Pelvic Organ Prolapse - Treatment and Prevention

A prolapse is a drooping or descending of organs, in this case of the pelvic organs, which are the rectum, vagina, cervix, uterus, and the bladder. These are all supported by the pelvic floor muscles. These muscles allow you to be able to control your bladder and bowel movement. Additionally, they are important during birth, as they provide an extra support for the baby. The pelvic muscles are just as important when it comes to sexual intercourse for women and men. These muscles also help toward supporting the spine, together with your back and abdominal muscles.

These muscles and their tissues can weaken and no longer be able to complete their function. Once the muscles can no longer give the proper support, one or several organs of the pelvic descend, leading to the condition known as pelvic organ prolapse.

Risk factors

One of the most common reasons that lead to the pelvic organ prolapse is pregnancy. This is also why women are more affected by the condition than men. Other reasons may be obesity, constipation, chronic coughing, hysterectomy (removal of the uterus), etc. It's believed that genetics may also play a part in the condition developing.

The condition of pelvic organ prolapse may also be known in different terms, depending on the affected organ.

• A prolapse of the bladder is known as a cystocele.
• A descending of the urethra, urethrocele
• A prolapse of the uterine, simply known as uterine prolapse
• Prolapse of the small bowel, enterocele
• A rectum descending is known as rectocele

There are some conditions that may lead to pelvic organ prolapse, such as:

• Marfan’s syndrome
• Ehlers-Danlos syndromes
• Joint hypermobility syndrome

The condition sometimes shows no symptoms at all, while others may experience:

• Lower back pain
• Pain during intercourse
• Constipation
• Pressure or a feeling of being full in the pelvic region
• Bleeding or spotting outside the menstrual cycle
• Urinary incontinence, the involuntary excretion of urine

The symptoms that appear have to do with what organ is affected. Urinary incontinence refers to a bladder prolapse, constipation refers to rectum descending. Back pain is usually a symptom of small intestine prolapse, while uncomfortable intercourse may be a symptom of the uterine descending.

Diagnose

Pelvic organ prolapse diagnosis usually occurs after one or several symptoms start to show. However, it can also stand out during a routine exam, for example, a Pap smear. To confirm the diagnosis a CT scan, ultrasound or MRI of the pelvis may be needed, or an X-ray of the urinary tract.

As there are cases, where the condition does not show any symptoms, it is important to get your regular check-up done with a gynecologist. To exclude other issues, your doctor may also take a urine test, to make sure that there are no infections or insert a supra-pubic catheter; a small tube inserted into your bladder to search for other problems.

Treatment

There are some therapies, which are used to treat the pelvic organ prolapse. These include:

• a surgical removal of the affected organ, such as a hysterectomy, removal of the uterus.

These vary between a total hysterectomy, the complete removal of the uterus and a subtotal hysterectomy, the removal of the upper part of the uterus.

• pelvic floor reconstructive surgery
• a repair of the prolapsed organ (for example the bladder, known as cystocele repair; or of the rectum and small bowel, known as a rectocele repair)
• repair of the wall of the vagina, known as a vaginal vault suspension
• the closing of the vagina, known as vaginal obliteration
• Pessary treatment: a plastic device is inserted into the vagina and helps provide the necessary support for the floor organs. There are different kinds of pessaries and are used depending on the severity of the condition. They are all made out of silicone, but vary in shape ring, cube, disk-shaped, U-shaped. Your doctor will decide after examination, which pessary best fits you. It's important for it not to be too small, so that it falls out, or too big so that you feel discomfort. Some pessaries can be removed on your own for cleaning, while others need to be removed by a doctor. These appointments would take place every one to three months.
• In mild cases, Kegel’s exercise can lead to the adequate strengthening of the muscles, so that no other, more invasive therapies are needed. Kegel exercises can be done at anytime and anywhere. They are very simple and involve a simple movement as tightening of the muscles, holding for around five seconds and releasing. If you´re not sure what muscles you need to tighten, try stopping your urine stream. The muscles used for this action are the same muscles you need to tighten during the Kegel exercises. However, stopping the urine stream should not become a habit, as this may leave your bladder half-full, leading to infections of the urinary tract.

Prevention

There are risk factors for the pelvic organ prolapse, which you can do nothing about, such as your family genetics, your age, the removal of the uterine after a condition or a difficult birth. However, there are also some things you can do that may improve your chances of not getting the condition.

Try to maintain a healthy weight, as obesity is a risk factor of pelvic organ descending. Try to eat a healthy diet and avoid constipation; should you notice that you do have constipation, consult your doctor to treat it the best way possible and not put the pressure on your muscles for a longer period of time than needed.

The same is recommended if you are suffering under coughing for a longer period of time. Seek professional help to get the right treatment, as chronic coughing may also cause weakening of the muscles. Kegel exercises are also a good way of strengthening your pelvic floor muscles.