Pelvic Organ Prolapse
Pelvic organ prolapse is a medical condition that occurs when the normal support of the vagina is lost, resulting in “sagging” or dropping of the bladder, urethra, cervix and rectum. As the prolapse of the vagina and uterus progresses, women can feel bulging tissue protruding through the opening of the vagina.
Causes and Risk Factors
By studying large numbers of women with and without prolapse, researchers and urogynecologists have identified certain risk factors that predispose, cause, promote or worsen pelvic organ prolapse. The strength of our bones, muscles and connective tissue are influenced by our genes and our race. Some women are born with weaker tissues and are therefore at risk to develop prolapse. Caucasian women are more likely than African American women to develop pelvic organ prolapse. Loss of pelvic support can occur when any part of the pelvic floor is injured during vaginal delivery, surgery, pelvic radiation or back and pelvic fractures during falls or motor vehicle accidents. Hysterectomy and other procedures done to treat pelvic organ prolapse also are associated with future development of prolapse. Some other conditions that promote prolapse include: constipation and chronic straining, smoking, chronic coughing and heavy lifting. Obesity, like smoking, is one of the few modifiable risk factors. Women who are obese have a 40 to 75% increased risk of pelvic organ prolapse. Aging, menopause, debilitating nerve and muscle diseases contribute to the deterioration of pelvic floor strength and the development of prolapse.
We do not know exactly how common pelvic organ prolapse is because research is limited to women who seek health care. It is estimated that nearly 50% of all women between the ages of 50 and 79 have some form of prolapse. The lifetime risk that a woman will have surgery for the correction of prolapse or urinary incontinence in the United States is about 11%. We also know that only one-third of these women will undergo repeat corrective surgery for these conditions. Approximately 300,000 procedures for correction of pelvic organ prolapse are performed each year in the United States. We believe that is just the tip of the iceberg as many women manage their prolapse without surgery.
Some loss of support is a very common finding upon physical exam in women, many of whom do not have bothersome symptoms. Those women who are uncomfortable often describe the very first signs as subtle—such as an inability to keep a tampon inside the vagina, dampness in underwear or discomfort due to dryness during intercourse.
As the prolapse gets worse, some women complain of:
- A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements
- The feeling that they are “sitting on a ball”
- Needing to push stool out of the rectum by placing their fingers into the vagina during bowel movement
- Difficulty starting to urinate, a weak or spraying stream of urine
- Urinary frequency or the sensation that they are not emptying their bladder well
- The need to lift up the bulging vagina or uterus to start urination
- Urine leakage with intercourse
Bladder Control Problems
If you or someone you know is affected by loss of bladder control, you are not alone. Urinary incontinence affects 30 to 50% of women; although the rates go up with age, incontinence among young women is quite common. This condition affects men and women, although it is nearly twice as common in women. The prevalence of urinary incontinence does increase with age, but it is not considered normal at any age. Doctors should routinely question women over age 65 about bladder problems, including overactive bladder.
Certain events or conditions may make a woman more likely to experience urinary incontinence. Sometimes, very clear-cut events such as pregnancy, vaginal delivery, surgery, radiation or accidental injury can lead to these kinds of problems; other times, causes may be much less well-defined. Some other causes include:
- Chronic constipation, which causes excessive bearing down.
- Some lung conditions, where pressure from breathing disorders can increase the pressure in the abdomen and pelvis.
- Neurological conditions, like multiple sclerosis or spina bifida, where nerves and/or muscles may not function correctly.
- Certain occupations (usually those that involve heavy lifting or exertion) may also increase the risk.
- Some kinds of urinary incontinence can be related to medications taken for other health conditions (such as diuretics), or smoking and caffeine use, and obesity certainly has an effect.
- Uncommonly, certain other health conditions such as kidney or bladder stones, or even some forms of cancer can cause the bladder to lose urine.
- And, in many cases, there is no obvious underlying reason for why bladder control problems occur.
Many women who have these kinds of bladder control problems are reluctant to discuss them with anyone, or are embarrassed to acknowledge that they have a problem, even to themselves. Sometimes women are made to feel that these conditions are “normal,” especially as they get older, and that, since bladder control problems like this are rarely life-threatening, they are not really a problem. These points of view are often shared among family and friends, or even among some healthcare providers.
But the truth of the matter is that urinary incontinence can have a very significant impact. We know that it can undermine your sense of well-being and self-worth, and your ability to live your life the way you want. Scientific studies indicate that quality of life measures significantly decrease when a woman experiences these kinds of bladder control problems. After experiencing these problems, women may begin to stop exercising or participating in physical or social activities, which can further reduce health and quality of life. Work activities, travel and intimacy also may suffer as a result.
But there is no reason to allow this to continue. The good news is that 80 to 90 % of women who seek treatment will experience significant improvement. A wide array of treatment options, ranging from behavioral and diet changes all the way to surgical options exist, and are used every day to help women recover parts of their lives they may have let go. Get evaluated and review treatment options appropriate for your urinary incontinence. The more you know, the more confident you will be in choosing the direction of treatment.
Original publication date: May, 2008; Content updated: March, 2012