Pelvic organ prolapse isn’t uncommon. By the age of 80, more than one in 10 women will have had surgery at some point in their life to treat prolapse. Quite often, the most common symptom women complain of is feeling a bulge or lump from down below. Dr Avanti Patil, consultant gynaecologist explains more.
What is pelvic organ prolapse (POP)?
Your pelvic floor consists of layers of muscles and tissues that stretch - much like a hammock - from your tailbone to your pubic bone in front. For women, these muscles and ligaments keep the pelvic organs, such as the bladder, womb and bowel in place. If these support structures are weakened, due to excessive stretching, then the pelvic organs can protrude into the vagina. This is known as pelvic organ prolapse, or POP for short.
How common is POP?
It’s hard to know how many women are affected by prolapse since many decide not to consult their doctor about it. However, it does seem to be very common, especially in older women. It’s believed that around half of women over the age of 50 will show symptoms of POP.
What can cause POP?
When there is any kind of increased pressure within the abdomen it can lead to pelvic organ prolapse. Often, it’s a combination of these following factors that can lead to the condition:
- Pregnancy and childbirth
- Being overweight
- Ageing (mostly after the menopause)
- A persistent cough
- Heavy lifting
- After a hysterectomy (the top of the vagina can prolapse)
Are there different types of prolapse?
Depending on the organ that’s protruding into the vagina, there are different types of prolapse.
- Cystocele — the bladder bulges into the front wall of the vagina
- Uterine prolapse — the uterus drops down into the vagina
- Rectocele — the rectum bulges into the back wall of the vagina
It is estimated that one in 10 women who have undergone a hysterectomy experience the top of the vagina prolapse down.
What are the symptoms?
The type and severity of prolapse determine the symptoms. The commonest symptoms include:
- the sensation of a lump ‘coming down’ causing discomfort inside the vagina
- frequent urination or being unable to empty the bladder.
- urinary leakage when coughing, sneezing or laughing
- frequent cystitis due to bladder prolapse
- a lack of sensation or discomfort during sexual intercourse
- constipation or incomplete bowel emptying
- having to push back the prolapse to let stools pass
- low back pain
It is important to note that some patients don’t experience any symptoms at all and the prolapse may only be discovered following a vaginal examination by a specialist, such as during a smear test. It’s also worth noting here that a small prolapse can often be considered normal.
Is treatment always necessary?
No. If you only have a mild prolapse or have no symptoms from your prolapse, you may choose to just wait and see what happens. The following may ease your symptoms:
- Pelvic floor exercises – these can help strengthen your pelvic floor muscles. A physiotherapist who specialises in prolapse management can guide you.
- Lifestyle changes - lose weight, manage any chronic coughs that appear by stopping smoking, and avoid constipation, heavy lifting or high-impact exercises.
- Vaginal oestrogen cream - to reduce the thinning of the pelvic tissues.
What are the options for treating POP?
Your treatment options depend on which kind of prolapse you have and how severe it is. Treatment options include pessaries, physiotherapy and surgery.
A pessary is a prosthetic device – usually made of plastic or silicone - that fits into the vagina to support the pelvic organs and reduce protrusion of pelvic structures. If you don’t want to have surgery, then this might be a good option for you, especially if you want to have children in the future or have an underlying medical condition that makes surgery risky. Pessaries should be changed and cleaned regularly, which your doctor or nurse can do for you if you prefer.
The type of surgery you’ll undergo depends on your individual case: the type of prolapse you have, your age, overall health, how sexually active you are and whether you plan to have children in the future. Some women decide to postpone surgical interventions until their family is complete. The main goal of surgery is to relieve your symptoms and make sure that your bladder and bowel both function normally afterwards. If you’re sexually active, every effort will be made to ensure that your sex life is as enjoyable as ever after the operation.
Very recently, several new procedures have been developed where a mesh is sewn into the vaginal walls for extra support. However, the actual risks and benefits of using a mesh are still not clear, so it isn’t always the preferred method of choice.
Pelvic organ prolapse isn’t a life-threatening condition, although it may affect your quality of life. Not everyone needs to undergo surgery, but you’ll probably want to consider surgery if all other treatments have not helped so far. Your gynaecologist will always talk to you about the pros and cons of each procedure so you can decide whether you wish to go ahead with your operation.
Dr Avanti Patil is a highly qualified consultant gynaecologist who specialises in pelvic organ prolapse. If you believe you are suffering from this condition, visit her profile and book a consultation to talk about your options for treatment.