What is pelvic organ prolapse?
Pelvic organ prolapse occurs when a pelvic organ – such as your bladder, womb (uterus) or bowel – drops from its normal position in your lower belly and presses against the walls of your vagina.
More than one pelvic organ can prolapse at the same time. Organs that can be involved when you have pelvic prolapse include the:
- Urethra/bladder
- Uterus/cervix
- Rectum/small intestine
How common is pelvic prolapse?
Up to 40 per cent of women have a mild prolapse with minimal or no symptoms. Overall, about one in 9 women will ever need surgery in their lifetime.
What causes a pelvic organ to prolapse?
Vaginal birth
Pelvic organ prolapse is most often related to a history of vaginal childbirth. Normally your pelvic organs are kept in place by the muscles and tissues in your lower belly. During childbirth, these muscles and tissues can get weakened or stretched. If they don't recover, the pelvic organ support may be affected.
Increased abdominal pressure/straining
Pelvic organ prolapse can be made worse by anything that puts pressure on your belly, such as:
- Being very overweight
- Prolonged cough
- Frequent constipation
- Pelvic tumours
Postmenopausal hormonal changes
Older women are more likely to have pelvic organ prolapse. This is because a reduced level of the female hormone oestrogen after menopause, causes thinning and weakening of the pelvic connective tissue.
Genetic factors
Some women may have an inherited risk for prolapse, while others have some conditions that affect the strength of connective tissue, leading to pelvic organ prolapse.
What are the symptoms?
With mild prolapse, there may be no symptoms.
Symptoms in more severe cases of pelvic organ prolapse may include:
- A heavy dragging feeling in the vaginal region
- Feeling a pull in the groin area or pain in the lower back
- Noticing a lump outside the vaginal opening
- Releasing urine without meaning to, needing to urinate a lot or incomplete bladder emptying
- Having problems with bowel movement, such as constipation or incomplete emptying
- Having vaginal discomfort during sexual intercourse.
How is pelvic organ prolapse diagnosed?
Your doctor will ask questions about your symptoms and assess your risk factors for prolapse. Your doctor will need to perform a general examination and a pelvic examination to look for any pelvic organ prolapse.
Management and treatment of pelvic organ prolapse
Treatment will be based on which pelvic organs have prolapsed, how severe your symptoms are and whether other medical conditions are present.
If your symptoms are mild, changes to your lifestyle may be effective in slowing down the progression of prolapse. These lifestyle changes include the following:
- Do pelvic strengthening exercise (Kegels exercise) every day. These exercises help strengthen the muscles of the pelvis.
- Maintain an ideal body weight. Excessive weight gain increases pressure on the pelvic floor
- Avoid lifting heavy things.
- Quit smoking. The chronic cough associated with smoking may worsen an existing prolapse.
- Correct constipation. Increase your daily consumption of dietary fibre to combat constipation. The chronic straining caused by constipation weakens and damages the connective tissue and muscles in the pelvis.
- Cut back on caffeine if you have a urinary problem. Caffeine acts as a diuretic and can cause you to urinate more often.
Non-surgical treatment
A pelvic support device in the form of a pessary can be fitted to support the prolapsed organ. It is a removable device that is placed in your vagina and helps to hold the pelvic organ in place. Regular change of the pessary is needed to prevent infection. A pessary is suitable in a woman who has not completed her family, or is not fit for surgery.
Surgical treatment
You may want to consider surgery if:
- The prolapsed organ is causing you a lot of discomfort.
- You have a problem with your bladder or bowel control.
- The prolapse makes it difficult for you to have sexual intercourse.
- Non-surgical options have failed to improve your symptoms
Types of surgery for pelvic organ prolapse include:
- Surgery to repair the vaginal tissue that supports a prolapsed organ, such as the bladder/rectum
- Surgery to hitch up the upper part of the vagina
- Surgery to remove the prolapsed womb, especially if the womb is diseased or the family is complete
- Surgery to treat urinary leakage
- Surgery to close up the vaginal canal
Conclusion
Pelvic organ prolapse is common and often involves more than one organ. In mild prolapse, preventive measures are available to slow down its progression. Surgery may be indicated in symptomatic women when conservative management does not help.
How to find out more?
Although pelvic floor disorders are rarely life-threatening, they can nonetheless rob patients of their dignity and self-confidence. The SGH Pelvic Floor Disorder Service is here to help affected individuals ‘stay in control’ and improve their quality of life.
For more information, please contact the SGH Call Centre at 63214377 or 63213616 and ask for the Pelvic Floor Nurse in charge.
About the Pelvic Floor Disorder Service (PFDS) at SGH
The SGH PFDS is a joint initiative by the Departments of Colorectal Surgery, Urology and Obstetrics & Gynaecology. It was established in 2008 to provide integrated and holistic care to patients with pelvic floor disorders.
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