Pelvic Organ Prolapse: Types, Symptoms and Treatments

Pelvic organ prolapse (POP) is a common condition that affects both men and women, but it is more prevalent in women due to factors such as pregnancy, childbirth and menopause.

In this blog, we will explore what pelvic organ prolapse is, the different types and severity levels, causes, symptoms, prevention strategies, available treatments and when to seek medical advice.

It is important to note that seeking professional medical advice is crucial for accurate diagnosis and individualised treatment plans.

What is Pelvic Organ Prolapse?

Pelvic organ prolapse refers to the descent or displacement of one or more pelvic organs from their normal positions. The pelvic organs, including the uterus, bladder, rectum, and bowel, are supported by a complex system of muscles, ligaments, and connective tissues. When this support weakens or becomes damaged, the organs may protrude into the vaginal canal, resulting in pelvic organ prolapse.

Types and Severity of Pelvic Organ Prolapse

There are several types of pelvic organ prolapse, depending on the specific organs involved:

Uterine Prolapse

The type of prolapse occurs when the uterus descends into the vaginal canal. This condition can vary in severity, ranging from mild, where the uterus is only slightly displaced, to severe, where the cervix or uterus protrudes outside of the vaginal opening.

Cystocele (Bladder) Prolapse

This occurs when the bladder protrudes into the front wall of the vagina. It is the most common type of pelvic organ prolapse.

Rectocele Prolapse

This type involves the rectum bulging into the back wall of the vagina.

Vaginal Vault Prolapse

This type occurs when the top of the vagina descends after the uterus has been removed.

Prolapse Severity

The severity of pelvic organ prolapse is categorised into four stages:

• Stage 0: No prolapse detected.
• Stage 1: Mild prolapse, where the organ descends only a short way into the vagina.
• Stage 2: Moderate prolapse, where the organ descends to the opening of the vagina.
• Stage 3: Severe prolapse, where the organ protrudes outside the vaginal opening.

Prevalence of Pelvic Organ Prolapse

Pelvic organ prolapse is a prevalent condition, affecting a significant number of individuals worldwide. However, precise statistics may vary due to underreporting and differences in healthcare systems.

It is estimated that approximately 40% of women over the age of 50 experience some form of pelvic organ prolapse, with the prevalence increasing with age.

Causes of Pelvic Organ Prolapse

Various factors contribute to the development of pelvic organ prolapse, including:

1. Pregnancy and childbirth: The stretching and weakening of the pelvic floor muscles during pregnancy and vaginal delivery can increase the risk of prolapse.
2. Age and menopause: The natural hormonal changes and the loss of estrogen during menopause can weaken the pelvic floor muscles and supportive tissues.
3. Chronic constipation and straining during bowel movements: Consistent straining increases pressure on the pelvic organs, potentially leading to prolapse.
4. Obesity: Excess weight can put additional strain on the pelvic floor muscles, increasing the risk of prolapse.
5. Family history: There may be a genetic predisposition to weak connective tissues, making some individuals more susceptible to pelvic organ prolapse.

Symptoms of Pelvic Organ Prolapse

The symptoms of pelvic organ prolapse can vary depending on the specific organs involved and the severity of the prolapse.

Common symptoms may include:

1. A feeling of pelvic pressure or heaviness.
2. A sensation of something protruding from the vagina.
3. Discomfort or pain during intercourse.
4. Difficulty emptying the bladder or bowel completely.
5. Urinary incontinence or increased urgency to urinate.

Prevention and Management

While it may not be possible to prevent all cases of pelvic organ prolapse, adopting certain lifestyle habits can help reduce the risk and manage the condition:

1. Pelvic floor exercises: Regularly performing pelvic floor exercises, also known as Kegels, can strengthen the pelvic floor muscles and improve support for the pelvic organs. Kegel exercises may be done with or without pelvic floor trainers. For more information see our Guide to choosing a pelvic floor trainer.
2. Maintaining a healthy weight: Maintaining a healthy weight reduces the strain on the pelvic floor muscles and can help prevent prolapse.
3. Avoiding heavy lifting and straining: Minimising activities that put excessive pressure on the pelvic floor, such as heavy lifting and chronic constipation, can reduce the risk of prolapse.
4. Smoking cessation: Smoking can contribute to the weakening of connective tissues, so quitting smoking is beneficial for overall pelvic health.

Treatment Options

The appropriate treatment for pelvic organ prolapse depends on several factors, including the severity of the prolapse, the presence of symptoms, and the individual's overall health.

Treatment options may include:

1. Conservative management: For mild cases, lifestyle changes such as pelvic floor exercises, weight management and avoiding straining may provide relief and prevent further progression.
2. Pessaries and sponges: Pessaries and prolapse sponges are removable devices inserted into the vagina to support the pelvic organs and alleviate symptoms.
3. Pelvic floor physical therapy: Specialised physical therapy can help strengthen the pelvic floor muscles, improve coordination and provide symptom relief.
4. Surgical intervention: In severe cases or when conservative measures do not provide adequate relief, surgery may be recommended. Surgical options range from repairs of specific organs to complete pelvic floor reconstruction.

When to Seek Medical Advice

If you experience symptoms of pelvic organ prolapse, it is important to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

Seek medical advice if you:

1. Notice a bulging sensation or protrusion from the vagina.
2. Experience persistent pelvic pressure or discomfort.
3. Have difficulty emptying your bladder or bowel.
4. Encounter pain or discomfort during sexual intercourse.

Pelvic organ prolapse is a prevalent condition that affects many individuals, particularly women. Understanding the types, symptoms, causes, prevention strategies, available treatments, and when to seek medical advice is crucial for managing the condition effectively.

Each person's experience with pelvic organ prolapse is unique, so it is essential to consult a healthcare professional for personalised guidance and support.

Sponges for Pelvic Organ Prolapse

Pelvic Floor Trainers

References:

1. Brown, J. S., Waetjen, L. E., Subak, L. L., Thom, D. H., Van den Eeden, S. K., Vittinghoff, E., ... & Huang, A. J. (2006). Pelvic organ prolapse surgery in the United States, 1997. American journal of obstetrics and gynecology, 195(6), 1762-1771.
2. Handa, V. L., & Harvey, L. (2004). Caring for women with pelvic organ prolapse. JAMA, 291(11), 1360-1366.
3. Haylen, B. T., Maher, C. F., Barber, M. D., Camargo, S., Dandolu, V., Digesu, A., ... & Petri, E. (2016). An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). International Urogynecology Journal, 27(2), 165-194.
4. Wu, J. M., Matthews, C. A., Conover, M. M., Pate, V., & Jonsson Funk, M. (2014). Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstetrics and gynecology, 123(6), 1201-1206.

Disclaimer: This blog is for informational purposes only and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider for accurate diagnosis and appropriate treatment.