Pelvic Organ Prolapse

What is Pelvic Organ Prolapse?

Female pelvic organ prolapse (FPOP) is a medical a medical condition in which a pelvic organ, such as the uterus, bowel or bladder herniate or prolapse downward into the vaginal canal (known as uterovaginal prolapse) or anal canal (known as rectal prolapse).

Where uterovaginal prolapse occurs, the location of the bulge in the vaginal cavity is an indicator of which pelvic organ has prolapsed.

Types of Prolapse

Uterine Prolapse

Uterine prolapse occurs when the uterus or womb descends into the vaginal cavity. The cervix may be felt low in the vaginal canal or may protrude from the vaginal opening in more severe cases of uterine prolapse.

Uterine Pelvic Organ Prolapse

Cystocele

Cystocele occurs when the bladder prolapses into the vaginal cavity. A bulge on the anterior (front) wall of the vaginal wall may be an indicator of cystocele.

Cystocele pelvic organ prolapse

Rectocele

Rectocele is a prolapse of the wall of the rectum into the vaginal cavity. A bulge into the posterior (back) wall of the vaginal cavity may be an indicator or rectocele.

Rectocele pelvic organ prolapse

Prolapse can range in severity or from a mild displacement to more severe, where the organ can prolapse outside of the introitus or vaginal opening.

Uterine Prolapse Grades

Grades of Uterine Prolapse. Source: Reasearchgate

Who is at risk?

Childbearing is believed to have the largest role to play in pelvic organ prolapse with the onset of prolapse common during pregnancy and childbirth, particularly in the case of vaginal deliveries.

It has also been though that prolapse may be congenital and that lifestyle factors such as obesity and smoking may put people at higher risk. Age and other conditions which increase pressure in the abdomen, such as constipation and chronic coughing, or lifting heaving objects may also increase the risk of prolapse.

Symptoms

Many people with mild pelvic organ prolapse may not have any symptoms.

More server cases of prolapse may include the following symptoms;

  • Feeling a bulge within the vaginal cavity
  • A feeling of pressure or pain in the pelvic area
  • Pain during intercourse
  • Light bladder leakage
  • Inability to completely empty the bladder when urinating or bowel when passing a stool

Diagnosis

Book an appointment with your GP if you suspect you have any of the above symptoms as the sooner treatment is sought for prolapse the better the outcome. During your consultation, you will be asked for your medical history and a physical examination will be performed. You may be asked to bear down during the physical examination to enable the doctor to locate and assess the severity of the prolapse. You may also be required to perform a urine stream test and be required to have an MRI or X-ray.

Treatment

For mild cases of PFOP, treatment may not be required and you should monitor your symptoms over time. You may be asked to do exercises to increase your pelvic floor tone or visit a Womens Health Physiotherapist who specialises in treating pelvic conditions.

A pessary may also be subscribed to you. A pessary is a rubber or plastic ring, disc, cube, bridge or doughnut-shaped object which is inserted into the vagina and acts as a sling to support the bulging pelvic organ. You will be able to insert and remove the pessary for regular cleaning and they will need to be replaced every 3-6 months.

Pessaries used for pelvic organ prolapse. Source: PelvicExercises

For more advanced stages of prolapse, surgery may be required. 

Prevention

  • Maintain good pelvic floor tone by performing Kegel exercises regularly, particularly as you age and after childbirth.
  • Maintain a healthy weight.
  • Eat a diet high in fibre and drink plenty of water to prevent constipation.
  • Avoid smoking. 
  • If possible, avoid lifting heavy objects.

Using a menstrual cup with prolapse

The majority of people with mild prolapse will be able to use a menstrual cup. People with more severe forms of pelvic organ prolapse may not be able to use a cup as the cavity within the vaginal canal is reduced and can cause a menstrual cup or tampon to be pushed out.

Sources

https://www.racgp.org.au/afp/2015/july/pelvic-organ-prolapse-–-a-review/

https://www.mayoclinic.org/diseases-conditions/rectocele/diagnosis-treatment/drc-20353419

https://my.clevelandclinic.org/health/diseases/17344-pelvic-organ-prolapse

https://www.thewomens.org.au/health-information/vulva-vagina/vaginal-prolapse/more-about-pessaries

https://www.pelvicexercises.com.au