Category: Science

Understanding Pelvic Organ Prolapse: Causes, Symptoms, and Treatment 

Steven Shin
October 2024

Pelvic organ prolapse (POP) is a condition seen primarily in elder women. It occurs when the muscles and connective tissues that support the pelvic organs become weakened or damaged.  This weakening allows the organs to drop from their usual positions and cause discomfort that potentially affecting a woman’s quality of life. While pelvic organ prolapse can be distressing,  treatment options exist and this can be managed without surgery [1].

Cause of Pelvic Organ Prolapse 

The causes of pelvic organ prolapse are multifactorial, but pregnancy and childbirth remain the most significant risk factors. During childbirth, the pelvic floor undergoes extreme stress. The levator ani muscles and the connective tissue that secures the vagina to the sidewalls of the pelvis are both vital for maintaining pelvic stability. In a healthy individual, the vagina is positioned horizontally on top of the levator ani muscles, offering robust support to the pelvic organs [2]. However, the levator ani muscles can stretch beyond their normal limits that leads to injury. This overstretching causes the vaginal opening to widen and shifts the burden of support from the muscles to the connective tissues.  

Aging is the second most common cause of pelvic organ prolapse as muscle strength and tissue elasticity naturally decline over time. The lack of estrogen weakens the muscles and connective tissues of the pelvic floor, further exacerbating the risk. Other risk factors of Pelvic Organ  Prolapse include obesity, chronic conditions such as diabetes or constipation, and lifestyle habits  such as smoking [2].

Symptoms of Pelvic Organ Prolapse 

Many women with pelvic organ prolapse may not notice any symptoms. On the other hand,  women may experience a range of symptoms that affect their quality of life. The most common sign of prolapse is a feeling that something is “coming down” or a bulge protruding from the vaginal opening. Some women may feel or see a soft lump while washing themselves, while others might experience discomfort, pressure, or a dragging sensation in the pelvic area. Some may notice difficulty with bowel movements or find it challenging to keep tampons in place. 

Treatments of Pelvic Organ Prolapse

Not all cases of pelvic organ prolapse require medical treatment. Mostly, women with mild symptoms can manage their condition with lifestyle changes and conservative treatments.  However, certain situations, such as sores on the vaginal wall or bladder problems like ureteral kinking may require medical treatment. Regardless, please see your doctor the moment you notice symptoms.  

For women’s non-surgical options, Kegel exercises are often recommended. These exercises target the muscles that support the pelvic organs and can help strengthen them. Working with a pelvic floor therapist improves the effectiveness of these exercises. Pessaries, small silicone devices inserted into the vagina, can provide additional support to the pelvic organs [3]. These devices help relieve symptoms by holding the vaginal walls in place.  

Lifestyle modifications like avoiding heavy lifting, quitting smoking, and managing constipation can also reduce symptoms. Obesity and chronic health issues like diabetes and constipation aggravate prolapse, so managing these factors is crucial. 

For women with more severe prolapse that significantly affects their quality of life, surgery may be necessary. Surgical procedures aim to repair and reinforce the damaged tissues, restoring the organs to their proper positions. Surgery can be performed either through the abdomen or the vagina [3]. In cases where the prolapse causes more serious complications, such as difficulty emptying the bladder or bowel, surgery may be the best option to restore normal function. However, about 25% of women may require additional surgeries later due to the recurrence of prolapse [3].  

Pelvic organ prolapse is a common condition that affects many women. It is often treatable, and many women can manage their symptoms without surgery. Non-surgical treatments, such as pelvic floor exercises and pessaries, can be highly effective. For those with more severe cases,  surgery is an option to improve quality of life. If you suspect you have pelvic organ prolapse, it’s important to consult your healthcare provider to explore the best treatment options for your individual needs.

Reference 

[1] Iglesia, C. B., & Smithling, K. R. (2017). Pelvic organ prolapse. American family physician,  96(3), 179-185. 

[2] Collins, S., & Lewicky-Gaupp, C. (2022). Pelvic organ prolapse. Gastroenterology Clinics,  51(1), 177-193. 

[3] American College of Obstetricians and Gynecologists. (2019). Pelvic organ prolapse.  Urogynecology, 25(6), 397-408.

Polycystic Ovarian Syndrome: Understanding your Symptoms and Knowing your Treatment Options 

Chaimaa Riad
October 2024

Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder that affects around 5-10% of women of reproductive age.^[4]While its prevalence is high, scientists are unsure of the cause of this disorder. Symptoms can often be overlooked, as PCOS can present in a variety of ways with very general symptoms. It is specifically challenging to diagnose PCOS in young girls because symptoms can often be seen as normal signs of puberty.^{[2] [4]}It is important to recognize any signs and symptoms of hyperandrogenism and express concerns to your primary care provider to get the tests necessary to diagnose PCOS. 

Signs and Symptoms to Consider 

Family history is important to consider: 

• Let your doctor know if there is a history of PCOS in the family, or a family history of acne, hirsutism, or obesity.^[2] 

PCOS is strongly associated with metabolic dysfunction: 

• Women should be aware of recent weight gain. While girls going through puberty are likely to gain weight, there should be a discussion of the progression of the weight gain. ^[2] 
• Signs of insulin resistance are also associated with PCOS. The increase in fat associated with hyperandrogenism is likely to cause your body to not be able to respond properly to the insulin created in your body, leading to an increase in sugar levels, leading to type 2 diabetes.^[2] 

Irregular menstrual cycles: 

• Oligomenorrhea (infrequent menstrual periods)^[1] 
• Menorrhagia (heavy bleeding)^[1] 
• Primary amenorrhea (failure to get a first period by 15 years old)^[1] 
• Secondary amenorrhea (not having a period for at least three months)^[1] ○ Infertility^[1] 

Skin changes 

• Hirsutism (excess hair growth on the face or body) ^[2] 
• Abnormal acne or oily skin ^{[1] [2]} 
• Acanthosis nigricans (hyperpigmentation usually in the axilla, groin, and neck secondary to diabetes).^[2][3] 

Cardiovascular concerns

• Although unclear, there have been concerns about atherosclerosis forming in young women who have PCOS. This can increase risk of stroke as well as heart attacks. More studies need to be done to properly assess this risk in women with PCOS.^[1] 

Diagnosis 

According to the World Health Organization, diagnosis of PCOS includes at least two out of three of the following: 

1. Symptoms that suggest high androgens (hirsutism, acne, high testosterone levels on lab testing) with no explanation of why there are high androgen levels ^[5] 
2. Irregular menstrual cycles, as explained above in greater detail ^[5] 
3. Ultrasound imaging showing polycystic ovaries ^[5] 

Laboratory studies are especially important to ensure that other endocrine disorders are ruled out, including: 

• Hypothyroidism: TSH levels ^[3] 
• Hyperprolactinemia: Prolactin levels ^[3] 
• Congenital Adrenal Hyperplasia: 17-hydroxyprogesterone levels ^[3] 

Treatment Options 

After a diagnosis of PCOS is made, there are various methods of management:

• Lifestyle modifications – a healthy diet and increased physical activity are ways that can help manage the comorbidities of PCOS including diabetes and obesity. In addition to this, women should follow up with their PCP to assess for any worsening of diabetes or any development of cardiovascular changes such as hypertension.^[1] 
• Medical management: As discussed, diabetic management can vary, and can be managed with medication, as well as hypertension.^[1] Additionally, oral contraceptives can help with irregular menstrual cycles.^[1] Specific types of medication vary based on the presentation and severity of the specific symptoms. 

There is no specific management for PCOS, but rather symptom-based intervention to help prevent serious complications. It is important to discuss with your PCP to know which specific intervention is right for you based on your symptoms. ^[1][4] 

References 

[1] Hoeger, K. M., Dokras, A., & Piltonen, T. (2020, November 19). Update on PCOS: Consequences, challenges, and guiding treatment. OUP Academic. 

https://academic.oup.com/jcem/article/106/3/e1071/5992309?login=false

[2] Screening and management of the hyperandrogenic adolescent. ACOG. (2024). https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/screening-an d-management-of-the-hyperandrogenic-adolescent 

[3] Teede, H. J., Piltonen, T., Costello, M. F., & Misso, M. L. (2018, August). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. American Society for Reproductive Medicine. https://www.fertstert.org/article/S0015-0282(18)30400-X/fulltext 

[4] Why polycystic ovarian syndrome is often misdiagnosed. Why Polycystic Ovarian Syndrome Is Often Misdiagnosed: Women’s Healthcare of Princeton: Gynecologists. (n.d.). https://www.princetongyn.com/blog/why-polycystic-ovarian-syndrome-is-often-misdiagnosed [5] World Health Organization. (2023, June). Polycystic ovary syndrome. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome