By June Bechara, AWC Lebanon
What is pelvic organ prolapse?
The "pelvic floor" is a group of muscles that form a kind of hammock across your pelvic opening. Usually, these muscles and the tissues surrounding them keep the pelvic organs in place. These organs include your bladder, uterus, vagina, small bowel and rectum.
Sometimes these muscles and tissue develop problems. Pelvic organ prolapse refers to the “prolapse” or drooping of any of the pelvic floor organs. Some women develop pelvic floor disorders following childbirth. Moreover, as women age, pelvic organ prolapse and other pelvic floor disorders become more common.
Common causes include:
- Pregnancy, labor and childbirth (the most common causes), especially giving birth to a baby weighing more than 8½ pounds
- Obesity
- Respiratory problems with a chronic, long-term cough
- Constipation
- Pelvic organ cancers
- Surgical removal of the uterus (hysterectomy)
- Menopause: A woman’s ovaries stop producing hormones that regulate her monthly cycle. The hormone estrogen, which helps keep pelvic muscles strong, is in lower supply.
- Genetics may also play a role in pelvic organ prolapse. Connective tissues may be weaker in some women, perhaps placing them more at risk.
What are the symptoms of pelvic organ prolapse?
Some women notice nothing at all, but others report a feeling of pressure or fullness in the pelvic area. Often this feeling gets worse as the day goes on or gets worse after standing, lifting or coughing.
Some more possible symptoms include:
- A backache low in the back
- Painful intercourse
- Problems inserting tampons
- A feeling that something is falling out of the vagina
- Urinary problems such as leaking of urine or a chronic urge to urinate
- Bladder infections
- Constipation – needing to push organs back into place following a bowel movement.
- Spotting or bleeding from the vagina
Symptoms depend somewhat on which organ is drooping. If the bladder prolapses, urine leakage may occur. If it is the rectum, constipation and uncomfortable intercourse often occur. A backache, as well as uncomfortable intercourse, often accompany small intestine prolapse. Uterine prolapse has the same symptoms.
In many cases, a woman will feel no symptoms from prolapse and will find out about it only during a routine gynecological exam. Experiencing any of these symptoms should not embarrass you. Discuss them with your physician if you have any of these .
Pelvic organ prolapse – an unknown issue
The statistics are quite alarming. One third of women in the US can have some pelvic area prolapse issues. It might be only 25% who notice the indications. Most likely, 11% will end up undergoing a surgical procedure during their lifetime. Women over the age of 40 are usually affected most (41% - 50%).
Most women might ignore symptoms when they are mild, and some might not even experience any discomfort, unaware that they have a prolapse. When symptoms do occur, they tend to be related to the organ that has prolapsed. Prolapse can affect the quality of life, and one of five women who have prolapse will seek medical help.
Questions to ask your doctor about your prolapse:
- What type of prolapse do I have?
- How severe is it?
- Do I need treatment and if so, what treatment do you recommend and why?
- What if I choose not to have any treatment?
- What can I do to ease the symptoms?
Treatment of pelvic organ prolapse
Pelvic floor physical therapy, which can include Kegel exercises (relaxing and tightening the muscles that control urine flow), is essential for any woman. The physician can also insert a pessary into the vagina to support the prolapsed organs. The pessary, made of silicone, is usually fitted to the patient and is removable.
Surgery is an option for women who are not comfortable with the idea of using a pessary, or who have tried it and found it did not relieve their symptoms. There are several different types of surgery, based on the location and severity of the prolapse and other health issues.
Women presenting prolapse symptoms should be taken seriously by their doctors and be given better information about their choices of treatment. The physician should support the woman in her choices.
- Do you suspect you may have pelvic organ prolapse? The Association for Pelvic Organ Prolapse Support (APOPS) has prepared this questionnaire. Print it out, answer the questions, and take it to your gynecologist or primary care practitioner for analysis.
For more information about pelvic organ prolapse:
https://my.clevelandclinic.org/health/diseases/16030-vaginal-and-uterine-prolapse
https://www.mayoclinic.org/diseases-conditions/uterine-prolapse/symptoms-causes/syc-20353458
https://www.webmd.com/urinary-incontinence-oab/pelvic-organ-prolapse#1
https://www.health.harvard.edu/womens-health/what-to-do-about-pelvic-organ-prolapse
https://riachisurgery.com/labib-riachi-surgery/diagnosis-treatments/pelvic-organ-prolapse/pelvic-organ-prolapse/
https://www.uchicagomedicine.org/forefront/womens-health-articles/2019/january/demystifying-pelvic-organ-prolapses
https://www.womenshealth.gov/a-z-topics/pelvic-organ-prolapse
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0741-2