The organs inside the lesser, or true, pelvis of women (uterus, bladder and rectum) are normally held in position with the assistance of a complex of ligaments and muscles, known as the “pelvic floor”.
If these supporting structures weaken due to hyperextension, then the pelvic organs lose their support and may project (prolapse) into the vagina.
This condition is called pelvic organ prolapse.
Occasionally, the prolapse is so severe that the organs may bulge from the vagina.
Most sufferers do not consult their physician about their problem.
Studies have demonstrated that half of the female population over the age of 50 are sufferers, and that at least one woman in 10, over the age of 80, has undergone one surgical procedure for the treatment of prolapse.
The main cause is the loosening of the supporting ligaments and muscles due to:
- Pregnancy: the most common cause
- Age: the ligaments normally loosen, mostly after menopause
- Weight gain
- Constipation, weight lifting: they cause an increase in the intra-abdominal pressure and result in organ prolapse
- Hysterectomy: this weakens the supporting structures of the vagina and prolapse of the vaginal stump may occur
There are several types of prolapse, depending on the organs projecting into the vagina (e.g. uterus, bladder or bowel).
More than one organ may be involved and thus we may have multiple prolapses.
Symptoms of prolapse
- It may cause no discomfort and be an incidental finding during clinical examination
- The most common symptom is the sensation of “mass moving downwards”. The symptoms are aggravated with standing or physical activity
- In severe cases, this mass may project outside the vagina
- In cases where the bladder is involved, there may be a compromise in the urinary outflow, as well as frequent voiding ,occasionally incontinence and UTIs
- If the bowel is involved, constipation may occur
- During sexual intercourse, there may be hypesthesia in the area or difficulty
It is performed with the clinical examination of the vagina.
If there is a difficulty in the urinary outflow or incontinence, additional tests must be conducted, such as urine culture, ultrasound and full urodynamic study.
In women with mild symptoms, no treatment is required.
In cases with mild symptoms, preventive measures may improve the symptoms or slow down the prolapse deterioration. These are:
- Body weight reduction
- Chronic cough and constipation management
- Refrainment from heavy physical exercise and weight lifting
- Pelvic floor exercises to strengthen the area
- Use of topical estrogens
- Vaginal pessary placement: this is indicated in cases of uterus prolapse or cystocele, but less indicated in rectocele (posterior prolapse).
- Surgical treatment: this is mostly utilized when the patient’s quality of life is affected or when all other therapies have failed. The main objective of the surgical procedure is to fix the organs into their anatomic position and restore sexual function.
There are several treatment options which depend on:
- Type of prolapse
- Accompanying symptoms
- Desire for procreation
- Overall health status of the patient