Pelvic Organ Prolapse: Types, Causes, Symptoms, Diagnosis, Treatment, Recovery, Complications
What Is Pelvic Organ Prolapse?
Any type of weakness during pelvic relaxation which results in the tissues of the bladder, rectum, or the uterus to bulge and prolapse into the vagina is termed as Pelvic Organ Prolapse. As of late, this condition has become a talking point of women health, and physicians routinely conduct screenings on their patients for Pelvic Organ Prolapse. By the time a female reaches the age of 75 she has had surgery to correct Pelvic Organ Prolapse.
What Are The Different Types Of Pelvic Organ Prolapse?
Pelvic Organ Prolapse is classified based on the parts of the vagina they affect. The different types of Pelvic Organ Prolapse are illustrated below:
- Cystocele And Urethrocele: A cystocele is a condition in which there is protrusion of the bladder into the front wall of the vagina. Urethrocele is a condition in which the urethra protrudes into the front wall of the vagina.
- Rectocele: This is a condition in which the rectum protrudes into the back wall of the vagina resulting in significant difficulty with passing stools.
- Uterine Prolapse: In this condition, there is a prolapse of the uterus into the vagina. Females who have had hysterectomy in the past can develop a condition called vaginal vault prolapse in which the top part of the vagina protrudes into the lower part of the vagina.
What Increases The Risk Of Having A Pelvic Organ Prolapse?
Some of the risk factors for Pelvic Organ Prolapse are as follows:
Labor And Delivery: Females who have increasingly long hours of labor pain are at risk for developing this condition. Also, females who give birth to a baby who is of a relatively large size are at increased risk for developing this condition.
Obesity: Overweight females tend to put excessive pressure on the abdomen thus putting them at an increased risk for Pelvic Organ Prolapse.
Smoking: Chronic smoking produces increased incidences of coughing which again puts increased pressure on the abdomen resulting in increased risk for Pelvic Organ Prolapse.
Constipation: Chronic constipation tends to cause excessive pressure on the vaginal wall thus increasing the risk for development of Pelvic Organ Prolapse.
Occupational Hazards: Women who work in industries which require them to lift heavy items on a routine basis also put extra pressure on the abdomen and increase the risk for developing Pelvic Organ Prolapse.
Surgical Procedures: Procedures like hysterectomy may lead to weakness of the pelvic structures thus increasing the risk of Pelvic Organ Prolapse.
Medical Conditions That Can Cause Pelvic Organ Prolapse: Certain medical conditions, especially of the nervous system like multiple sclerosis, muscular dystrophy etc. increase the risk of Pelvic Organ Prolapse significantly. In fact studies suggest that Pelvic Organ Prolapse occurs more in females who have these conditions.
Genetic Factors As A Cause For Pelvic Organ Prolapse: Studies have suggested a genetic link towards development of Pelvic Organ Prolapse in that weakness of the supportive tissues of pelvis tends to be passed on from one generation to the other and a female with a first degree relative like mother or sister with Pelvic Organ Prolapse is more at risk for getting this condition.
What Are The Causes Of Pelvic Organ Prolapse?
The pelvis is supported by the pelvic floor muscles, the pelvic fascia, and ligaments. When there is weakness of the pelvic floor muscles there is increased pressure on the fascia and the ligaments which eventually leads them to break resulting in the pelvic organs to prolapse and apply pressure on the vaginal wall. Females who have had multiple childbirths tend to have weak pelvic floor muscles and thus are at increased risk for developing this condition. Increased body weight, surgical procedures to the pelvic area, disorders of the connective tissues also lead to weak pelvic floor muscles and eventual development of Pelvic Organ Prolapse.
What Are The Symptoms Of Pelvic Organ Prolapse?
The symptoms of Pelvic Organ Prolapse depend on type of prolapse that a female has. Mild cases of prolapse may not produce any symptoms at all whereas severe cases of prolapse may have different types of symptoms some of which are mentioned below.
The most common symptom of Pelvic Organ Prolapse is a feeling of pain and pressure with bending, leg weakness, and low back pain. If the prolapse is caused due to cystocele or urethrocele then it can cause stress incontinence and difficulty initiating urination. If the prolapse is caused due to a rectocele then the patient may experience difficulties with having a bowel movement resulting in pain and chronic constipation. Pelvic Organ Prolapse may also result in problems with sexual activity due to severe pain.
How Is Pelvic Organ Prolapse Diagnosed?
Pelvic Organ Prolapse is quite a difficult medical condition to diagnose and is often diagnosed on routine examinations. The patient may be experiencing symptoms but she may be not sure of the exact location of the symptoms thus finding it difficult to tell it to the physician. In case if a Pelvic Organ Prolapse is suspected then a detailed history will be taken to include a history of childbirths along with any complications during childbirths. The physician will then conduct a detailed pelvic exam. The following tests will then be conducted in order to find out the type of prolapse the patient is experiencing.
- Cystoscopy: This will allow the physician to investigate the area of the bladder and urethra looking for any abnormalities.
- Intravenous Pyelogram: This test will show whether the kidney, bladder, ureter, and urethra are in their normal anatomical positions.
- CT Scan Of The Pelvis: This will be done to look at the pelvic areas closely to look for any evidence of prolapse.
- Urodynamic Studies: This study will be done to look whether the body is storing and releasing urine normally or not.
What Are Treatments For Pelvic Organ Prolapse?
Treatment for Pelvic Organ Prolapse is usually not required in mild cases even though the patient will be advised to stay away from risk factors which may increase their symptoms. In case if the patient is overweight then she will be recommended to lose her weight. She will also be advised not lift heavy items and if she is a smoker she will advised to quit smoking Since Prolapse is not a condition which advances and worsens with time hence aggressive treatment is not required unless the symptoms become real bad.
In cases where the symptoms experienced by the patient are really severe then the only treatment for Pelvic Organ Prolapse is a surgery to correct the prolapse but this is done only as a last resort. Some of the noninvasive treatments for Pelvic Organ Prolapse are:
Kegel Exercises For Pelvic Organ Prolapse: Patients with Pelvic Organ Prolapse are advised to perform Kegel exercises regularly. These exercises strengthen the pelvic floor muscles. If it is done regularly then it goes a long way in preventing the prolapse from worsening.
Pessary Placement For Pelvic Organ Prolapse: This is done for patients who are deemed not to be good surgical candidates or who want to avoid surgical procedures for Pelvic Organ Prolapse. A vaginal pessary is a small device which is put in the vagina to support the pelvic region.
Surgical Treatment For Pelvic Organ Prolapse: Surgery for pelvic organ prolapse is done as a last resort. Before the surgery is undertaken, a detailed preoperative pelvic examination will be performed to confirmatively identify the location of the prolapse and the structures which are prolapsing. The surgical technique used to correct Pelvic Organ Prolapse is called pelvic Reconstruction. This procedure may be done through the vagina or the abdomen. An incision is made and the surgeon repositions the prolapsed structures into their normal anatomical positions. Any defects caused by the prolapse to the vagina are also repaired during this procedure.
Recovery Period After Surgery For Pelvic Organ Prolapse:
The postoperative stay is usually for two to three days. The patient can return to normal activities in a few weeks.
Complications Following Surgery For Pelvic Organ Prolapse:
Some of the possible complications of Pelvic Reconstruction surgery are urinary tract infection, urinary incontinence which may be permanent or temporary, infection, bleeding, and in rare cases injury to the urinary tract which may require additional surgery. Some patients may experience pain with sexual activity but this is temporary.
Can Pelvic Organ Prolapse Recur Following Surgery?
Pelvic Organ Prolapse has a tendency to reoccur especially in cases of cystocele, although with improved surgical techniques utilized the recurrence rate is dropping down significantly. Also, after undergoing the surgery if the patient avoids stressful activities like heavy lifting, straining during a bowel movement, and diligently performs Kegel exercises then the chances of recurrence of Pelvic Organ Prolapse become significantly less.