What is Pelvic Organ Prolapse?

A prolapse occurs when organs drop from their natural position and sometimes protrude. Normally the vagina and uterus are secured to the pelvis by connective tissue that forms ligament-like structures as well as a strong "envelope" around the vaginal walls. As pelvic floor muscles weaken, these connective structures give way, allowing the vagina to become displaced towards and at times beyond the vaginal opening. The bladder above and the rectum below the vagina are thereby affected, leading to the following symptoms.

What are the symptoms?

• Loss of bladder (see urinary incontinence) or possibly bowel control
  
  
• Difficulty voiding
  
  
• Urinary frequency
  
  
• Problems with bowel movements
  
  
• Feelings of pelvic or vaginal heaviness, bulging, fullness and/or pain
  
  
• Recurrent bladder infections
  
  
• Excessive vaginal discharge
  
  
• Discomfort or lack of sensation with intercourse

How common is Pelvic Organ Prolapse?

It is a very common disorder particularly in older women. Half of all women over the age of 50, experience some degree of pelvic organ prolapse. By the age of 80, more than 1 in every 10 women will have undergone surgery for prolapse.

Causal factors

• Congenital weakness of the pelvic ligaments.
  
  
• Multiple vaginal deliveries. This is more likely if labour has been prolonged.
  
  
• Oestrogen deficiency i.e. menopause
  
  
• Obesity
  
  
• Chronic cough
  
  
• Constipation
  
  
• Previous pelvic surgery

Types of pelvic organ prolapse

Cystocele? A cystocele, or anterior wall prolapse occurs when the bladder drops from its normal position into the vagina. This can lead to dragging discomfort, the sensation of a lump in the vagina and occasionally urinary symptoms. It can also cause discomfort during intercourse.

Rectocele? A rectocele, or posterior wall prolaps occurs when the rectum protrudes into the or out of the vagina. It may cause problems with bowel movements or the feeling of incomplete bowel emptying.

Enterocele? An enterocele occurs high in the back of the vagina allowing the small intestine to protrude into the vagina. In severe cases, the protrusion may be seen or felt outside the vagina.

Vaginal Vault? A vaginal vault prolapse occurs when the tissue which attaches the top of the vagina to the pelvic sidewall, becomes torn. This causes the top of the vagina to drop, which in turn causes the front and the back of the vagina to drop.

Uterine? A uterine prolapse occurs when the uterus drops either by itself or as a result of the prolapse from a different part of the vagina. This may cause lower back pain. A patient with total uterine prolapse may complain protrusion of the cervix and a blood-stained discharge.

Treatment

Losing weight, pelvic floor exercises and hormone replacement therapy given at the time of the menopause may help prevent development of postmenopausal prolapse but is unlikely to alter established prolapse.

Pessary

This is useful if the patient is medically unfit for surgery, has not completed family, for relief of symptoms whilst awaiting surgery and as a therapeutic test to confirm that surgery might help.

Surgical

For minor prolapse, this can be carried out under local anaesthesia with the aim of going home on the same day.