Prolapse

What is a pelvic organ prolapse?

A pelvic organ prolapse (POP) describes what happens when pelvic organs such as the bladder, uterus or rectum slip from their normal position and either press against the vaginal walls or protrude into or from the vagina. Pelvic organs are usually supported and kept in the proper position by the muscles and ligaments of the pelvic floor. When these muscles and ligaments are weakened or damaged, the organs can be pushed down towards the vaginal opening.

What are the symptoms of POP?

The symptoms of prolapse can vary according to the severity of the prolapse and which organs have changed position. Each woman may have differing symptoms. The most common symptoms of pelvic organ prolapse are:

  • A lump or bulge in the vagina or vaginal entrance
  • A dragging sensation or feeling that something is pushing or falling
  • A dull back ache or discomfort in the pelvic region
  • Constipation – rectal prolapses
  • Stress incontinence
  • Increased frequency of urination
  • Urinary tract infections
  • Pain during sex
  • Limited depth of vaginal penetration

Symptoms of a prolapse may vary over time and even over the course of a day. They tend to be more noticeable at the end of a working day, or after long periods of standing, while being ameliorated when lying down. Exercise, physical exertion, and repetitive sneezing or coughing can cause symptoms to become more pronounced.

What are the different types of prolapse?

Not all prolapses are the same, and are classified according to severity or degree of the prolapse, which can vary from mild to severe. More detailed and intricate classifications are used for clinical and scientific reasons. Prolapses may also differ depending on where the pelvic floor is weakened or damaged, and which organs have been affected. Possible prolapses include:

  • Uterine prolapse – descent of the uterus and cervix into the vaginal canal due to weak or damaged pelvic support
  • Cystocele – descent of the bladder can be noted by a bulge over the anterior vaginal wall
  • Rectocele – descent of the rectum, which is noted by a bulge over the posterior vaginal wall
  • Enterocoele – similar to a rectocele but involves a higher part of the vagina and the small bowel pushing down
  • Vaginal vault prolapse – descent of the vagina into the vaginal canal, can occur in women who have had a hysterectomy

What causes prolapse?

Pelvic organ prolapse tends to happen when there is damage or weakness of the structures that support the pelvic organs. Things that can contribute to the problem are:

  • Pregnancy and childbirth
  • Menopause and ageing
  • Increased abdominal pressure
  • Genetic factors

Pregnancy and childbirth

Having a baby is one of the most significant causes of prolapse. Pregnancy can contribute to the weakening of the pelvic floor due to hormonal changes and the extra weight and pressure of the baby. The risk increases with the number of pregnancies, vaginal births, prolonged second stage labour, the delivery of large babies, and forceps delivery. The damage that occurs during the pregnancy and childbirth tends to go unnoticed at the time, as symptoms develop later in life.

Menopause and ageing

Oestrogen plays an important role in maintaining the strength of the pelvic floor. When the ovarian production of oestrogen decreases after menopause, the pelvic floor tissue can become weaker. This can aggravate existing damage or trigger prolapse symptoms that were unnoticed.

Increased Abdominal Pressure

An increase to the pressure inside the abdomen puts a strain on the pelvic floor and perineal muscles. If the pressure is significant and sustained over a long period of time it can exacerbate the prolapse. Some condition that can cause increased abdominal pressure include obesity, chronic coughing associated with bronchitis or smoking, occupations that require heavy lifting, or intense physical work.

Genetic factors

Some women can be born with deficiencies in some of the proteins that make up the connective tissues. This can present as weak bone joints and less resistant ligaments that are predisposed to prolapse, which can be caused by events that do not usually cause a prolapse.

How is a genital prolapse diagnosed?

The diagnosis can be done for most women by physical examination, in addition to a general and abdominal inspection by a gynaecologist. The doctor will ask you to lie down for the examination, but may also ask you to stand up and cough or strain. It may not always be obvious which organ has prolapsed and an ultrasound or MRI may be used for a better diagnosis.

How are genital prolapses treated?

A genital prolapse is not a life-threatening disease, but it may cause considerable discomfort and distress. The treatment will depend on the severity and type of prolapse, severity of the symptoms, and if the patient and doctor have any preference. Treatment options include:

  • Lifestyle changes – diet, weight loss, pelvic floor exercises
  • The use of an intra-vaginal ring to mechanically reduce the prolapse and alleviate symptoms, which is recommended to be used while waiting for surgery
  • Surgery – there are several different types of surgery that can help reduce a prolapse depending on the type of prolapse and the patient’s condition

If you suspect you may have weakened pelvic organs, can touch your cervix easily, have discomfort in your pelvis, or any other symptoms that seem unusual, please see your doctor – the earlier you are diagnosed, the better your outcomes.