Pelvic Organ Prolapse


    Pelvic organ prolapse is a medical condition that occurs when there is weakness or damage to the normal support of the pelvic floor. The pelvic organs include the vagina, cervix, uterus, bladder, urethra, intestines and rectum. The pelvic organs are held in place by muscles of the pelvic floor and layers of connective tissue called fascia. Pelvic organ prolapse occurs when the muscles and fascia of the pelvic floor can no longer support the pelvic organs. This occurs when the muscles and fascia become weakened, stretched, or are torn causing the organs that they support to drop downward.

    Incidence
    Pelvic organ prolapse is common in women and the incidence increases after childbearing and as women increase in age. 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 to correct pelvic organ prolapsed or urinary incontinence is about 11%, or more than one in 10 women. We also know that only one-third of these women who have surgery will undergo repeat corrective surgery for these conditions. Approximately 300,000 procedures for correction of pelvic organ prolapsed are performed each year in the United States, but many more women suffer from this condition as they manage their prolapsed without surgery. 

    Causes 
    Injuries to the muscles or fascia of the pelvic floor are typically caused by women having children, especially vaginal or operative vaginal deliveries. Menopause, aging, and intense repetitive physical activity can also lead to pelvic organ prolapse. Other factors that lead to increased pressure in the abdomen can worsen or lead to pelvic organ prolapse, such as obesity, chronic constipation, and chronic coughing. In some cases prolapse is a hereditary disorder meaning that it runs in families.

    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 ethnicity. 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.

    Symptoms 
    Women with pelvic organ prolapsed often have no symptoms. Those who do notice prolapse often complain of a bulge near the opening of the vagina or have a pressure sensation in their pelvic region and or lower abdomen. Common complaints of women with prolapsed are being unable to wear a tampon, urinary and/or bowel fecal incontinence, vaginal dryness or irritation, and pain with intercourse. As the pelvic organ prolapse gets worse some women complain of:

    • A bulging, pressure 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 or around the vagina during a bowel movement
    • Difficulty starting to urinate, a weak or spraying stream of urine
    • Urinary frequency or the sensation that they are unable to empty their bladder well
    • Lower back discomfort
    • The need to lift up the bulging vagina or uterus to start urination
    • Urinary leakage with intercourse

    Evaluation
    Pelvic organ prolapse is typically diagnosed by a simple pelvic exam as part of a comprehensive physical exam. A clinician may use a system of measurements called the “pelvic organ quantification,” or POP-Q system exam, to enable them to track changes and assess severity of prolapse. The clinician may use a speculum and examine the different parts of the vagina to determine which part of the vagina is prolapsing and to what extent.

    Other exams or studies may be utilized to assess other symptoms associated with prolapse:

    • Multi-channel Urodynamics: A study that assesses bladder function may be utilized to evaluate urinary incontinence or assess difficulty with urinating. 
    • Cystoscopy: A procedure that uses a camera to look into the bladder for any anatomical abnormalities that could be contributing to urinary symptoms. 
    • Defecography: A radiologic study to look at prolapse symptoms associated with bowel function. 
    • Pelvic Ultrasound: A radiologic study that looks at reproductive organs, bladder, or muscles of the pelvic floor. 
    • Pelvic Floor MRI: A radiologic study that assesses the muscles, organs, and support of the pelvic floor which can be used to assess how the pelvic floor functions with straining. 
    • CT Scan of Abdomen and Pelvis: A radiologic study that helps assess other aspects of the abdomen/pelvis and urinary tract system to rule out other medical conditions that may have similar symptoms to prolapse.

    Sources

    Original publication date: May 2008; Content updated: July 2013


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