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Pelvic Organ Prolapse

  • What is a pelvic organ prolapse?

    Pelvic organ prolapse

    Pelvic organ prolapse occurs when the pelvic organs drop from their original position in the pelvis. This is a very common condition, especially among older women. It occurs when the pelvic floor muscles become weak or damaged, and can no longer support the organs of the pelvis. The pelvic organ prolapse can involve any of the pelvic organs including the uterus (womb), ovaries and fallopian tubes as well as the rectum and bladder.

    Types of pelvic organ prolapse

    There are several types of pelvic organ prolapse:

    Bladder prolapse

    This type of pelvic organ prolapse is also called anterior prolapse or cystocele. It occurs when the wall located between your bladder and vagina stretches and weakens. The weakening of this wall causes the bladder to droop down and press into your vagina. This condition may cause you to feel the constant urge to urinate and experience problems with emptying your bladder, such as urinary retention.

    Rectal prolapse

    Also called posterior vaginal prolapse or rectocele, rectal prolapse occurs when the fascia – the fibrous tissue that serves as a wall to separate the rectum from the vagina – weakens, creating a bulge in your vaginal wall. Various conditions can increase your risk of developing a rectal prolapse, primarily those that can cause pressure on your pelvic floor like chronic constipation, chronic cough, pregnancy, and childbirth. Although small bulges may not show any symptoms and rarely cause any pain, it is still important to have it checked by your doctor, especially when the bulge becomes more prominent and uncomfortable.

    Small bowel prolapse

    Small bowel prolapse, or enterocele, a form of pelvic organ prolapse in which the small intestine descends into your lower pelvis and presses at the top portion of your vagina, forming a bulge. A mild to moderate small bowel prolapse may not produce any signs and symptoms, and most often, the only way to know that you have the condition is if you go for a pelvic examination.

    Urethral prolapse

    Also known as urethrocele, urethral prolapse happens when the urethra – the tube part that transports urine from the bladder to the outside of the body – descends and prolapses into your vaginal canal. When the muscles and tissues that support your urethra are damaged due to pregnancy, prolonged labor or menopause, the urethra widens, causing it to curve downward and press into your vagina. Just like bladder prolapse, urethrocele can cause you problems with urination, such as difficulty passing urine and completely emptying your bladder.

    Uterine prolapse

    Just like other forms of pelvic organ prolapse, uterine prolapse is caused by conditions and activities that can cause pressure on your pelvic floor. When there is excessive pressure on your pelvis, the muscles and tissues that hold the uterus in place become weak. This allows the uterus to slip from its normal position and bulge down into your vagina or birth canal.

  • A prolapse is caused by the continuous weakening of the supporting tissues of the pelvic organs. This weakening may be caused by:

    • Chronic cough or strain from constipation
    • Collagen deficiency
    • Congenital (present at birth) weakness of the pelvic floor muscles, ligaments and fascia
    • Menopause – The supporting tissues become weaker with age and menopause
    • Obesity, large fibroid (fibrous growth), tumour or previous pelvic surgery
    • Pregnancy and childbirth, especially after a difficult and prolonged labour
    • Strenuous physical work or heavy lifting
    • A dragging sensation in the lower abdomen and pelvis
    • A swelling sensation in the vagina or a lump outside the vagina
    • Backache that progresses through the day
    • Difficulty in or inability to have sex – this may cause anxiety or depression
    • Difficulty in passing urine or stools
    • Difficulty in walking or sitting
    • Vaginal bleeding and discharge (not part of the menstrual cycle)
  • Mild prolapse can be treated with pelvic floor exercises, while moderate prolapse may require a ring pessary or surgery. Seek treatment early as the more severe the prolapse, the lower the success rates from treatment or surgery.

    Severe prolapse requires additional surgery to reduce the recurrence rate (from more than 30% to less than 10%). These additional surgeries include using a mesh to hold up the pelvic floor, hitching up surgeries to the ligaments. These are very sub-specialised surgeries and require specially trained surgeons to perform.

    Consult an O&G specialist to find out more about your condition and the best treatment options for you.

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  • Generally, pelvic organ prolapse is not a life-threatening condition. However, some cases of pelvic organ prolapse result to complications such as:

    • Urinary incontinence or bladder control problems
    • Difficulty in urinating
    • Urinary tract infections
    • Hydronephrosis and kidney damage
    • Pain around the vulva and vestibule in women
    • Bowel control
    • Constipation
    • Pain during sexual intercourse
    • Prostate inflammation (in men)
    • Bed wetting

    The treatments for pelvic organ prolapse may also cause some complications. If you use a pessary to treat pelvic organ prolapse, you may experience vaginal discharge, vaginal bleeding and ulcers in the vaginal epithelium. Likewise, while complications are rare after a surgery for pelvic organ prolapse, it also comes with the risk of having complications like infection, bleeding and pelvic organ damage.

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