Understanding Pelvic Organ Prolapse in Women

Pelvic organ prolapse (POP) occurs when the group of muscles and tissues responsible for supporting the pelvic organs, known as the pelvic floor, becomes weakened and is unable to securely maintain the organs in their proper positions.

The affected organs can include the uterus (womb), vagina, bowel, bladder, urethra, and rectum.

Pelvic organ prolapse is a common condition that affects approximately 1 in 10 women over age 50. However, it is a topic that is not commonly discussed because some women may feel ashamed or confused regarding the condition and its treatments. Additionally, many women may not have even heard of it.

Types of pelvic organ prolapse

Various types of prolapse can occur depending on which pelvic organ is protruding into the vagina. It is common for individuals to experience more than one type of prolapse simultaneously.

Anterior vaginal wall prolapse (cystocele or cystourethrocele) happens whenthe bladder bulges into the front wall of the vagina.

Posterior vaginal wall prolapse (enterocele) happens when the bowel bulges forward into the back wall of the vagina.

Uterine prolapse happens due to the protrusion or descent of the uterus into the vagina.

After a hysterectomy, some women may experience vault prolapse, where the upper part of the vagina droops downwards.

Pelvic organ prolapse is typically categorised on a scale ranging from 1 to 4 to indicate its severity, with 4 representing a severe prolapse.

Symptoms of pelvic organ prolapse

Symptoms will vary depending on the type and severity of the prolapse:

• A bulge or dragging sensation in the vagina. Symptoms may worsen if standing for too long.
• Incontinence (leaking urine) or needing to pass urine more frequently.
• May leak urine when laughing or coughing.
• Difficulty with emptying bowel or constipation.
• Uncomfortable sex or a lack of feeling during intercourse.

Some women may not experience any symptoms of pelvic organ prolapse.

Risk factors of pelvic organ prolapse

Several factors can contribute to the weakening of the pelvic floor and increase the risk of developing pelvic organ prolapse. These factors can collectively impact the strength and integrity of the pelvic floor, potentially leading to pelvic organ prolapse.

• Pregnancy and childbirth, particularly in cases of prolonged or difficult labour, the delivery of a large baby, or multiple births.
• Ageing and going through menopause.
• Overweight.
• Chronic constipation or a long-term health condition that leads to frequent coughing and straining.
• Undergoing a hysterectomy.
• Engaging in a profession that involves heavy lifting.

Diagnosis of pelvic organ prolapse

Your doctor will conduct a pelvic examination, which includes an internal examination of your vagina. The internal examination is similar to a cervical smear test, where your doctor would insert a speculum into your vagina to hold and see if there is a prolapse. It typically takes only a few minutes. Your doctor will discuss with you should you require further tests.

Treatment options for pelvic organ prolapse

If pelvic organ prolapse is not causing you significant discomfort, treatment may not be necessary. Self-help measures that you can consider to potentially improve your well-being or functionality include increasing dietary fibre, staying well-hydrated for more effortless bowel movements, losing weight to alleviate pressure on the pelvic organs, and engaging in exercises (yoga and Pilates) to build core strength.

If treatment is necessary, it will be determined by various factors, including the type of prolapse, severity of symptoms, age, underlying health issues, and sexual activity status.

Treatment for pelvic organ prolapse may include:

• Vaginal pessary: A silicone device that is inserted into the vagina to support pelvic organs. This can be used to alleviate the symptoms of moderate or severe prolapses, and they serve as an alternative for individuals who cannot or would prefer not to have surgery. It is necessary to replace or remove, clean, and reinsert the pessary every 4 to 6 months, which can be done by a doctor, nurse, or yourself.

• Pelvic floor exercises: Kegel exercises helpstrengthen the pelvic floor muscles and provide some form of relief to symptoms.

• Vaginal hormone treatment (oestrogen): This is recommended for menopausal women as tablets, cream or a ring that is inserted into the vagina to reduce discomfort.

Surgery may be considered if non-surgical treatment does not improve symptoms of prolapse. However, surgical procedures should be delayed in women who still wish to have children, as childbirth after surgery may increase the chance of a prolapse returning. 

• Obliterative surgery (colpocleisis): In this surgery, your doctor would close off the vaginal opening. It is typically considered for women with advanced prolapse after other interventions have proven ineffective and when they are confident that they no longer wish to engage in sexual activity in the future.
• Reconstructive surgery: This is the most common type of surgery for pelvic organ prolapse. The objective of reconstructive surgery is to restore pelvic organs to their original position. Certain types of reconstructive surgery are performed via a vaginal incision, while others involve incisions in the abdomen or with laparoscopy.

Prevention of pelvic organ prolapse

Steps that you can take to lower your risk of developing pelvic organ prolapse include maintaining a healthy weight or working towards weight loss if you are overweight.

Including fibre-rich foods in your diet can help prevent constipation and reduce the need to strain during bowel movements, potentially lowering the risk of pelvic floor prolapse.

Avoid smoking because smoking can lead to chronic coughing, which places strain on the pelvic floor muscles.

Make an appointment at Gleneagles Hospitals

If you suspect that you are experiencing symptoms of pelvic organ prolapse, get in touch with us to find out more about our Obstetrics & Gynaecology Servicesat your nearest Gleneagles Hospital.

You may also contact the Health Screening Centre at your nearest Gleneagles Hospital for health screening appointments