Pelvic Organ Prolapse
Pelvic organ prolapse (vaginal prolapse) is a common condition in women, occurring when a pelvic organ shifts from its normal position to push against the vaginal walls. This movement causes pressure, stretching and pain. Most frequently, pelvic organ prolapse occurs after childbirth, menopause, or a hysterectomy when the muscles and ligaments supporting a woman's pelvic organs become more lax.
Pelvic organ prolapse can involve a number of different organs, including the vagina, the uterus, the bladder, the small intestine or the rectum. In rare cases, the urethra may also prolapse. Although pelvic organ prolapse is usually a benign condition, if it worsens is can lead to increased pain and disability and may require surgical repair.
Risk Factors for Pelvic Organ Prolapse
Most commonly, pelvic organ prolapse occurs after the straining of pelvic muscles during a vaginal childbirth delivery. Risk factors for this condition include the following:
- Chronic cough, smoking, lung disorders
- Frequent constipation
- Pelvic tumor
- Low estrogen levels
- Neuromuscular conditions or spinal cord injury
Aging, which leads to weakening muscles, contributes to pelvic organ prolapse. Family history is also a contributing risk factor.
Symptoms of Pelvic Organ Prolapse
Women who have a pelvic organ prolapse may experience some or all of the following symptoms:
- Frequent urination or incontinence
- Pain during sexual intercourse
- Pressure in the lower abdomen or against the vaginal wall
- Pulling or stretching in the groin or lower back
- Needing to press on the back of the vaginal wall to move the bowels
- Sensation that something is protruding from the vagina
- Vaginal spotting or bleeding
While any of these symptoms may indicate a problem with pelvic organ prolapse, the most common first indicator of this disorder is the feeling of pressure in the lower belly and inside the vagina, particularly when standing, lifting or jumping.
Diagnosis of Pelvic Organ Prolapse
The gynecologist is usually able to diagnose this condition through a pelvic examination, medical history, and review of symptoms. Tests that may be administered to confirm a diagnosis of pelvic organ prolapse include:
- CT scan
- Intravenous pyelogram
- Urodynamic tests
Once pelvic organ prolapse has been diagnosed, the problem is staged according to its level of severity.
Treatment of Pelvic Organ Prolapse
Depending on the location and staging of the pelvic organ prolapse, and upon which organs are prolapsing, treatment methods may vary.
Patients experiencing only mild symptoms may be instructed to lose weight, reduce their caffeine intake and perform Kegel exercises to strengthen their vaginal muscles. Estrogen vaginal cream may be prescribed for postmenopausal women because this hormone helps to strengthen vaginal tissues, lessening atrophy. This may prevent further prolapse and may assist the patient's comfort in using a pessary, a device designed to support the vaginal walls.
When pelvic organ prolapse cannot be controlled with lifestyle changes or the insertion of a pessary, surgery may be required to repair one of the following:
- Vaginal wall (vaginal vault suspension)
- Urethra (urethrocele)
- Bladder (cystocele)
- Rectum (rectocele)
- Small bowel (enterocele)
In some cases, where the uterus is exerting undue pressure on the vagina, a hysterectomy may be recommended. In rare cases, the vaginal opening is closed entirely during a procedure known as a vaginal obliteration.
While it is often necessary to treat pelvic prolapse because of its tendency to worsen over time, it is usually best to treat the condition as conservatively as possible.