Everything You Need to Know About Pelvic Organ Prolapse

pelvic organ prolapse | symptoms, causes & treatment

Pelvic Organ Prolapse | Anatomy, Causes & Treatments

What causes our organs to drop or press into or out of the vagina or anus? Oh yes, we're going there. Our team is here to lead the way.
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Let's start with the anatomy. In the female pelvic floor (though prolapse can be found in males as well), in the back we have the rectum, in the middle we have the vagina, and in the front we have the bladder and urethra. ⁣⁣The vagina itself has two main walls—the anterior wall (in the back) and the posterior wall (in the front).⁣⁣ This is important because it helps us to identity the different types of vaginal prolapse that can occur. ⁣⁣
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Pelvic Organ Prolapse (POP) is the descent of one or more of the anterior vaginal wall, the posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy).⁣⁣

What causes prolapse?⁣⁣

Situations of chronic, increased intra-abdominal pressure i.e. the pressure inside my pelvis and abdomen is chronically too high, and poorly regulated by the surrounding structures. For example, when you sneeze or cough, you have a sharp increase of intra-abdominal pressure, and the pelvic floor has to be able to move or deform out of the way to accommodate that pressure.

In certain cases, where the pelvic floor is unable to meet or regulate that pressure, you can end up with prolapse. ⁣⁣People who deal with chronic constipation can also see an increase in the laxity of the ligaments in the pelvic organs. Chronically stressing those structures can lead to chronic over-stretching, then leading to prolapse.⁣

The cause of prolapse is multifactorial but primarily associated with:

Pregnancy and vaginal delivery, which can lead to direct pelvic floor muscle and connective tissue injury
Hysterectomy⁣⁣
Pelvic surgery⁣
Conditions associated with sustained episodes of increased intra-abdominal pressure, such as obesity, chronic cough, constipation, and repeated heavy lifting.⁣⁣

At times, in more severe cases of POP, surgical intervention may be necessary. However, there are many conservative treatments including pessary use, and pelvic floor muscle training. HCP should primarily focus on identification and alleviation of POP related symptoms.⁣ Pessary use is ideal for patients who do not desire surgical treatment. With proper training and understanding of pessary management, most patients can be successfully fitted and taught to manage pessary for short and long term relief of signs and symptoms. Patient satisfaction is high, making pessary an important tool in treating prolapse.⁣⁣

Sources⁣⁣

Pelvic Organ Prolapse⁣⁣. Cheryl B Iglesia and Katelyn R smithling Am Fam Physician, 2017 Aug 1;96(3):179-185.⁣⁣

Nonsurgical Management of POP Patrick J Culligan, Obstet Gynecol. 2012 Apr;119(4):852-60. Doi: 10.1097/AOG.0b013e31824c0806

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