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Pelvic organ prolaspe, are you at risk?

Vaginal prolapse is a common condition where the bladder, uterus and or bowel protrudes into the vagina. This can cause symptoms such as a sensation of a vaginal lump, constipation, difficulty emptying the bowel or bladder or problems with sexual intercourse.

Symptoms may include

  • A sensation of a bulge or something coming down or out of the vagina
  • Discomfort during sexual intercourse.
  • Feeling like you’re sitting on a ball.
  • Vaginal bleeding.
  • Increased discharge.
  • A pulling or heavy feeling in the pelvis.
  • Constipation.
  • Stress incontinence; leaking a small amount of urine on sneezing coughing or during exercise
  • Urge incontinence; an urgent need to visit the toilet and to leak before you get there or if you don’t go.
  • Needing to go to the bathroom frequently (referred to as frequency) during the day or night.
  • Recurrent bladder infections.
  • An inability to control the passing of flatulence (wind) from the back passage.

Note: it is possible to have pelvic organ prolapse without any symptoms, with the condition is only identified during an internal examination such as a cervical screening.Treatment is only recommended when the prolapse is symptomatic.


Types of prolapse

  • Uterine prolapse: The the uterus bulges downward, due to weak, loose ligaments
  • Cystocele: prolapse of the ladder into the front wall of the vagina
  • Rectocele: prolapse of the rectum into the back wall of the vagina
  • Enterocele: prolapse of the small intestine or bowel into the top of the vagina
  • A Recto-enterocele; A combination of the last two is known
  • Vaginal vault prolapse: A vaginal vault prolapse occurs when the top of the vagina descends in women who have had a hysterectomy.

Note: It’s possible to have more than one of these types of prolapse at the same time.


Causes of Prolapse

Pelvic organ prolapse is caused by weakening of tissues that support the pelvic organs, muscles, ligament and fascia. Although there’s rarely a single cause, the risk of developing pelvic organ prolapse can be increased by:

  • Age
  • After childbirth,
  • Menopause
  • Being overweight, or having large fibroids (non-cancerous tumours in or around the womb) or pelvic cysts – which creates extra pressure in the pelvic area
  • Previous pelvic surgery such as a hysterectomy or bladder repair
  • Repeated heavy lifting and manual work
  • Long-term chronic cough because you smoke, have bad bronchitis or asthma
  • Chronic constipation, or excessive straining when going to the toilet
  • Hypermobility syndromes
  • Inherited conditions such as Ehlers-Danlos syndrome or Marfan syndrome
  • Genetics: as a consequence, a congenital weakness explains why some women who have never had children develop a prolapse.
  • Finally, some women are born with a weakness in their pelvic floor muscles and so are at a higher risk of prolapse.

Can a prolapse be prevented?

  • There are several things you can do to reduce your risk of prolapse, including:
  • Doing regular pelvic floor exercises (see post on pelvic floor)
  • Maintaining a healthy weight or losing weight if you’re overweight
  • Avoiding constipation and straining when going to the toilet
  • Care with heavy lifting

How is prolapse treated?

Many women with prolapse don’t need treatment, as the problem doesn’t seriously interfere with their normal activities. Lifestyle changes including as weight management and pelvic floor exercises are the usual recommendations in mild cases.


Conservative treatment

If the symptoms require treatment, a prolapse may be treated effectively using a device inserted into the vagina, called a vaginal pessary, these are designed to hold the prolapsed organ in place.

Women’s health physiotherapy or osteopathy can be very successful in helping to reduce symptoms. However, if the prolapse is troublesome, soft ring pessaries can be prescribed these hold the walls of the vagina away from the centre and hence tighten the “hammock” of tissues that hold the organs. More, these rings need to be regularly changed and are often used along with topical oestrogen creams.


Pelvic floor repair

Surgery is the next step if conservative treatment hasn’t been successful, or in severe cases. Repair of prolapse with vaginal or abdominal surgery can be performed with supporting sutures inserted. In some cases, a complete hysterectomy is also often required, especially if the womb has prolapsed out. Following surgery, most women experience a better quality of life. However, there are some post-surgical risks and lifestyle changes required, which should be discussed in full before surgery.


Please note:

For guidance only; this information should not be regarded as a substitute for medical advice, diagnosis or treatment given in person by an appropriately trained health professional.


References

inters JC, Dmochowski RR, Goldman HB, et al.; American Urological Association; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction. Urodynamic studies in adults: AUA/SUFU guideline. J Urol. 2012;188(suppl 6):2464-2472.

Continence Foundation of Australia. Guidelines for the use of support pessaries in the management of pelvic organ prolapse. 2012.

Maher C, Feiner B, Baessler K, et al. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;(4):CD004014.

Hagen S, Stark D, Glazener C, et al.; POPPY Trial Collaborators. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet. 2014;383:796-806.