I find a lot of my patients tend to ask me, “what is prolapse?” Let’s start off by stating the pelvic organs include the vagina, uterus, bladder, urethra, and rectum. These organs are held in place by muscles of the pelvic floor. Pelvic organ prolapse occurs when tissue and muscles can no longer provide adequate support and the pelvic organs being to drop.
The next question patients tend to ask is, “What causes pelvic organ prolapse?” It is caused by a weakening of the pelvic floor muscles which can occur after pregnancy and vaginal childbirth. Other causes include menopause, aging, and repeated heavy lifting, being overweight or obese, chronic constipation or straining to have bowel movements. Chronic coughing due to smoking, asthma, or other medical conditions can also cause prolapse. It can happen at any age.
Most patients will have some degree of prolapse and not know it as they are asymptomatic. The first symptom tends to be feeling a bulge inside the vagina. Other symptoms include:
- pelvic pressure or fullness
- organs bulging out of vagina
- leakage of urine
- difficulty completely emptying bladder
- problems having a bowel movement
- lower back pain
- problems with inserting tampons or applicators
So, now we know what pelvic organ prolapse is, what can cause it, and what symptoms you may have. Let’s talk about the different types of prolapse
- Cystocele: descent of bladder
- Enterocele: descent of small intestine
- Rectocele: descent of rectum
- Uterine prolapse: descent of uterus
- Vaginal vault prolapse: descent of top of vagina
As you can see, even if you have had a hysterectomy it is still possible to have pelvic organ prolapse. The diagnosis of pelvic organ prolapse is done in the clinic setting with evaluation to see if there is any descent of the pelvic organs when you strain or cough.
Now let’s talk about treatment options. If there is minimal evidence of a bulge and you are not having any discomfort then there is no need to do anything. You would follow up in clinic periodically to ensure the prolapse is not getting worse. Other options include a pessary or surgical management.
A pessary is a device that is inserted into the vagina to support the pelvic organs. Many women find immediate relief in symptoms with pessary use. These may be used for short term or long-term treatment. These devices come in many shapes and sizes. We can determine the best fit for you in clinic. If you have a pessary, I would see you in clinic every few months to ensure there the device is secure and there are no vaginal issues. In some instances, patients may be able to take care of these devices at home without frequent office visits.
Surgical management can also be performed if your symptoms are worsening. These procedures can be done as an outpatient, meaning you can go home the same day of your surgery. These surgeries involve reduction of the bulge. Many times a prolapse can mask symptoms of urinary incontinence. We will determine this prior to the surgery and if it is appropriate, we can offer you support for your urinary issues at the same time of your prolapse surgery. Overall, surgery helps to restore the organs closer to their original positions.
There are things you can do to help prevent pelvic organ prolapse now. Pelvic floor exercises are used to strengthen the muscles supporting the pelvic organs. Kegel exercises are important and may improve incontinence and slow the progression of prolapse. There are physical therapists dedicated to pelvic floor exercises in the Memphis area that we can refer you to if needed.