Pelvic Organ Prolapse

Almost half of women above the age of 50 suffer some degree of pelvic organ prolapse.

Pelvic organ prolapse occurs in women when pelvic floor muscles don't support the uterus, bladder, ureter, vagina, cervix, small intestines and/or the rectum. When these organs drop out of position, it's called a prolapse.

• The bladder is the organ most prone to prolapse.
• Men are less likely to experience this problem, but occasionally, their bladder or rectum will drop down.

Symptoms

Symptoms of pelvic organ prolapse may include:

• Bladder protrudes through the vagina
• Feeling of pressure through your lower abdomen/pelvic area
• Urine incontinence
• Inability to have sex

Causes

These pelvic floor muscles get stretched or torn during delivery. Women who have had lots of children are the most likely to experience prolapse. These muscles may also weaken as a woman gets older. Other causes or predispositions include:

• Pelvic radiation
• Family history
• Surgery in the pelvic area
• Being Caucasian
• Constipation accompanied by straining and pushing
• Smoking
• Heavy lifting
• Prior hysterectomy
• Obesity

Diagnosis

A physical exam is required for diagnosis. You might be asked to bear down to see the extent of prolapse. Other tests help your doctor evaluate your individual prolapse situation. These tests include:

• Bladder function test. Evaluates whether your urine leaks when your bladder is put back into place.
• Pelvic floor strength tests. During the physical exam, your doctor will see how strong your muscles and ligaments are.
• MRI. Magnetic imaging provides your doctor a detailed picture of your entire pelvic area and the locations of each organ. An MRI is useful in complex situations.
• Ultrasound. This provides images of your bladder and kidneys and the muscles of your anus. Again, this test is reserved for complex cases.

Other advanced tests may be ordered to determine how severe the prolapse is so that your medical team can plan the best treatment to prevent recurrence.

Treatments

Non-surgical treatments include pelvic floor exercises, called Kegels. The patient contracts and relaxes the pelvic floor muscles to strengthen them. Bio-feedback allows patients to learn to exercise the exact areas which need strengthening. Other potential non-surgical treatment options may be recommended:

• A pessary inserted into the vagina holds the prolapsed organs in place.
• Losing weight may help some patients.
• Treating constipation and adding fiber to a patient's diet may provide significant relief.
• Behavior modification, including avoiding heavy lifting and bending over.

Hormone therapy may be used before surgery to help strengthen weak muscles and help with vaginal dryness. Estrogen therapy is not appropriate for every woman.

Surgery is recommended when the prolapse is severe or causes major pain. Patients and their physicians consider multiple factors before deciding on surgery, including sexual activity and if the patient wants more children.

Depending on the type of repair, surgery may be through the vagina or abdomen. It may be done laparoscopically or robotically-assisted. An open incision allows a surgeon to tack the vagina to the tailbone. Mesh is sometimes used. It's important to realize that surgery only corrects the bulge, but does not address the underlying cause which is weak pelvic floor muscles. Prolapses may recur.