Authored By: Dr. Vinatha Puli
MBBS, DGO, DFSRH, MRCOG, CCT (UK)
Clinical Director – Obstetrics & Gynaecology
What you need to know about pelvic organ prolapse?
What is pelvic organ prolapse?
Uterus (womb), bladder & rectum (back passage) are the organs present within a woman’s pelvis. They are normally held in their place by ligaments and muscles called pelvic floor. If these support structures are weakened there will be bulge of organs from their natural position into the vagina. When this happens it is known as pelvic organ prolapse.
Is it common to have prolapse?
It is very common especially in older women. As many women don’t go to doctor or talk about it, it might be difficult to know exactly the proportion of women who can have this problem. It is estimated that at least 50% of women over 50 years of age will have symptoms with pelvic organ prolapse.
Why does pelvic organ prolapse happen?
Being Pregnant and giving birth are most common reasons for weakening of pelvic floor. More births the woman had, more difficult births, more bigger babies, more likely is the chance of you having the prolapse.
After menopause it is common. Being overweight, constipation, persistent cough, and prolonged heavy lifting can also increase the chance of having the prolapse. Sometimes there is hereditary tendencies too.
What symptoms will be there if I have a prolapse?
Sometimes there might not be any problem at all and we will know only when examination is done. Most of the times, it is the sensation of lump coming down is the symptom.
Backache, heaviness or dragging discomfort in the vagina can be there.
If bladder is also prolapsed – You may experience need to pass urine frequently, incomplete emptying, frequent urine infections.
If bowel is also prolapsed – You can have constipation or incomplete bowel emptying.
Some women might have to push the lump back to be able to empty bladder or bowel. Sex might be uncomfortable and lack of sensation during intercourse can be distressing.
Will I need tests?
Prolapse is usually diagnosed by performing a vaginal examination. Your doctor will insert a speculum (a metal or plastic instrument used to separate the walls of Vagina) to assess the prolapse and to determine exactly which organs are prolapsing.
Urine test will be done to check for infection. If you have leakage of urine special tests like Urodynamics will also be done.
What are the treatment options?
If mild prolapse and no symptoms, you might choose to take wait and see option, however losing weight if you are overweight, reducing cough, avoiding constipation, avoiding heavy lifting can help to reduce worsening of the problem.
Kegels or pelvic floor exercises will help to strengthen the pelvic floor muscles.
If you are unable to do these exercises you will be referred to a physiotherapist to guide you doing the right way. Vaginal hormone might be recommended.
Other options include pessaries or surgery.
Pessary – Is a good way of supporting the prolapse. If you don’t wish the surgery or if surgery is too risky for you due to any medical condition you will be given this option. Pessary is made of plastic or silicone. There are many varieties and sizes of pessaries available. Your doctor will advise the right one for you. Most commonly used pessaries are ring pessaries. Fitting the right size pessaries can sometimes take more than one attempt. They have to be changed frequently. You have to report to your doctor if you experience any irritation or bleeding.
Surgery – Choosing surgery will depend on severity of your symptoms, effect on quality of life and if other options are not helpful. There will be some risks with any operation especially if you are overweight or have any medical problems. The usual surgery that is done is removal of uterus and pelvic floor repair.
Lifting up the uterus or vagina to a bone of your spine or a ligament within your pelvis are also available especially if prolapse is recurrent.
Closing off the vagina will be considered only if many surgeries are unsuccessful or you are in very poor medical health.
How successful is the surgery?
In 75% of women surgery is successful. However in 25% of women, prolapse can come back and might require further surgery at a later date.