Pelvic Organ Prolapse: An Overview

Pelvic organ prolapse is a type of pelvic floor disorder that affects around 3% of women in the U.S. Due to the sensitive nature of the symptoms of pelvic organ prolapse (POP), many women who develop this disorder feel uncomfortable speaking with their doctor about it. Omar Cabrera, M.D., an OB/GYN at Texas Health Women’s Care in Stephenville, a Texas Health Physicians Group practice, and on the medical staff at Texas Health Stephensville, gives us some insight into what POP is and how it can affect women at any age.

 

What is pelvic organ prolapse?

According to Cabrera, pelvic organ prolapse is a broad term to describe a type of hernia that occurs in the pelvis. This hernia occurs as a result of the weakening of muscles and tissues in the pelvic region. When these particular muscles and tissues are weak, they are not able to adequately support the pelvic organs (like the vagina, uterus, bladder, and rectum), which causes these organs to “prolapse”, or bulge.

Cabrera states that some of the common types of prolapses are:

  1. Cystocele – when the bladder bulges into the vagina.
  2. Rectocele – when the rectum bulges into the vagina.
  3. Enterocele – when the intestines bulge into the vagina
  4. Uterine prolapse – when the uterus bulges into the vagina.

 

What causes pelvic organ prolapse and who is most at risk for developing it?

“There is a thin, connective tissue [in our bodies] called fascia,” Cabrera explains. “Fascia within the pelvis helps to maintain a support of the vagina to keep structures where they belong.”

Since pelvic organ prolapse is a type of hernia, this means the prolapse is due to the weakening of this fascia or other muscles within the pelvic region.

As for who is most at risk for developing pelvic organ prolapse, Cabrera says various factors come into play.

“Increasing number of childbirths, advancing age, [or] obesity,” are a few of the risk factors he lists.

The Office on Women’s Health mentions that in addition to childbirth itself, giving birth to large babies (8 ½ pounds or more) in particular increases your risk for pelvic organ prolapse. Furthermore, when a woman’s hormones change during menopause, estrogen plummets. This loss of estrogen may play a role in the development of pelvic organ prolapse, though it’s not clear why.

“Factors that increase belly pressure such as constipation or heavy lifting [may also contribute to pelvic organ prolapse],” Cabrera adds. “Family history [or] being born with certain connective tissue disorders [are factors to consider as well].”

 

What are the symptoms of pelvic organ prolapse?

“Common symptoms include a feeling of a bulge or pressure within the vagina,” says Cabrera. “In more severe cases, a woman may need to push that bulge to relieve the discomfort. [Some] women may have symptoms such as leakage of urine with physical movement or activity.”

Other urinary symptoms may include frequent strong urges to urinate or not being able to completely empty the bladder. Cabrera also claims that pelvic organ prolapse can interfere with bowel movements. The prolapse may cause constipation, and some women might have to apply pressure with a finger to the back wall of the vagina to allow a bowel movement to pass.

The Office on Women’s Health mentions that sometimes women can see the prolapse in addition to being able to feel it. Pelvic pressure caused by the prolapse may get worse as the day goes on, during sex, when coughing, or when standing for long periods of time. Lastly, if a woman is having trouble inserting tampons, POP could be the cause.

Despite how obvious these symptoms may seem, Cabrera points out that some women don’t experience any symptoms at all and therefore don’t realize they have pelvic organ prolapse. But for those who do experience symptoms, it can be very distressing, uncomfortable, and difficult to talk about.

 

How is POP diagnosed and what are the treatments?

“Pelvic organ prolapse is generally diagnosed with a physical exam,” Cabrera explains. “This is often found on a routine annual in patients that have no pelvic symptoms.”

In regards to treatment, women who have no bothersome symptoms may elect to not receive any treatment. On the other hand, for women who do need treatment, Cabrera says that it’s important to note that POP treatment tends to focus primarily on improving quality of life. For example, women who have trouble urinating, or if bowel movements become obstructed and aren’t able to pass—these types of symptoms affect daily life and would certainly call for treatment.

Depending on the severity of the prolapse, some treatments may require surgery and some may not.

Nonsurgical treatment options include:

  • A vaginal pessary
    • This is a silicone device that provides support for the pelvic region when it is placed inside the vagina
  • Pelvic floor muscle exercises
    • A pelvic floor physical therapist can help women restore strength in their pelvic floor muscles by teaching them specific exercises for this region

Surgical treatment options are typically recommended when nonsurgical treatment options fail. Surgery can be performed on the vagina or the uterus to help repair the prolapse.

 

Is POP preventable?

While not entirely preventable, Cabrera says there are ways to reduce the risk of developing pelvic organ prolapse.

He recommends, “Maintaining a normal weight, having a diet rich in fiber, performing pelvic floor exercises, not smoking, and avoiding activities that increase your belly pressure such as straining or heavy lifting.”

To find an OB/GYN near you, visit TexasHealth.org.

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