Pelvic organ prolapse (POP) is a topic that we have started hearing more about the past few years. Unfortunately, most of this information is causing fear and worry. Because of this, we want to ensure that we are taking the time to educate on POP and providing information that is useful in helping you navigate this diagnosis or even information that you will be able to share when you hear the fearmongering.
First, what is POP?
Pelvic organ prolapse occurs when the pelvic organs, such as the bladder, uterus, or rectum, descend from their normal position down into the vaginal canal. This is diagnosed during a physical examination in which the provider will assess the amount of movement noted visually and take measurements of this movement. The provider should assess different areas of the vaginal walls and also should assess this in different positions with the patient. It is known that POP can present more with gravity present, and a standing position assessment can be beneficial as well.
Some common symptoms include:
- Vaginal heaviness, pressure, or bulging
- Pain with sex
- Difficulty urinating or defecating
- Urinary Incontinence
Common Causes of POP
- Genetic factors: Some women may be more prone to POP simply because of their genes. They may have a genetic predisposition that has less elasticity in their tissues.
- Obesity: Excessive weight can increase the amount of strain placed on the pelvic floor muscles and ligaments.
- Pregnancy and childbirth: The resiliency of the pelvic floor helps to support a growing baby. Proper labor and delivery techniques can decrease the risk of injury to the pelvic floor structures.
- Age: During the aging process, various tissues and structures weaken throughout the body. The pelvic floor is no exception, but there are things you can do to improve function.
- Chronic Constipation: Constant straining will cause the pelvic floor muscles to weaken. During defecation, the pelvic floor muscles are supposed to relax to allow for feces to escape.
- Connective tissue disorders: There are certain conditions such as Ehler’s Danlos or Marfan’s that influence the connective tissue throughout the body. These conditions may have a higher risk of prolapse.
Two Facts, That No One Mentions
- It is said that more than 40% of women have POP on physical exam, BUT only about 3% are symptomatic. What does this mean? This means that some level of laxity may be common and more importantly that most women who have prolapse do not have symptoms! This means that their quality of life is not impacted, and that they have the opportunity to focus on prevention-based activities to decrease their risk of becoming symptomatic.
- Less than 1 out of every 5 women with prolapse that is symptomatic will need surgical intervention. What does this mean? This means that most women are able to navigate the diagnosis of prolapse without surgery and that they benefit from conservative based care!
If I have POP, is there hope outside of surgery?
Yes!
Kegels, pelvic floor contractions, have gained a lot of attention. If properly performed, these exercises can help strengthen muscles at the pelvic floor. It is important to know that kegels are not the end all answer to prolapse and that if performed improperly and/or when not appropriate it can make symptoms worse. To learn how to properly perform kegels, and to see if kegels are even appropriate as a part of your treatment I would recommend seeing and pelvic physical therapist.
Seeing a pelvic physical therapist can help you learn better techniques to avoid straining with bowel movements and how to better coordinate your breath so that you avoid increased pressure being placed on the pelvic floor. A physical therapist who specializes in the pelvic region should look at more than just the location of the prolapse. They should look at you as a whole person to best address your complaints and move towards your goals. Your physical therapist should be able to provide insight on how the pelvic floor muscles coordinate with various tasks, and can also educate if there have been any known injuries to these structures.
One option that a lot of patients do not know about is the use of a pessary. A pessary is a medical device that can be inserted into the vaginal canal to help support the pelvic organs when there is both pelvic floor weakness and/or increased laxity of the ligamentous structures. These devices come in different shapes and sizes and the type should be considered prior to surgical intervention. The type of POP that is present, along with various factors related directly to the patient will help the provider advise on the type of pessary that would be best.
There is one last option that is often overlooked, and that is an approach that combines physical therapy with the pessary. At times, support is key to helping someone learn how to properly engage muscles. The pelvic floor should not be exempt from this rationale and the use of a pessary can allow for strengthening to occur in an effective manner, including the higher grades of POP as well. A number of physical therapists are trained in pessary fittings and they can answer the questions that you have and also help you safely manage pessaries.
Life After POP
Pelvic organ prolapse is a common yet often misunderstood condition that affects many women. By raising awareness and providing accurate information, we can empower individuals to seek the help and support they need. Remember, there are effective treatment options available. With the right guidance, it is possible to manage and improve your quality of life. Many women who are symptomatic are able to continue participating in the activities that they enjoy following proper care. Don’t forget that majority of women who have prolapse are not symptomatic, and this could be your reality as well with proper management and preventative care.
References
Aboseif C, Liu P. Pelvic Organ Prolapse. [Updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563229/
Marian Wiegersma, Chantal M C R Panman, Liesbeth C Hesselink, Alec G A Malmberg, Marjolein Y Berger, Boudewijn J Kollen, Janny H Dekker, Predictors of Success for Pelvic Floor Muscle Training in Pelvic Organ Prolapse, Physical Therapy, Volume 99, Issue 1, January 2019, Pages 109–117, https://doi.org/10.1093/ptj/pzy114
Nüssler E, Granåsen G, Bixo M, Löfgren M. Long-term outcome after routine surgery for pelvic organ prolapse-A national register-based cohort study. Int Urogynecol J. 2022 Jul;33(7):1863-1873. doi: 10.1007/s00192-022-05156-y. Epub 2022 Mar 21. PMID: 35312802; PMCID: PMC9270303