Pelvic Organ Prolapse (POP): What You Can Do About It

Pelvic organ prolapse is the medical name for the dropping of any of the organs in your pelvis, in which they then place pressure against the walls of your vagina. This dropping of organs typically occurs because the muscles which hold the pelvic organs in place become weak or stretched from childbirth, surgery, or simply aging.

A large percentage of women have pelvic organ prolapse to one degree or another at some point in their lives. It can be both uncomfortable and painful, however it is not considered to be a severe health risk. In some cases, the dropping never worsens, and some women will find that it actually improves over time.

It is important to note that more than one organ can drop and cause a prolapse at the same time. The organs that are located in your pelvis are:

• Bladder:
  (This is the most common organ to suffer prolapse.
  When the bladder drops it can also cause urinary incontinence.)
• Uterus
• Vagina
• Urethra
• Rectum
• Small bowel

What Causes The Organs To Drop?

The most commonly noted cause of pelvic organ prolapse is the strain experienced during childbirth.

Your pelvic organs are held in place by the surrounding tissues and the muscles in your lower abdomen. The pushing and pressures of childbirth can stretch these muscles and weaken them. When this happens it is possible for your pelvic organs to drop because they are no longer being properly held in place by the weakened muscles.

Another common cause of organ dropping is surgery. A hysterectomy is the removal of the uterus and after this removal the remaining pelvic organs no longer have the necessary support to remain in place.

Anything the puts pressure on your abdomen can cause an organ prolapse. Some common factors are:

• Extreme excess weight
• A persistent cough
• Constipation that occurs frequently
• Tumors of any of the pelvic organs

As we age, our muscles naturally stretch and weaken, so it is more common in older women. It also appears to be genetically related and has been known to run in families.

Symptoms Commonly Associated With Prolapsed Organs

Symptoms include:

• Feelings of pressure in the lower abdomen caused by the pelvic organs pressing against the vaginal walls.
• A feeling of fullness in the lower abdomen.
• A feeling that something is falling from your vagina.
• Lower back pain or a pulling sensation in the groin area.
• Frequent urination or urinating involuntarily.
• Pain in the vagina during sexual intercourse.
• Frequent constipation or other bowel problems.

Diagnosing Organ Prolapse

A prolapse can be difficult to diagnose. In some cases, the prolapse does not cause any symptoms, and is discovered during a routine gynecological exam. Some women may be aware that some type of problem exists, but may be uncertain of the cause or exact location.

When your doctor suspects that a pelvic organ prolapse is present, he or she will ask questions regarding your symptoms, your pregnancy and childbirth history, other health problems you have experienced, and will perform a physical exam that includes a pelvic exam.

If the exam indicates that it is present, there are several tests that can be done to confirm the presence of the prolapse. These tests include:

• Cystoscopy: This is a test that shows your doctor the urethra and the inner lining of the bladder.
• Intravenous pyelogram (IVP): This is an x-ray that will show the position, size, and shape of the bladder, urethra, ureters, and kidneys.
• Computed tomography scan (CT scan): This is a more detailed x-ray that gives the doctor a detailed view of the organs within the pelvic region.
• Urodynamic tests: This test shows how your body stores and releases urine.

Organ prolapse is described by doctors via a classification scale. By identifying the level of the prolapse, the doctor can determine the appropriate treatment to ensure long term success. One of the most common classification systems uses the distance of the lowest part of your pelvic organs to the vaginal opening.

Available Treatments

Treatment will vary based on which organs are prolapsed and to what degree they are prolapsed. The severity of your symptoms can also play a role in the treatment options available.

When symptoms are mild, doctors will normally recommend that you make certain changes to your lifestyle. Changing habits to create a healthier you can relieve many of the symptoms of a serious prolapse. Kegel exercises are often recommended to strengthen the pelvic muscles. Losing weight can relieve pressure on the pelvic organs.

Limiting the intake of diuretics such as caffeine and alcohol can help by reducing the frequency of urination.

You will also be cautioned to avoid heavy lifting which can further strain your pelvic muscles.

If lifestyle changes are not sufficient to treat your symptoms, your doctor may recommend you be fitted with a device called a pessary, which will help relieve the pressure and pain associated with your prolapse. The pessary is a removable device that is inserted into the vagina and holds the pelvic organ in place.

Those with severe prolapsing symptoms may find they are unable to keep a pessary in place.

A final option for treating a prolapse is surgery.  If you are still of childbearing age and plan of having children, you may want to hold off on using the surgery option. Childbirth can often cause the prolapse to return.

The decision regarding whether or not to have surgery is dependent on the severity of your symptoms, and how much impact they have on your lifestyle. Take the following points into consideration when thinking of surgery:

• When you only have mild symptoms surgery is typically unnecessary. Doctors only recommend surgery when the prolapse seriously affects your daily life.
• There are a variety of different surgeries available for organ prolapse. The type of surgery that is appropriate will depend on which organ(s) are prolapsed.
• Those who are no longer able to enjoy a normal life, have bowel or bladder problems, or experience constant pain are best suited to surgery.
• While surgery will correct your current prolapse, another prolapsed can occur after your surgery. In some cases, the surgery will aggravate a prolapse in another organ.
• Consider changing your lifestyle to relieve the symptoms before considering surgery.

Some of the types of surgery used for pelvic organ prolapse include:

• Repairing the tissue that surrounds the prolapsed organ.
• Repairing the tissue around your vagina.
• Closing the opening of your vagina.
• A hysterectomy to remove your uterus.

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Surgery is not always the best solution. Additionally, prolapse can return even after you have had surgery to correct it. Consult with your doctor to determine all of your options before opting for pelvic organ prolapse surgery.

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