A pelvic organ prolapse is a women’s health problem involving a descent of the pelvic organs into the vagina. It’s very common, with up to half of women post-childbirth experiencing some level of prolapse. Pelvic organ prolapse is also more frequently found in women after menopause.
The pelvic organs include your uterus, bladder, and bowel. Normally they are held in position with connective tissue such as ligaments and your pelvic floor muscles. However, when these supporting tissues become weakened, torn, or stretched, one or more of these organs may descend, resulting in a bulge or protrusion into your vagina.
If only mild, a prolapse may not cause any symptoms. Some women only realise they have a degree of pelvic organ prolapse during a medical exam for something else, such as a cervical screening test (formerly known as a pap smear).
Conversely, the symptoms of a pelvic organ prolapse can be significant and cause you discomfort in your daily activities. Pelvic organ prolapse symptoms include:
Female pelvic organ prolapse is not fully understood, though research has identified several risk factors and underlying causes for the condition. In general, activities that cause repeated and excessive stress on your pelvic floor combined with risk factors for poor support from the surrounding connective tissue can lead to a pelvic organ prolapse.
Pelvic organ prolapse is more common in:
You are more likely to experience a prolapse if you have any of the above risk factors and also:
Women who have a family history of pelvic organ prolapse, particularly in other women within your immediate family, are more likely to experience a prolapse themselves. This is possibly due to inheriting genes that make your pelvic floor muscles looser, or that cause your connective tissues to be more prone to weakening or stretching.
If you have a known inheritable condition that affects your collagen or connective tissue such as Ehlers-Danlos syndrome, Marfan syndrome, or joint hypermobility syndrome, you may also be more likely to experience pelvic organ prolapse.
Not all cases of pelvic organ prolapse need surgical intervention. If you have no symptoms or if your symptoms are mild, it may be appropriate to manage with conservative treatment.
A comprehensive examination with Dr Mayooran will identify the degree and type of prolapse, which pelvic organs are involved, and whether you may have other risk factors contributing to your condition.
Pelvic floor physiotherapy with a physiotherapist experienced in pelvic floor dysfunction aims to strengthen your pelvic floor muscles, alleviate your symptoms, and prevent your condition from worsening. Your physiotherapist will prescribe an exercise regime focused on improving the muscle tone of your pelvic floor, and also show you techniques for bracing these muscles before any action that may increase pressure in the area, such as heavy lifting or coughing. Pelvic floor physiotherapy is usually the first recommendation for treatment of mild pelvic organ prolapse.
A pessary is a device inserted into the vagina to provide physical support for the prolapsed organs. It is usually made from a safe, surgical-grade material and is easily removable for cleaning or replacement. Some women may choose to wear it long-term, while others may only insert it at certain times, such as during physical exercise. When properly fitted to your body by a gynaecologist, a vaginal pessary for pelvic organ prolapse can provide immediate relief from your symptoms.
Understanding how certain activities or behaviours can exacerbate your prolapse, and taking steps to modify these, can help to avoid further deterioration as well as relieve your symptoms. These lifestyle strategies may include managing your weight to reduce pressure on your pelvic floor, applying safe techniques for lifting heavy objects, quitting smoking to help with a chronic cough, or managing constipation through a high-fibre diet and hydration.
Surgery for pelvic organ prolapse by Dr Mayooran is performed with a minimally-invasive approach through laparoscopy or via the vagina. Depending on your type and degree of prolapse, and your personal preferences, he may also offer robotic surgery. There are several different surgical methods for managing a pelvic organ prolapse, though all aim to repair or reconstruct the damaged supporting tissues and secure the position of your pelvic organs.
