Pelvic Organ Prolapse

Pelvic organ prolapse is a condition in which one or more pelvic organs (bladder, uterus, colon, or the top of the vagina in cases where the uterus and cervix have been removed) descend from their normal position through the vagina, causing a bulge. Prolapse is not life-threatening, but it can cause pain and discomfort.

Symptoms

Symptoms of pelvic organ prolapse include:

• Frequent urination or a heavy sensation when urinating
• Difficulty urinating, such as feeling that the bladder does not empty completely, needing to go to the bathroom more frequently, or experiencing small urine leakage when coughing, sneezing, or exercising (stress incontinence)
• Discomfort or numbness during sex
• A feeling of heaviness in the lower abdomen and genital area
• A sensation that something is descending into the vagina – it may feel like sitting on a small ball
• Feeling or seeing a bulge inside or outside the vagina

Sometimes, pelvic organ prolapse has no symptoms and is discovered during a gynecological examination performed for another reason, such as during a Pap test.

Types of Prolapse

There are different types of prolapse, named according to the organ that is prolapsing:

• Anterior vaginal wall prolapse (Cystocele) – When the bladder drops into the vagina
• Posterior vaginal wall prolapse (Rectocele) – When the rectum bulges into the vagina
• Uterine prolapse – When the uterus descends into the vagina
• Vaginal vault prolapse – When the top of the vagina sags (usually after a hysterectomy)

Pelvic organ prolapse is usually classified on a scale from 1 to 4 to indicate its severity, with 4 being a severe prolapse.

Treatment Options

In most cases, treatment is conservative (non-surgical). If symptoms become bothersome, medical or surgical treatment may be needed based on the following factors:

• Age
• Desire for childbearing
• Sexual activity
• Severity of symptoms
• Degree of prolapse
• Other health issues

Treatment

No treatment guarantees a complete resolution of the problem, but the chances of symptom relief are good.

Lifestyle and Dietary Changes

Certain lifestyle and dietary changes can help relieve symptoms. If incontinence is an issue, limiting excessive fluid intake and avoiding alcohol and caffeine-containing beverages may be beneficial. Bladder training (urinating at scheduled intervals) may also be helpful for women with incontinence.

Women with bowel problems may benefit from increasing fiber intake to prevent constipation and straining during bowel movements. Stool softeners may sometimes be prescribed. If a woman is overweight, weight loss can improve overall health and possibly relieve prolapse symptoms.

Pelvic Floor Exercises (Kegel Exercises)

Pelvic floor exercises help strengthen the muscles around the urethra, vagina, and rectum. Regularly performing these exercises can improve incontinence and slow the progression of prolapse. A healthcare professional or physiotherapist can help ensure the correct technique. Mobile apps are also available to assist women in performing and tracking their pelvic floor exercises.

Estrogen Therapy

For mild prolapse in postmenopausal women, estrogen therapy may be recommended to alleviate symptoms such as vaginal dryness or discomfort during intercourse.

Estrogen therapy is available as:

• A vaginal cream
• A vaginal tablet
• A vaginal ring that releases estrogen

Pessary Device

A pessary is a device inserted into the vagina to support pelvic organs, and many women find immediate symptom relief with its use. Pessaries come in various shapes and sizes and can be used for short- or long-term treatment. The choice of pessary depends on the woman’s symptoms and the type of prolapse.

Surgical Treatment

Surgery may be an option for women who have not found relief with non-surgical treatments. Surgery can help alleviate some but not all symptoms. Generally, there are two types of surgery:

1. Pelvic floor repair surgery – Aims to restore organs closer to their original position and improve symptoms that do not respond to conservative methods.
2. Vaginal closure or narrowing surgery – Involves shortening, narrowing, or closing the vagina.

Pelvic floor repair surgery can be performed either vaginally or laparoscopically, depending on the severity and classification of the patient’s prolapse.