What is pelvic organ prolapse?

Pelvic organ prolapse is a prevalent condition that impacts a significant number of women, especially as they get older. It occurs when the pelvic organs, such as the uterus, bladder, or rectum, descend or protrude into the vaginal canal. This happens when the supporting tissues and muscles of the pelvic floor become weakened or stretched. Pelvic organ prolapse can cause a range of symptoms and discomfort, but there are treatment options available to alleviate these symptoms and improve quality of life.

What are the signs and symptoms of pelvic organ prolapse?

The signs and symptoms of pelvic organ prolapse can vary depending on the organs involved and the extent of the condition. Some common indicators and manifestations include:

• A sensation of a bulge or pressure in the vagina: Women experiencing pelvic organ prolapse may perceive a sensation of a bulge or pressure in the vaginal region. This sensation can be described as a feeling of something descending or protruding from the vagina.
• Vaginal discomfort or pain: Certain women may encounter discomfort or pain in the vaginal region, particularly during activities that raise intra-abdominal pressure, such as lifting heavy objects or exerting effort during bowel movements.
• Urinary issues: Pelvic organ prolapse can lead to urinary symptoms like urinary incontinence (leakage of urine), frequent urination, urgency (sudden span urge to urinate), or difficulty emptying the bladder completely.
• Bowel problems: Prolapse can also affect bowel function, leading to symptoms such as constipation, difficulty with bowel movements, or a sensation of incomplete emptying.

What causes pelvic organ prolapse?

Several factors contribute to the development of pelvic organ prolapse. These include:

• Pregnancy and childbirth: The process of pregnancy and vaginal childbirth can stretch and weaken the pelvic floor muscles and supportive tissues, making them more susceptible to prolapse later in life.
• Ageing: As women age, the supportive tissues of the pelvic floor naturally weaken, increasing the risk of prolapse.
• Hormonal changes: Reduced levels of oestrogen during menopause can lead to further weakening of the pelvic floor muscles and connective tissues.
• Chronic coughing or heavy lifting: Conditions that result in chronic coughing, such as chronic bronchitis or asthma, and activities involving repetitive heavy lifting can strain the pelvic floor muscles, contributing to prolapse.

Treatment of pelvic organ prolapse

Treatment options for pelvic organ prolapse depend on the severity of symptoms, the impact on daily life, and the individual's overall health. If conservative measures are not effective or the prolapse is severe, surgical options may be considered. Surgical procedures aim to repair or reinforce the weakened pelvic floor tissues and restore organ support.

Surgical procedures for pelvic organ prolapse include anterior and posterior colporrhaphy, sacrocolpopexy, hysterectomy, colpocleisis, and uterosacral ligament suspension. Anterior and posterior colporrhaphy repair the front and back vaginal walls, respectively, while sacrocolpopexy uses mesh or tissue to reinforce vaginal walls and attach them to the sacrum. Hysterectomy removes the uterus, alleviates pressure on other organs, and colpocleisis involves narrowing the vaginal opening. Uterosacral ligament suspension attaches the uterosacral ligaments to the sacrum to support the uterus. The choice of surgery depends on the specific prolapse, the patient's health, and the surgeon's expertise, so a thorough evaluation is essential for personalised treatment planning.