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Pelvic Organ Prolapse

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Introduction

Pelvic Organ Prolapse is a pelvic floor dysfunction that affects women.

The pelvic floor is a set of muscles and tissues that keep the pelvic organ in position. A few women experience pelvic disorders during childbirth due to damage in the pelvic region’s muscles and tissues.

Ageing may also cause the pelvic organs to prolapse and could lead to other pelvic floor dysfunctions. The pelvic organs are supported by surrounding tissues, muscles, and nerves. A minor disorder in these may result in pelvic organ droop or prolapse, giving rise to complications.

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What are the types of Pelvic Organ Prolapse?

  • Anterior prolapse: A bulging bladder in the front wall of the vagina
  • ● Vaginal vault prolapse
  • Uterine prolapse occurs in postmenopausal women who have experienced more than one vaginal deliveries.
  • Enterocoele: When the small intestine bulges into the vagina
  • Rectocele: When the rectum bulges into the vagina
  • ● Prolonged pressure in your abdomen
  • Cystocele: when your bladder drops out of the vagina
  • ● After a hysterectomy, the vaginal wall may drop or bulge into the vagina.

What are the Causes of Pelvic Organ Prolapse?

  • ● Pregnancy, labour, or childbirth: During pregnancy, the muscles and tissues surrounding the pelvic organs loosen, making it difficult to hold on to the organs.
  • Weight gain: Excess body weight can pressurise the abdominal region, which in turn affects the uterus or surrounding organs
  • ● Respiratory issues with a prolonged cough can cause excessive pressure on the uterus causing urine leakage.
  • Constipation: Restricted bowel movements require the patient to apply pressure to release the waste. This can cause significant damage to the pelvic floor muscles.
  • Pelvic organ cancers: The tumours in the pelvic organ make the retention of organs difficult.
  • Hysterectomy: Removing the uterus leaves a void, and hence, it is difficult to keep the organs intact.
  • ● Pelvic floor disorders may also occur because of urinary incontinence, faecal incontinence and pelvic organ prolapse. However, the frequency of pelvic organ prolapse is less in comparison to faecal or urinary incontinence.
  • ● Genetic factors may also cause pelvic organ prolapse. Connective tissue impairment can also trigger the risk of prolapse.

What are the Symptoms of Pelvic Organ Prolapse?

  • ● A heavy feeling in the pelvic area
  • ● Lower back pain
  • ● Difficulty inserting tampons
  • ● Dyspareunia
  • ● Experience of something falling out of the vagina
  • ● Bleeding or spotting from the vagina
  • ● Constipation or difficult bowel movements
  • ● Feeling a bulge in the vagina.
  • ● Draggy discomfort in the vagina
  • ● A feeling of incomplete urination or the need to visit the toilet frequently.
  • ● Urine oozing out while coughing, sneezing, or exercising.
  • ● Urine leakage or bowel movement disorders
  • ● Giving birth to overweight babies

Symptoms are related to specific organ dysfunction. If the bladder prolapses, urine may leak. In the case of rectal prolapse, the patient may experience constipation and pain during intercourse. Small intestine prolapse leads to backaches and uncomfortable sexual intercourse.

How is Pelvic Organ Prolapse Diagnosed?

Pelvic Organ Prolapse is usually diagnosed by pelvic exams, which include:

  • ● X-ray of the urinary tract
  • ● Pap smear in particular
  • ● Pelvic CT scan
  • ● Pelvic ultrasound
  • ● Pelvic MRI scan
  • ● A urine test
  • ● Small tube insertion into the bladder to check for the problems

How is Pelvic Organ Prolapse Treated?

  • ● Behavioural therapies that include kegel exercises that help strengthen the pelvic floor muscles
  • ● Insertion of a pessary into the vagina. It is a synthetic device that supports the drooping organs
  • ● Surgery involves removing the affected organ, or removing the uterus (hysterectomy), repairing the affected tissue.
  • ● Refrain from lifting heavy objects
  • ● Treating constipation
  • ● Healthy weight maintenance by walking, exercise, and other activities
  • ● Pelvic floor exercises strengthen the pelvic muscles and help keep the organs intact.
  • ● Hormonal treatment that aids in preventing pelvic organ prolapse
  • ● Surgery to remove affected organs
  • ● Eating a healthy diet that is rich in fibre

Surgeries for Pelvic Organ Prolapse include:

  1. Obliterative surgery or closing of the vagina to support organs that are prolapsed
  2. Reconstructive surgery to restore organs to their original position
  3. Reconstructive surgery is also done through the abdominal incision using laparoscopy
  4. Using body tissues as a mesh in repairing the prolapse and providing pelvic floor support

What are the Risks Associated with Pelvic Organ Prolapse treatments?

Pain, infection, bladder or bowel injury. Further risks include bleeding with blood clots. Further, placing the mesh inside the vagina may be extremely painful, and there is a chance of the mesh eroding.

Gynaecological surgery includes dissection near the bladder, rectum, uterus and the vessels of the pelvis. The side effects of surgery include bleeding, infection, thromboembolism, and visceral damage.

Conclusion

Pelvic floor muscles weaken with age. Hence, it is essential to take care of pelvic floor muscles by incorporating a healthy diet, weight maintenance, and exercise, strengthening the pelvic floor. Refraining from unhealthy eating habits and having a diet rich in fibres also helps prevent prolapse.

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FAQ's

What are Some Things you Mustn't Do if you Experience Prolapse?

If you are diagnosed with Pelvic Organ Prolapse, you must avoid lifting or pulling heavy objects that cause strain. Avoid being on your feet for too long as your pelvic organs may experience pressure during prolonged standing.

How do you Know When your Prolapse is Severe?

Watch out for the following signs:

  • ● Pulling sensation in your pelvis
  • ● Protruding tissue from your vagina
  • ● Urine leakage, incontinence or retention
  • ● Difficulty in bowel movements

Is Hysterectomy a Part of Prolapse Surgery?

The Pelvic Prolapse surgery can be performed with or without a hysterectomy. However, a hysterectomy is performed to ease the rest of the surgery.

How does Uterine Preservation Help with the Improvement of Symptoms?

Uterine preservation helps reduce the operative time and risk of surgery. It also helps minimise vaginal incisions and avoids complications like erosions while keeping the supporting sutures intact.

How Successful is Pelvic Organ Prolapse?

Many factors affect reconstructive pelvic surgery. Some of them include pelvic floor problems, decreased muscle tone, impaired nerve functions, and weak connective tissues.

It may prove quite successful if you maintain a healthy weight and lifestyle. However, there are instances when the surgery fails because of daily activities that involve strenuous activity and stress.

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