Pelvic organ prolapse is a condition commonly seen in women that occurs when one or more of the pelvic organs herniate, or drop, from the normal position. In severe cases, the cervix or vaginal walls protrude through the vaginal opening.What Causes Pelvic Organ Prolapse?
Many conditions lead to pelvic organ prolapse. Strain on the pelvic muscles or surgery that lessens support of the organs can cause them to shift and prolapse. Common causes include:
- Strain from childbirth
- Obesity
- Hysterectomy
- Long-term cough
- Chronic constipation
- Pelvic organ tumors
Pelvic organ prolapse also runs in families. Having a mother or sister with pelvic organ prolapse places a woman at higher risk.
What are the Symptoms of Pelvic Organ Prolapse?
When symptoms are present, they range from mild to severe and are based on the type and location of the prolapse, including:
- Pelvic pressure or fullness
- Urinary incontinence or frequency
- Low back pain
- Pain in the lower belly
- Uncomfortable or painful sexual intercourse
- Bowel incontinence
- Difficult bowel movements
How is Pelvic Organ Prolapse Diagnosed?
Some cases of pelvic organ prolapse are diagnosed during a routine pelvic examination. Your gynecologist may ask you to push or bear down to identify the area of prolapse. Other diagnostic test may also be necessary, including the following:
- Urodynamic Testing –determines bladder function – including how urine is stored and released
- Cystoscopy –a scope is inserted to look inside your bladder
- CT scan – a special x-ray used to view the inner structure of the pelvis
- Intravenous pyelogram (IVP) – an x-ray of the kidneys, bladder, and ureter performed using contrast material that has been injected
- Defecography – an x-ray that allows your doctor to observe the rectum during defecation
What are the Treatment Options for Pelvic Organ Prolapse?
Management of pelvic organ prolapse is based on the patient’s goals. Women with only mild symptoms may respond to non-surgical treatment such as, Kegel exercises to strengthen the pelvic muscles, biofeedback techniques, a high fiber diet to aid bowel movements, losing weight or avoiding lifting and other activities that strain the pelvic muscles.
Medical treatment options include:
Pessary – a non-surgical, removable device usually made of silicone that is placed in the vagina for support
Estrogen therapy – Used in some post-menopausal women to strengthen the pelvic muscles
Surgical Treatment Options:
Many types of pelvic organ prolapse can be repaired robotically, laparoscopically, vaginally or through an abdominal incision. The surgery performed is based on the type of prolapse.
Cystocele repair–a cystocele is a defect that causes the bladder to protrude into the vagina. The patients own tissue or a synthetic tissue is placed to restore proper bladder position
Rectocele/enterocele repair – repair of rectoceles (protrusion of the rectum into the vagina) or enteroceles (small bowel protrusion) involves reconnecting the stretched or torn tissue and repairing the vaginal wall
Vaginal vault suspension surgery – use of native tissue or synthetic mesh to reattach the vagina to support ligaments
Vaginal obliteration – closure of the vagina in severe cases and a specific candidate
Hysterectomy – removal of the uterus is performed to treat a uterine prolapse (when the uterus drops into the vagina)