Pelvic Organ Prolapse (POP) Treatment : Causes & Symptoms

Overview

Pelvic organ prolapse (POP) is a type of pelvic floor disorder. The pelvic floor includes the muscles, ligaments, and tissues that support your pelvic organs such as the vagina, uterus, bladder, and rectum. When the supporting structures weaken, one or more of the pelvic organs tend to descend into the vaginal space. It may appear as a bulge in the vaginal region. This condition is known as pelvic organ prolapse.

What is meant by a Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when one of the pelvic organs starts drooping or prolapsing into the vaginal space. When the structures that support the pelvic organs become loose or if they sustain any damage, these organs tend to shift out of place and descend down into the vaginal space. In severe cases of prolapse, these organs are seen protruding from the vagina as a bulge. Pelvic organ prolapse is often accompanied by urine or fecal incontinence (ie, involuntary loss of urine or unintentional passage of stool). There are different types of organ prolapse.

• Cystocele (prolapse of the bladder into your vagina)
• Urethrocele (prolapse of the urethra)
• Uterine prolapse (prolapse of the uterus)
• Vaginal vault prolapse (prolapse of the bladder into your vagina)
• Enterocele (small intestine prolapse)
• Rectocele (rectum prolapse)

The severity of pelvic organ prolapse is often graded based on the extent of descent and the impact on surrounding structures. The classification system includes stages from I to IV, with higher stages indicating more severe prolapse.

What Causes a Pelvic Organ Prolapse?

A pelvic organ prolapse is a result of enhanced pressure in the abdomen, which can be due to any of the following causes:

• Labor, pregnancy, or childbirth increases the risk of prolapse
• Constipation can put excess pressure on the pelvic floor
• Excess body weight can strain the pelvic floor
• Hysterectomy (surgical removal of the uterus)
• Respiratory issues resulting in chronic cough
• Hormonal changes, especially during menopause
• Genetic predisposition to pelvic floor disorders
• Aging can cause your pelvic muscles to lose strength
• Activities that involve repetitive heavy lifting
• Women with weaker connective tissues are more at risk

It's important to note that several factors can interact, and an individual may have multiple contributing factors. Additionally, not all women with risk factors will develop pelvic organ prolapse, and some women without apparent risk factors may experience it.

What are the Symptoms of a Pelvic Organ Prolapse?

The symptoms of pelvic organ prolapse (POP) can vary depending on the specific organs involved and the severity of the prolapse. Common symptoms may include:

• A feeling of fullness or pressure in the pelvic region
• A visible or palpable bulge in the vaginal area
• Constipation or a feeling of incomplete emptying
• Urinary incontinence or leakage of urine
• Urge for urination or recurrent urinary tract infections
• Chronic lower back pain
• Painful intercourse
• Discomfort or pain in the pelvic region 

It's important to note that not everyone with pelvic organ prolapse experiences symptoms, and the severity of symptoms can vary. Additionally, symptoms may worsen with activities that increase intra-abdominal pressure, such as lifting heavy objects or straining during bowel movements.

How is a Pelvic Organ Prolapse Diagnosed?

As the first step, your doctor will take your medical history and examine your pelvic organs. This may be all required for a diagnosis.

Tests may be suggested if s/he suspects a prolapse. There can be prolapse of more than one organ. Also, the doctor will need to find out the severity and the presence of any other related conditions. The tests include:

• Bladder function tests to see how it and surrounding structures are functioning
• Intravenous pyelography or urinary tract X-ray to view kidneys, ureters, and bladder
• Voiding cystourethrogram (X-rays of the bladder before and after the patient pees) to see if anything is wrong with the bladder/urethra
• Pelvis’ CT scan to rule out other conditions
• Pelvis ultrasound (image of the pelvic organs) to view if more than one organ has drooped/prolapsed/slipped out of place
• Pelvic’ MRI scan (3D image of pelvic organs and muscles) to confirm the condition

What are the Treatment Options for a Pelvic Organ Prolapse?

Treatment for pelvic organ prolapse (POP) depends on the severity of symptoms, the specific organs involved, and the impact on an individual's quality of life. Treatment options can range from conservative measures to surgical intervention. Here are some common approaches:

• Pelvic Floor Exercises (Kegel Exercises): Strengthening the pelvic floor muscles through Kegel exercises can provide additional support to the pelvic organs and may help alleviate mild to moderate symptoms.
• Lifestyle Modifications: Adopting certain lifestyle changes, such as maintaining a healthy weight, avoiding heavy lifting, and addressing constipation, can help manage symptoms and prevent further progression.
• Pessaries: A pessary is a device inserted into the vagina to provide structural support and help hold the pelvic organs in place. Pessaries come in various shapes and sizes and can be a non-surgical option for symptom management.
• Physical Therapy: Pelvic floor physical therapy involves working with a specialized physical therapist who can provide guidance on exercises and techniques to improve pelvic floor muscle function.
• Hormone Replacement Therapy (HRT): In postmenopausal women, hormone replacement therapy may be considered to address hormonal changes that can contribute to pelvic organ prolapse.
• Surgery: In more severe cases or when conservative measures are not effective, surgical intervention may be recommended. Surgical options include procedures such as anterior and posterior colporrhaphy, sacrocolpopexy, or the use of mesh for additional support. The choice of surgery depends on factors such as the type and severity of prolapse, the woman's overall health, and her preferences.

It's important for individuals experiencing symptoms of pelvic organ prolapse to consult with a healthcare professional for a comprehensive evaluation.

Preventive Methods for a Pelvic Organ Prolapse

Following preventive measures will help you stay away from developing a pelvic organ prolapse:

• Kegels on a regular basis
• Maintaining a healthy weight
• Avoiding smoking
• Avoiding constipation
• Being cautious during heavy weight lifting (using legs and not back or abs)

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