerves, ureters).
• Pelvic pain.
• Recurrent prolapse.
• Voiding dysfunction.
• Mesh erosion.
• Anesthesia complications.

Certain lifestyle changes can help manage POP symptoms and their progression so you can maintain your quality of life.

1. Incontinence products: Bladder control supplies, such as adult pull-ons, bladder control pads, and adult briefs, absorb leakage to keep you dry throughout the day or night.
2. Kegel exercises: Pelvic floor exercises, such as Kegels, reduce symptoms of POP and strengthen your pelvic floor. You can do these exercises at home or with a pelvic floor physical therapist. A pelvic floor therapist will be able to teach you more advanced exercises.
3. Dietary modifications: Avoid bladder irritants, such as spicy foods, citrus, carbonated drinks, alcohol, and caffeine. These are known to irritate the bladder, which can worsen the symptoms of POP. Dietary modifications can also help you avoid chronic constipation.
4. Pelvic floor muscle strain: Avoid straining your pelvic floor muscles, which can occur during heavy lifting and certain types of exercise.
5. Weight management: Maintain a healthy weight to reduce the amount of pressure placed on your pelvic floor.

POP can be a challenging condition to navigate, but understanding the causes, symptoms, and treatment options is the first step towards improving your quality of life. Remember, you're not alone. Many women experience POP at some point in their lives.

Whether you choose non-surgical management or opt for a surgical procedure, there are ways to find relief and regain control of your pelvic health. Don't hesitate to talk to your provider about any concerns you have. With the right support and treatment plan, you can live a full and active life despite POP.

Disclaimer

Information provided on the Aeroflow Urology blog is not intended as a substitute for medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.