Pelvic Organ Prolapse: Causes, Symptoms, Risk Factors, Diagnosis and Treatment

Pelvic organ prolapse is the term used to describe the displacement of one or more pelvic organs. This results in a prolapse, or vaginal protrusion.

Normally, the muscles and connective tissues of the pelvic floor hold the pelvic organs in place. The pelvic organs include the uterus, bladder, urethra, and rectum. Pelvic organ prolapse is caused by the weakening of the muscles and tissues of the pelvic floor. This could be caused by pregnancy, menopause, or childbirth.

Pelvic organ prolapse can be treated. Nonsurgical care is frequently beneficial. Surgery may be required in some circumstances to realign the pelvic organs.

Causes Of Pelvic Organ Prolapse

The cause of pelvic organ prolapse is weakening of the muscles and tissues that support the organs. Natural childbirth is the most common cause.

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Symptoms Of Pelvic Organ Prolapse

 Sometimes there are no symptoms at all associated with pelvic organ prolapse. When signs manifest, they could include:

• Observing or feeling a tissue protrusion at the vaginal opening or above it.
• Pelvic heaviness, pressure, or pain.
• Lower back pain.
• Changes in the urine: Increased urination, an intense urge to urinate, trouble emptying the bladder, or a weak stream of urine could be some of these.
• Changes in the bowel, such as the inability to empty the stool or the requirement to hold the vaginal bulge with fingers to evacuate waste. This is called stenting.
• Sexually related issues, such as pain during sex.
• Pelvic floor weakness frequently affects more than one location. For instance, if you currently have one type of pelvic organ prolapse, your chances of developing another type are increased.

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Risk Factors Of Pelvic Organ Prolapse

Pelvic organ prolapse is associated with the following risk factors:

• Multiple births, vaginal births, babies born with large birth weights, and deliveries aided by tools.
• Getting older
• Having an issue with weight
• Following a pelvic surgery
• Persistently uncomfortable cough, such as that brought on by chronic obstructive lung illness, long-term constipation, or heavy lifting.
• Possess a family history of prolapsed pelvic organs or connective tissue problems.

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Diagnosis Of Pelvic Organ Prolapse

The diagnosis of pelvic organ prolapse begins with a review of medical history and a pelvic organ examination. This could aid the physician in identifying the kind of prolapse you might have.

Tests can be necessary as well. Testing for pelvic organ prolapse may include:

• Examinations of Pelvic Floor Strength: A professional in medicine evaluates the sphincter and pelvic floor muscles during a pelvic exam. The strength of the muscles and ligaments supporting the walls of the bladder, urethra, rectum, uterus, and vagina are evaluated.
• Checking the bladder's functionality: A few tests find out whether the bladder leaks while the pelvic exam is being done while it's being held in place. The degree to which the bladder empties could be assessed by other tests.
• Patients with complex pelvic organ prolapse may benefit from both MRIs and ultrasounds as imaging modalities.

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Treatment Of Pelvic Organ Prolapse

How you are treated will depend on how bothersome your symptoms are. If your pelvic organ prolapse affects you, your doctor may suggest controlling it without surgery or advise against therapy altogether. If your symptoms get worse and begin to negatively impact your quality of life, you could need surgery.

Urinary and gastrointestinal symptoms may not be related to the prolapse, but they can be. If the symptoms are unrelated to the prolapse, treatment may not be able to alleviate them.

Medication

Menopause is very commonly experienced by prolapse sufferers. Menopause causes a decrease in oestrogen. Low oestrogen levels can damage vaginal tissue, which can lead to a dry vagina. To find out if oestrogen therapy is right for you, speak with your doctor. Using vaginal oestrogen could be one such technique.

Physical Assistance

To strengthen your pelvic floor muscles, your doctor may suggest biofeedback-based pelvic floor exercises. Biofeedback is the use of monitoring devices that have sensors implanted in the rectum and vagina or applied to the skin. 

On the exercise plan, a computer screen shows you whether you are using the right muscles. It also shows the force applied to each squeeze or contraction. This helps you acquire the right form for the exercises. Over time, strengthening the pelvic floor muscles may aid in symptom reduction.

Pessaries

Using a pessary is one noninvasive way to maintain prolapsed pelvic organs. These silicone devices come in a variety of forms and sizes. The pelvic organs are placed into the vagina to maintain their position.

Some people who wear pessaries may learn to take them off at night, clean them, and then reapply them in the morning. For some, getting a prosthesis replaced can mean visiting the doctor every three months.

Surgery

If your pelvic organ prolapse disturbs you, surgery can be helpful. The goal of the surgery is to reduce certain symptoms and the vaginal bulge. Usually, the operation aims to repair the prolapse and realign the pelvic organs. This is what we call reconstructive surgery. The surgical approach will depend on the prolapse's location and whether it affects many locations.

• Anterior prolapse: The most common site of prolapse is the front, or anterior, vaginal wall. An anterior prolapse most commonly affects the bladder. This type of prolapse is known as a cystocele.

An incision in the vaginal wall is necessary to perform an anterior prolapse repair. A surgeon pushes the bladder up and stitches the connective tissue between it and the vagina to keep it in place. This is known as a colporrhaphy.

The surgeon also removes extra tissue. If you have incontinence, the surgeon might suggest a bladder neck suspension or sling to support your urethra.

• Posterior prolapse: This type of prolapse affects the vaginal wall towards the back, or posteriorly. A posterior prolapse is a rectal prolapse. Such prolapses are called rectoceles. A surgeon stitches the connective tissue separating the vagina and rectum to lessen the protrusion. The surgeon also removes extra tissue.
• Uterine prolapse: If you plan to become childless, the surgeon might suggest uterine resection.
• vaginal vault prolapse: The top vaginal wall may become unstable and fall out after a hysterectomy. This type of prolapse may damage the bladder as well as the rectum. The small bowel is often affected. When it is, the protrusion is called an enterocele. The surgeon may do the surgery via the vagina or abdomen. The surgeon uses the ligaments supporting the uterus to make the necessary adjustments during a vaginal procedure.

An abdominal approach can be carried out laparoscopically, robotically, or openly. Tiny mesh fragments may be used to support the vaginal tissues. If you have any concerns, talk to the surgeon about the benefits and possible risks of using mesh materials.

Prolapse surgery only treats the tissue that is protruding. If you are unaffected by the bulge, there is no need for surgery. Surgery does not restore the deteriorating tissues. Prolapse may therefore occur again.

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