What is Pelvic Organ Prolapse ?
Pelvic organ prolapse is the herniation or downward displacement of the intra-abdominal organs through the vaginal walls. Pelvic organ prolapse is a common health problem affecting millions of women worldwide. Although many women recognise and report that this condition affects their daily activities and sexual function, they do not consult a physician or express their complaints.
Pelvic organ prolapse occurs as a result of impairment of the pelvic floor muscles, which support and hold the intra-abdominal organs. When these muscles become excessively lax, the intra-abdominal organs move downwards, resulting in prolapse through the vagina. Depending on the organ affected, physicians use different terms to describe these conditions:
- Bladder prolapse – cystocele
- Rectal prolapse – rectocele
- Uterine prolapse
Who Is Affected and What Are the Risk Factors?
- Having had multiple or difficult deliveries
- Giving birth to a large baby
- Persistent coughing, heavy lifting or chronic constipation
- Obesity
- Advanced age
What Are the Symptoms of Pelvic Organ Prolapse (Uterine Prolapse)?
Although pelvic organ prolapse may not always cause symptoms, patients may present with the following complaints:
- A palpable mass in the vagina or a sensation of fullness, pressure or heaviness
- Bowel symptoms: A sensation of incomplete emptying, a strong need to strain during defecation and the need to use a finger to assist with complete evacuation
- Urinary symptoms: Frequent urination, urinary leakage when laughing or coughing, a sensation of incomplete bladder emptying, the need to manually reduce the prolapse in order to initiate or complete urination and the need to change position in order to begin or complete urination
- Pain: Lower abdominal, back or lower back pain
- Sexual dysfunction
How Is Pelvic Organ Prolapse (Uterine Prolapse) Diagnosed? Is There a Test for It?
Following the examination, your physician will inform you whether any form of prolapse is present.
How Is the Examination Performed?
The patient is positioned on a gynaecological examination table, and the external and internal genital organs are examined. The physician asks the patient to strain in order to determine which organ or organs are responsible for the prolapse.
Patients who are unable to strain sufficiently are asked to cough. This increases intra-abdominal pressure and helps determine the severity of the prolapse.
Prolapse may worsen and become more pronounced due to gravity, daily activity and prolonged standing. In some cases, in order to assess the full extent of the prolapse, the physician may also examine the patient while she is standing and ask her to strain.
In the second stage, the examination is performed by inserting an examination instrument called a speculum into the vagina.
How Is Prolapse Treated?
If the patient has no complaints related to the prolapse, treatment may not be necessary. In patients with significant prolapse or related symptoms, surgical or non-surgical treatment methods may be selected.
The choice of treatment varies according to the patient’s age, the severity of the findings, whether sexual activity is continuing and whether the patient wishes to have children.
Non-Surgical Treatment Methods
- Vaginal pessary: This is the standard treatment for patients who do not undergo surgery. Its success depends on the patient. The patient must actively participate in pessary use and be willing to comply with hygiene and usage requirements. If a pessary of the appropriate size and type is fitted, the patient is more likely to adapt to its use. The size may need to be changed depending on age and weight gain or weight loss.
- Pelvic floor exercises: These are also known as Kegel exercises.
Surgical Treatment
Surgical treatment is based on repositioning the organs and strengthening the tissues that support them. Following the examination and diagnostic evaluations, the physician will discuss the surgical options with the patient and decide together which type of surgery should be performed.
What Happens If Uterine Prolapse Is Left Untreated? What Are the Possible Complications?
The patient’s complaints may persist and progressively worsen. With ageing, tissue elasticity may deteriorate, and the ligaments and muscles that hold the organs in place may weaken, increasing the severity of the symptoms.
Friction affecting the prolapsed organ and oestrogen deficiency may lead to bleeding, ulceration and infection in the protruding tissue.
How Can Uterine Prolapse Be Prevented?
- You should lose weight if you are overweight.
- If constipation is persistent, you should seek treatment and adjust your diet by increasing your intake of high-fibre foods.
- You should avoid activities that increase intra-abdominal pressure, such as heavy lifting and activities associated with chronic coughing.
- Regular Kegel exercises may be beneficial.
- Smoking should be discontinued.
Does Uterine Prolapse Affect Sexuality?
Sexual function may be affected if prolapse of the uterus or other pelvic organs causes painful sexual intercourse, if urinary leakage occurs during intercourse, if vaginal dryness is present or if the existing prolapse creates an obstruction within the vaginal canal that prevents sexual intercourse.
