Most women who’ve given birth know about basic pelvic floor health and the wonders Kegels can do, but pelvic organ prolapse (POP) may not be as familiar a term. Even though up to 40% of women develop some form of prolapse, many do not discuss prolapse with their clinicians until symptoms are well developed.
What is pelvic organ prolapse (POP)?
POP develops when weakened pelvic floor muscles allow the pelvic organs (i.e., uterus, bladder, and rectum) to protrude into or below the vagina. Your pelvic floor muscles are actually a layered network that create a “hammock” or sling-like support for your bladder, rectum, and uterus. When the supporting structure stretches or weakens, the organs begin to drop and press into the vaginal wall. There are three basic types of POP:
- Anterior wall prolapse, also known as a cystocele, describes a condition where the bladder bulges into or below the vagina.
- Uterine prolapse means the uterus has inadequate support and hangs down into and sometimes below the vagina.
- Posterior wall prolapse, also called a rectocele, occurs when the rectum pushes into the back of the vaginal wall.
Symptoms and stages of pelvic organ prolapse
Symptoms. One of the problems with prolapse is that women may not notice the problem until the condition has significantly progressed. Some symptoms to look out for include:
- Trouble urinating, caused by a kink in the ureter from a cystocele.
- Constipation, caused by a rectocele.
- Chronic urinary tract infections.
- A feeling of heaviness in the vaginal area resulting from the pressure of the imposing pelvic organ.
- A physical bulge protruding from the vagina.
Stages. Clinicians divide POP into four stages, depending on how far the organ has descended into or beyond the vagina.
- Stages 1 and 2 are considered mild and occur when any of the pelvic organs begin to fall into the vagina.
- Stage 3 is moderate and describes when a pelvic organ has fallen to or partly through the opening of the vagina.
- Stage 4 occurs when the organ is completely through the vaginal opening.
Risk factors for pelvic organ prolapse
Any condition that puts excessive pressure on the pelvic floor or compromises the muscle strength in your pelvic floor can contribute to developing POP. The largest risk of POP is women who’ve given birth, particularly vaginal deliveries. Other risk factors include:
- Obesity. Excess weight puts more pressure on the pelvic floor, which can weaken the support system for pelvic organs.
- Smoking. Chronic coughing can weaken your pelvic floor by putting repeated pressure on the muscles that support the bladder, uterus, and anus.
- Aging. Menopausal women’s pelvic floor muscles can deteriorate, either by stretching out over time or a decrease in muscle tone due to a lack of pelvic floor exercise.
- Constipation. Repetitive straining can weaken your pelvic floor.
Treatments for pelvic organ prolapse
After a pelvic exam, your doctor may suggest a variety of treatment depending on the severity of your prolapse. The main goal of any pelvic organ prolapse treatment is to create a stronger foundation for your pelvic organs. The type of prolapse and its cause will determine which treatment is right for you.
Conservative treatment involves strengthening the pelvic floor muscles by doing Kegel exercises. About 1 in 3 women do Kegels incorrectly, but there are external devices, like ELITONE, that do your Kegels for you.Pessaries
This vaginal device is an alternative to surgery. Pessaries are made of silicone or latex and range in shape from a ring (similar to a diaphragm) for mild prolapse to a cube for more severe cases. When inserted up into the vagina, a pessary helps support the protruding bladder, rectum, or uterus. Pessaries are fitted to the individual and require periodic removal and cleaning, either at home (mild prolapse) or in a doctor’s office (severe prolapse).Surgery
As a last resort, women undergo surgery to remedy the prolapse. The type of surgery depends on the diagnosis and can be done vaginally, laparoscopically, or abdominally.
- Hysterectomy removes the uterus so it no longer puts pressure on the vaginal wall.
- Cystocele/Rectocele repair surgically fixes the offending bladder or rectum, repositioning it and implanting a support material. Pelvic mesh surgery is a controversial topic, and the FDA banned some types of mesh.
- Closure of the vagina may be used in older patients. The vagina is sewn shut, eliminating the prolapse, as well as sexual intercourse.
What can I do about pelvic organ prolapse?
Women can take steps toward preventing POP by minimizing some of the risk factors (e.g., lose weight, stop smoking) and improving their pelvic floor health. One of the most important aspects of pelvic floor health is toning and strengthening your pelvic floor muscles. Kegel exercises play a big part in reinforcing these muscles, but they can be tricky to do effectively. Externally applied devices, like ELITONE, can do your Kegels for you, resulting in stronger pelvic floor muscles and fewer bladder leaks. For more information, check out these articles: