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Pelvic Organ Prolapse (POP)

Pelvic organ prolapse affects one-third of all women. It can be very uncomfortable and interfere with normal activities. It is so uncomfortable and personal that many women will suffer silently for years before seeking medical intervention. As such there is a general lack of knowledge and information. Fortunately, there are very effective treatment options available to you by experienced board certified urologists and urogynecologists.

What is Pelvic Organ Prolapse (POP)?

The pelvic organs include the cervix, uterus, vagina, small bowel, rectum and bladder.  These organs are held in place by a hammock like structure (or sling) comprised of a group of muscles.  This structure of muscles is called the pelvic floor. Damaged, torn or stretched muscles will become weak causing the structure to prolapse. Childbirth, age, constipation, cancers, hysterectomy, pelvic surgery or excessive weight are common stresses to the muscles that lead to prolapse. Some women may be genetical predisposed to having weaker muscles. Pelvic organ prolapse is is often referred to as “pelvic prolapse” or “vaginal prolapse”.

What causes Pelvic Organ Prolapse?

Pelvic organ prolapse is very common in women with the incidence increasing with age and after having children. Things that cause POP include:

  • Pregnancy and childbirth can cause injury to the muscles of the pelvic floor
  • Genetics including family members that have had POP
  • Caucasian women are more likely to develop POP
  • Smoking increases chances of developing POP
  • Pelvic floor injury caused by intense heavy lifting, childbirth and surgery
  • Obesity – obese woman have a 40% – 75% increased chance
  • Menopause and aging

Although childbirth is a big contributor, many women who have had multiple births will not experience POP.

What are the risk factors of Pelvic Organ Prolapse?

Things that may increase the probability of pelvic organ prolapse to occur include:

  • Genetics
  • Number of and types of delivery during childbirth
  • Weight or obesity
  • Smoking
  • Chronic constipation

 

Symptoms of Pelvic Organ Prolapse

The most common symptoms include:

  • Pelvic or vaginal pressure
  • A feeling that “something is falling out” (this is usually a prolapsing cervix and uterus)
  • Vaginal cramping, pain or low back pain
  • Difficulty emptying the bladder or rectum and the need to splint, or push the prolapse back in
  • Painful intercourse

It should be noted that often times there will not be any symptoms of POP.

How to Diagnose Pelvic Organ Prolapse

Diagnosis may include:

  • Pelvic exam
  • Urinary tract x-ray
  • CT scan
  • Ultrasound
  • MRI

Types of Vaginal Prolapse

There are 3 main types of vaginal prolapse.

Anterior Vagina Wall Prolapse (cystocele or stress incontinence):

This occurs at the top of the vagina. If the muscles that support the bladder fail or detach the bladder can drop or fall down to the vagina. This condition can cause recurrent bladder infections, frequency and loss of bladder control. Stress urinary incontinence is another symptom of prolapse.

Posterior Wall Prolapse (Rectocele or Enterocele):

When the support tissue between the vagina and the rectum is damaged, stretched or detaches it can cause the intestines to prolapse or fall out.

Apical or Uterine Prolapse (Vaginal Vault Prolapse):

This is when the upper portion of the vagina can lose its shape and support and can drop down into the vaginal canal or outside of the vagina. In can occur at the same time as uterine prolapse.

What are the Treatment Options for Pelvic Organ Prolapse?

Which treatment will depend on the severity and symptoms. Treatment options include:

1. Pelvic strengthening or physical therapy such as Kegel exercises.

2. Pessary – A small plastic device used to provide support to organs normally supported by the pelvic floor.

3. Surgery – There are several options depending on patient goals and particular prolapse. In general, we can repair the vagina prolapse through the vagina, or transvaginal reconstruction versus an abdominal approach. Typically, we offer a Robotic assisted abdominal approach rather than repairing through an incision. This reduces recovery time.

When is it appropriate to consider surgery?

When pelvic prolapse is effecting quality of life and causing pain, surgery may be needed. Common symptoms that may require surgery include:

  • Feeling as if something is “falling out”
  • Bulge inside our even protruding outside of the vagina
  • Pelvic pressure when lifting or straining
  • Painful intimacy
  • Difficulties with regularity and bowel movements
  • Incontinence urge or frequent urination

If you are experiencing any symptoms or have concerns there are many treatment options available to you. Suffer no more. To schedule an appointment call us at (425) 454-8016.

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