Prolapse

Pelvic Organ Prolapse Treatment

Pelvic organ prolapse is a condition in which one or more organs within the pelvis move downward from their normal position and bulge into the vagina. It can occur when the muscles and supporting tissues of the pelvic floor become weakened or stretched.

Prolapse can affect the uterus, bladder, rectum or the upper part of the vagina. Although it is common, symptoms can vary significantly from one woman to another. Proper evaluation helps determine the type and severity of prolapse and the most appropriate treatment.

What Is Pelvic Organ Prolapse?

The pelvic organs are normally supported by muscles, ligaments and connective tissues. When these supporting structures become weak, the organs may descend and create a feeling of pressure or a bulge in the vagina.

Prolapse may develop gradually and can become more noticeable while standing for long periods, coughing, lifting heavy objects or straining.

Types of Pelvic Organ Prolapse

• Uterine Prolapse: The uterus moves downward towards or into the vagina.
• Anterior Vaginal Wall Prolapse: The bladder may bulge into the front wall of the vagina. This is commonly called a cystocele.
• Posterior Vaginal Wall Prolapse: The rectum may bulge into the back wall of the vagina. This is commonly called a rectocele.
• Vaginal Vault Prolapse: The upper part of the vagina may descend, particularly after a previous hysterectomy.

Common Symptoms of Prolapse

Symptoms depend on the type and severity of prolapse. Common symptoms may include:

• A feeling of heaviness or pressure in the pelvis
• A bulge or lump felt inside or at the opening of the vagina
• A sensation that something is coming down
• Difficulty emptying the bladder completely
• Urinary leakage or increased urinary frequency
• Difficulty with bowel movements
• Constipation or the need to strain during bowel movements
• Lower back or pelvic discomfort
• Discomfort during sexual intercourse
• Symptoms that become worse after prolonged standing or physical activity

Causes and Risk Factors

Pelvic organ prolapse can develop because of weakening of the pelvic floor and supporting tissues. Several factors may increase the risk, including:

• Pregnancy and childbirth
• Multiple vaginal deliveries
• Increasing age and menopause
• Weakness of pelvic floor tissues
• Chronic constipation and repeated straining
• Chronic coughing
• Heavy lifting or physically demanding activities
• Previous pelvic or gynaecological surgery
• Being overweight
• Conditions that increase pressure inside the abdomen

Diagnosis and Evaluation

A detailed medical history and pelvic examination are usually important for diagnosing pelvic organ prolapse. The doctor assesses which pelvic organs are affected and how far they have descended.

Depending on the symptoms, additional evaluation may be recommended to assess bladder or bowel function and to plan treatment.

• Detailed medical and obstetric history
• Pelvic examination
• Assessment of bladder symptoms
• Assessment of bowel symptoms
• Urine testing when indicated
• Additional imaging or specialist investigations when required

Treatment Options for Prolapse

Treatment depends on the severity of prolapse, symptoms, overall health, age, future pregnancy plans and individual preferences. Not every woman with prolapse requires surgery.

Conservative Management

For mild or minimally symptomatic prolapse, conservative measures may be considered. These can include pelvic floor muscle exercises, management of constipation, weight management and avoiding activities that significantly increase pelvic pressure.

Vaginal Pessary

A vaginal pessary is a device placed inside the vagina to provide support to the pelvic organs. It may be suitable for some women who prefer a non-surgical approach or for those who are not suitable for surgery.

Surgical Treatment

Surgery may be considered when prolapse causes significant symptoms or affects daily activities and conservative treatment is not sufficient.

Depending on the type of prolapse, surgery may involve repair of the vaginal walls, restoration of pelvic support or other procedures designed to improve the position and function of the affected pelvic organs.

Pelvic Reconstruction for Prolapse

In selected patients, pelvic reconstructive surgery can be performed to restore support to the pelvic organs and improve symptoms. The exact procedure depends on the type and extent of prolapse.

A personalised assessment is important because prolapse can involve more than one pelvic compartment. Treatment is planned according to the patient's symptoms, examination findings and individual needs.

When Should You Consult a Gynaecologist?

You should consider a gynaecological evaluation if you notice a vaginal bulge, pelvic pressure, urinary leakage, difficulty emptying your bladder or bowel, or discomfort that may be related to pelvic organ prolapse.

Early evaluation can help identify the type and severity of prolapse and allow appropriate treatment options to be discussed.