Pelvic Organ Prolapse: Causes and Treatments


Pelvic Organ Prolapse

Pelvic organ prolapse is a disorder in which one or more of the pelvic organs drop from their normal position. It is caused by injury to the muscles or tissues that support the pelvic organs. The main cause of this injury is pregnancy and childbirth, especially vaginal childbirth. Other causes include prior pelvic surgery, menopause, and aging. This problem also runs in families.

I am in my mid-forties and have had three normal deliveries. Of late am getting a feeling of something coming down in my pelvis. I am also finding it difficult to control my urine. What’s wrong with me?

What you are describing is referred to as pelvic organ prolapse. It’s basically a weakness in the pelvic support system. The uterus (womb), which is normally positioned much higher in the pelvis, gets displaced downwards into the vaginal canal. Thus the feeling of ‘something coming down’. There is also an inevitable weakening of the vaginal walls. Other pelvic organs, like the bladder and bowels, may also prolapse into the vagina.

There are different types of prolapse that can occur. Keep in mind that often more than one organ can be affected at the same time. Prolapse occurs in stages. Mild cases are those in which the organs have dropped only a short distance. Severe cases are those in which the organs have dropped a greater distance. See those types here: The following videos show the different types

Several factors are at play in the causation of pelvic organ prolapse. For starters, pregnancy and vaginal childbirth cause enormous strain on the pelvic muscular support system. The muscles may not completely recover from birth trauma, and their tone weakens further with subsequent deliveries. In addition, some pelvic nerves may also get injured during delivery, further compromising pelvic support mechanisms. Nearly half of all women who have had children are affected by some degree of prolapse.

With advancing age, there is a gradual decline in the female hormones which play a significant role in pelvic organ function. Thus prolapse symptoms are more common towards the menopause. Some women may have an inherent muscular weakness, though is rare. Lifestyle factors like obesity and smoking are also predisposing factors to pelvic prolapse.

What you require is a gynecological assessment. The degree of the prolapse will determine the treatment options. As you also have urinary symptoms, these too will be assessed. You may be experiencing what is referred to as stress urinary incontinence, which is associated with pelvic prolapse. Additional tests may also be advised.

Treatment options for pelvic prolapse range from simple measures to complex surgical procedures. Those with mild symptoms can be treated with supervised pelvic floor exercises. These may gradually improve pelvic muscular tone, relieving prolapse symptoms and improving bladder function. Pelvic support devices, called pessaries, may be inserted into the vagina to aid uterine support. Corrective surgical procedures may eventually be advised, both to correct the prolapse and cure the urinary incontinence. Surgery is best done by a gynecologist specialized in pelvic organ disease, commonly referred to as a Urogynecologist.

Women can take preventive measures to limit pelvic organ prolapse. Regular pelvic floor exercises will maintain the pelvic muscular tone. Maintaining a healthy weight will limit the strain on the pelvic support systems. Avoid heavy lifting which strains the pelvic muscles. Eat a high fiber diet to help avoid straining when opening your bowels. For smokers, stopping smoking will reduce the risk of prolapse.

Some women will have a prolapse, but no symptoms at all. Others may feel embarrassed to seek help, but this should never be the case especially when the quality of life is affected.

Dr. Alfred Murage is a Consultant Gynecologist and Fertility Specialist.
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