What is Pelvic Organ Prolapse?

Approximately 50% of women will experience some form of prolapse in their lifetime, and with the prevalence increasing with age, it's crucial to shed light on this often misunderstood condition. Women aren’t the only ones affected, although men aren’t impacted by vaginal or uterine prolapse they do make up 10% of rectal prolapse cases. 

In this blog, we'll explore the various types of prolapse, common causes, recognizable symptoms, preventative measures, effective treatment options, and lifestyle modifications to empower individuals with the knowledge and resources needed to navigate prolapse with confidence and dignity.

What is Prolapse?

Prolapse, a condition characterized by the descent or displacement of pelvic organs such as the uterus, bladder, or rectum, often leads to discomfort and functional impairment. It is important to understand the nuances of prolapse in order to recognize symptoms, seek appropriate treatment, and enhance quality of life for individuals affected by this common yet often overlooked condition.

Types of Prolapse

In this segment, we'll explore the diverse spectrum of prolapse types, including pelvic organ prolapse, rectal prolapse, and cystocele, shedding light on the distinct anatomical variations and underlying causes of each.

• Bladder Prolapse (also known as cystocele or anterior vaginal wall prolapse): a condition where the bladder descends into the vagina, often due to weakened pelvic floor muscles and ligaments.
• Uterine Prolapse: a condition which occurs when the uterus descends or slips into the vaginal canal, often due to weakened pelvic floor muscles and ligaments.
• Vaginal Prolapse (also known as vaginal vault prolapse or vaginal wall prolapse): the descent or protrusion of the vaginal walls into or outside the vaginal opening
• Rectal Prolapse: a condition in which the rectum protrudes through the anus, either partially or completely, due to weakening of the muscles and tissues supporting the rectum and pelvic floor.
• Urethral Prolapse: a rare condition where the mucous membrane of the urethra protrudes from the opening of the urethra. 

What Causes Prolapse?

Prolapse occurs when the tissues and muscles that support pelvic organs weaken or become damaged, leading to their descent or displacement. Causes include: 

• Pregnancy & Childbirth
• Aging
• Obesity
• Chronic Constipation
• Connective Tissue Disorders
• Chronic Cough
• Pelvic Surgery
• Heavy Lifting
• Genetic Factors

Recognizing Symptoms of Prolapse

The signs and symptoms of prolapse differ depending on the type, by some signs include:

• Sensation of pelvic pressure or heaviness.
• Bulging or protrusion from the vaginal or rectal opening.
• Discomfort or pain in the pelvic region, especially during activities such as standing or lifting.
• Difficulty emptying the bladder completely (incomplete voiding).
• Urinary leakage or urinary incontinence.
• Difficulty controlling bowel movements (fecal incontinence) or experiencing constipation.
• Pain or discomfort during sexual intercourse (dyspareunia).
• Backache or lower back pain.
• Recurrent urinary tract infections (UTIs) or urinary retention.
• Feeling of a "lump" or "something falling out" from the vagina or rectum.

It's important to note that the severity and combination of symptoms can vary among individuals and depend on the type and extent of prolapse. Consulting with a healthcare provider for proper evaluation and diagnosis is essential for effective management and treatment.

Treatment Options for Prolapse

In this section, we'll explore a range of treatment options available for prolapse, from conservative measures such as pelvic floor exercises to surgical interventions, providing comprehensive guidance for individuals seeking relief from prolapse symptoms.

Conservative Treatment Options

Conservative treatment options for prolapse focus on strengthening the pelvic floor muscles and providing support to the pelvic organs. Pelvic floor exercises, such as Kegels, are often recommended to improve muscle tone and alleviate symptoms. Additionally, lifestyle modifications, such as maintaining a healthy weight, avoiding heavy lifting, and managing constipation, can help reduce the risk of prolapse progression and improve overall pelvic floor health. In some cases, pessaries, which are devices inserted into the vagina to provide support, may be used as a non-surgical option to alleviate prolapse symptoms.

Surgical Treatment Options

Other more involved options for prolapse may be considered when conservative measures are ineffective or if the prolapse is severe. Surgical interventions, such as pelvic organ prolapse repair, aim to restore the normal anatomical position of the pelvic organs and strengthen the supportive structures of the pelvic floor. 

Additionally, minimally invasive procedures, such as laparoscopic or robotic-assisted surgeries, offer alternatives to traditional open surgery with shorter recovery times and reduced risks. Non-surgical medical treatments, such as estrogen therapy or injectable bulking agents, may also be used to alleviate symptoms and improve pelvic floor function in select cases.

Prevention Strategies for Prolapse

Prevention strategies for prolapse focus on maintaining pelvic floor health and minimizing factors that contribute to weakening of the pelvic floor muscles and supporting structures. Engaging in regular pelvic floor exercises, such as Kegels, can help strengthen the muscles that support the pelvic organs and reduce the risk of prolapse. 

Additionally, maintaining a healthy weight through balanced nutrition and regular exercise can alleviate excess pressure on the pelvic floor. Avoiding heavy lifting, practicing proper lifting techniques, and managing chronic constipation are also important measures to prevent strain on the pelvic floor. 

Lastly, seeking prompt medical attention for conditions that increase intra-abdominal pressure, such as chronic coughing or constipation, can help prevent further damage to the pelvic floor and reduce the risk of prolapse.

Seeking Professional Help: When to Consult a Healthcare Provider

Seeking professional help is crucial for individuals experiencing symptoms of prolapse, as early intervention can lead to more effective management and treatment. It's important to consult a healthcare provider if you notice symptoms such as pelvic pressure, bulging sensation, urinary or bowel difficulties, or discomfort during intercourse. Additionally, individuals with a history of childbirth, pelvic surgery, or chronic conditions that increase intra-abdominal pressure should consider regular check-ups with a healthcare provider to monitor pelvic floor health and address any concerns promptly. By seeking timely medical guidance, individuals can receive personalized care and treatment options tailored to their needs, ultimately improving their quality of life and pelvic floor function.

Sources:

Carroll, L., O' Sullivan, C., Doody, C., Perrotta, C., & Fullen, B. (2022). Pelvic organ prolapse: The lived experience. PloS one, 17(11), e0276788. https://doi.org/10.1371/journal.pone.0276788