Pelvic Organ Prolapse
Pelvic organ prolapse (POP) is a common but rarely discussed gynecologic condition in which the organs in the pelvic region shift out of their normal position, or "prolapse".
Pelvic organ prolapse occurs in about 4 out of 10 women. About 1 in 10 women undergo surgery for pelvic organ prolapse by the time they are 80 years old.
Some women are too embarrassed or confused by how you feel to seek medical help. However, it is important that they raise the issue with their doctor to discuss treatment options.
Pelvic organ prolapse can be treated with a variety of methods, including nonsurgical and surgical procedures, depending on the severity of the prolapse and the associated symptoms.
Symptoms of Pelvic Organ Prolapse
Pelvic organ prolapse can be uncomfortable both physically and emotionally. Women with pelvic organ prolapse tend to limit their daily activities and avoid sex because of pelvic pain and the need to urinate frequently. Other symptoms include the following:
- Loss of bladder or possibly bowel control
- Difficulty completely emptying your bladder
- Increased need to urinate
- Feelings of pelvic or vaginal heaviness, bulging, fullness and/or pain, or a feeling that something is "dropping"
- Recurrent bladder infections
- Excessive vaginal discharge
- Pain or lack of sensation during sex
Cause of Pelvic Organ Prolapse
The organs in the pelvic area (uterus, vagina, bladder and rectum) are held in place by a web of muscles and connective tissues that act like a hammock. When this web becomes weakened or damaged, one or more pelvic organs shift out of normal position and literally "fall," or prolapse, into the vagina.
As a result, organs may press against the vaginal wall and produce a hernia-like bulge, causing discomfort and limiting physical and sexual activity.
The major risk factor for pelvic organ prolapse is having delivered a baby vaginally. Other risk factors for developing pelvic organ prolapse include:
- Loss of muscle tone with aging
- Family history of pelvic organ prolapse
Types of Pelvic Organ Prolapse
There are several different types of pelvic organ prolapse, defined by the organs that are involved. It’s also possible to have more than one type of prolapse.
- Bladder. The most common type of pelvic organ prolapse is a "cystocele". This is often called dropped bladder. As the front wall (or roof) of the vagina stretches or loses its attachment to the pelvis, it drops into the vaginal opening. The bladder, which rests on this area of the vagina, similarly “drops” out of position.
- Rectum. As the back wall (or floor) of the vagina loses its support, the rectum can protrude into the vaginal opening, creating a “pocket” called a "rectocele".
- Uterus: Prolapse of the uterus (and cervix) into the vagina is called uterine prolapse.
- Intestine/small bowel. Prolapse of the small bowel pushes the vagina towards the opening. This is called an "enterocele".
- Vagina. For women who have had a hysterectomy and no longer have a uterus, the top of the vagina pushes into the lower vagina. This is called vaginal vault prolapse.
Nonsurgical Treatment Options
- Behavioral/Muscle Therapy: If symptoms are mild, therapy often starts with Kegel exercises to help strengthen the pelvic floor muscles.
- Pessary: This device can be inserted into the vagina to support the pelvic area and help relieve mild symptoms of pelvic organ prolapse, including incontinence. Your doctor may recommend using vaginal estrogen along with the pessary. In some instances, a pessary may make urinary incontinence worse; if this happens, see your doctor to discuss other treatment options.
- Biofeedback: In this method, the patient exercises the pelvic floor muscles while connected to an electrical sensing device. The device provides “feedback” to help you learn how to better control these muscles. Over time, biofeedback can help you use your pelvic muscles to decrease sudden urges to urinate and lessen certain types of pelvic pain.
Surgical Treatment Options
For women whose symptoms don't respond to nonsurgical methods, your doctor may recommend pelvic reconstructive surgery. Your doctor may choose to perform one of several types of procedures. It is important for you to be familiar with each type of repair and to understand your choices.
Graft Augmented Repair: During this procedure, the surgeon repositions the prolapsed organs and secures them to surrounding tissues and ligaments using a soft mesh or biologic tissue graft. This surgery may be performed in one of three ways:
- Through small incisions in the vagina.
- Through an incision below the bikini line
- Through several small incisions in the abdomen together with a small camera called a laparoscope inserted through the belly button. This type of surgery is called laparoscopy.
Native Tissue Repair: This procedure, also referred to as Posterior and Anterior Colporrhaphy is performed through incisions in the vagina. It involves folding and then suturing, or stitching, the back (posterior) or front (anterior) wall of the vagina to support prolapsed organs.
Hysterectomy: A hysterectomy may be done in combination with other pelvic floor repair procedures, depending on the type of pelvic organ prolapse.
All surgeries present risks. For more information about treatment options, please consult your doctor.