What is it?
Pelvic organ prolapse (POP) is when any of the pelvic organs- the bladder, urethra, uterus, vagina, rectum, or small intestine- sit lower than normal due to tissue and muscle weakness, damage, or stretching. Typically, the organs push on the front or back wall of the vagina, causing the vaginal walls to collapse inward. POP is a subjective disorder (some women with POP have no symptoms at all) and treatment is directed by how severe a woman reports her symptoms are.
Symptoms
- Bulge at the vaginal or rectal opening that you can see or feel that may change depending on your position or activity (worse with coughing, lifting, straining with bowel movements, end of the day, prolonged standing/walking, etc.)
- Heaviness or pressure felt in the genital region
- Incomplete emptying of the bladder or bowels
Risk Factors
- Chronic constipation: straining, pushing and sitting on the toilet for an extended period of time can contribute significantly to the development and worsening of pelvic organ prolapse
- Increasing age
- Bearing children
- Excess body weight
- Genetics
- Chronic cough
- Long-term heavy lifting
Prolapse Terms
Cystocele (prolapsed bladder): when the bladder collapses into the vagina. It can make it harder to empty the bladder completely when you urinate. Incomplete bladder emptying can cause bladder infections. Some women with bladder prolapse also have urinary incontinence. If there is any straining with a bowel movement, it is a good idea to support the perineum with your hand to minimize the amount of downward movement of your bladder and other pelvic organs.
Rectocele (prolapsed bowel): when the bowel collapses into the vagina from behind, the stool can go in the wrong direction with straining. This can cause incomplete emptying of the bowel. Some women may need to push on the prolapse with their fingers or thumb inserted into the vagina to help empty the bowels. Changing the stool consistency, aiming for soft, formed stool and avoiding constipation, as well as learning correct evacuation postures and techniques can help relieve some of these symptoms.
Hysterocele (prolapsed uterus): when the cervix and uterus collapse into the vagina. You may be able to feel the tip of the cervix, which feels harder than the surrounding tissues, somewhat like the tip of your nose.
Urethrocele (prolapse of the urethra): when the urethra (the tube that urine passes from the bladder to the outside of the body through) tips closer toward the vaginal opening.
Vaginal vault prolapse: when the top of the vagina, after a hysterectomy, descends toward the vaginal opening.
Enterocele (prolapse of the small intestine): when the small intestine descends into the lower pelvic cavity, pushing on the vagina.
Physiotherapy Treatment
Conservative management of pelvic organ prolapse can be very effective in helping to reduce or abolish symptoms. Treatment may include:
- Inner core training and pelvic floor strengthening
- Postural correction
- Constipation/toileting education
- Symptom management education
- Exercise prescription
- Pessary education/fitting
- Referral back to doctor for medical and surgical consideration, as appropriate
If conservative management is not successful to the degree that a woman is satisfied with, corrective surgery may be considered, although most would agree that surgery is best left as a last resort.
Surgical Treatment for Prolapse
Some women choose to have surgery to manage their prolapse symptoms. The type of surgery needed depends on the organs that need to be repaired. In addition to lifting prolapsed organs, your surgeon might recommend removing the uterus (hysterectomy) or lifting the top of the vagina (vault suspension). Surgery for prolapse can also be combined with surgery for stress urinary incontinence.
- Surgical risks
- Infection at the surgical site
- Bleeding and damage to surrounding structures (bladder and bowel)
- Nerve injury related to your position during surgery
- Blot clot in legs/lungs
- Medical complications
- Anesthetic-related risks
- Urinary retention
- Pain with intercourse
If you suspect you have a pelvic organ prolapse and want to be assessed, call to book an appointment with us or see your doctor. If you have a diagnosis of prolapse and are looking for a conservative treatment option, book in for a pessary assessment and fitting today!
The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. Toronto Pessary Clinic expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.