Pelvic Organ Prolapse
Pelvic organ prolapse and pelvic floor problems are very common conditions that affect millions of women. They are associated with childbirth and menopause and can be a cause of discomfort, embarrassment and loss of self-esteem.
Prolapse can affect urinary, bowel and sexual function, therefore significantly affecting a woman’s quality of life. There are several symptoms associated with prolapse.
Symptoms of prolapse
- Feeling of a lump in the vagina
- Dragging sensation
- Inability to retain tampons
- Slow urinary flow or incomplete emptying of the bladder
- Feeling of needing to pass urine frequently, or urgently (stress incontinence)
- Difficulty emptying the bowels with associated straining
- Feeling that the bowels are not emptying properly
- Using a finger to push a lump back to help empty the bladder or bowels
- The feeling of an obstruction when having sexual intercourse
- Difficulty achieving penetration when having intercourse
- A feeling of vaginal laxity during sexual intercourse
Causes of Prolapse
Pelvic organ prolapse is caused by a weakening of tissues which support the pelvic organs and this can be caused by multiple factors. Childbirth injury is the most common cause of prolapse, particularly is labour has been overly long and strenuous, or if the baby is large.
The ageing process also contributes to prolapse, with the condition becoming more common as a woman gets older, therefore meaning that menopause is also a common cause of prolapse.
Other causes of prolapse include an unhealthy lifestyle, such as being overweight or long-term coughing associated with being a heavy smoker. Undertaking strenuous activities on a regular basis, such as heavy lifting or manual work, may also increase your chances of having pelvic prolapse.
When should I seek treatment?
After childbirth, many women will experience weakening of the pelvic floor muscles. These muscles and their attachments support the pelvic organs and when they weaken, there may be some descent of these pelvic organs into the vagina. This may lead to prolapse of the womb, bladder or rectum into the vagina, producing a lump or lumps.
Some women who experience prolapse will show no symptoms and they are therefore unaware that they have the condition. In these cases, it does not affect their life and usually goes away on its own. Sometimes a prolapse is incidentally discovered, for example at a smear test appointment.
In many women, however, prolapse of the uterus or vagina produces a feeling of a lump or dragging feeling. This may affect urinary, bowel or sexual function. If you have any of these symptoms and they are adversely affecting your quality of life, then treatment may be appropriate.
Assessing the extent of the problem will involve taking a detailed history, examination of the abdomen and a pelvic examination. Examination of the pelvis is carried out internally and takes place with the woman on her back, but may also include assessment in the standing position to best represent her symptoms.
Further investigations may involve urodynamics, to assess bladder function, or an ultrasound to assess the pelvic floor and to exclude a pelvic mass; a rare cause of prolapse, if it is suspected.
Prolapse can involve the front wall or roof of the vagina (anterior), or the back wall or floor of the vagina (posterior), it may also involve the womb (uterus). These conditions are not exclusive to one another, therefore a patient may have prolapse of one or both of the vaginal wall, with or without prolapse of the womb.
Treatment for this problem should take into account the effect on quality of life and is individualised to the woman. There are several treatment options, ranging from simple lifestyle changes and regular pelvic floor exercises to different types of vaginal device (vaginal pessary). For some women, surgery can be the best option, but for others, a conservative approach is more appropriate. This should be discussed with a consultant gynaecologist and all possibilities explored so that the best treatment can be chosen for you.