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.
