This refers to a drooping of the uterus, bladder or rectum into and beyond the vagina. It is more common in older women, affecting 1 in 3 women who have had children. 1 in 10 women will need surgery in their lifetime for POP.
Pelvic organ prolapse does not affect your physical health in majority of cases, but can significantly affect your quality of life.
The main cause of this is weakened pelvic floor muscles from damage sustained during pregnancy and childbirth as well as weakening from ageing and menopause. Another major cause of POP involves chronic increased pressure on pelvic floor muscles e.g. obesity, chronic cough, chronic constipation, jobs that involve heavy lifting/straining.
Some women have no symptoms at all and are only picked up during a routine gynaecology check. Others may have symptoms that include:
Prolapse can occur in any of the 3 different compartments – the front wall of the vagina (anterior), the back wall of the vagina (posterior) and the uterus/ top of vagina (apical). Most women will have a combination of 1 or more prolapse.
This is the most common, is medically called a cystocele, and involves the bladder bulging into the vagina through the front wall.
This is medically called a rectocele if it involves the rectum bulging into the vagina through the lower back wall, and an enterocele if it involves the small intestine bulging into the vagina through the upper back wall.
This is second most common, where the uterus drops into the vagina. For women with previous hysterectomy (removal of the uterus), the top of the vagina may collapse downwards out of the vaginal opening.
Because of the common cause of weakened pelvic floor muscles, many women may suffer from both POP and urinary incontinence.
You should consult a urogynaecologist, who is a gynaecologist specialising in female urinary disorders, to determine what type of pelvic organ prolapse you have, its severity and your treatment options. Your doctor will take a detailed medical history and perform a pelvic examination to check for the stage of your pelvic organ prolapse and pelvic floor muscle tone. An ultrasound scan will need to be performed to check your uterus and ovaries, and a bladder scan done to check the amount of urine remaining in your bladder after you have passed urine). Depending on your symptoms, you may also require urine tests and Pap smear/HPV test.
Some women may choose to do nothing and just observe if they are not having any symptoms. Treatment options include non-surgical and surgical.
Kegel (pelvic floor) exercises
These strengthens the weakened pelvic floor muscle tone and can improve mild pelvic organ prolapse. Kegel exercises need consistent daily efforts for at least 3 to 6 months to see results. Click here to find out how to do them.
Lifestyle changes
Avoid increased pressure on pelvic floor muscles by losing weight to maintain a healthy body mass index (BMI), treating conditions such as chronic cough and constipation, not lifting heavy loads.
Vaginal pessaries
These are soft, removable devices that is inserted in your vagina to support your prolapsed pelvic organs and hence provide relief of your symptoms of POP. Read more about them here.
The type of surgery advised by your urogynaecologist will depend on your severity of pelvic organ prolapse, age, general health, medical conditions, surgical history and sexual activity.
The type of surgery advised by your urogynaecologist will depend on your severity of pelvic organ prolapse, age, general health, medical conditions, surgical history and sexual activity. There is no one-size-fits-all. Each surgery for POP needs to be individualised. Surgery needs to done under general anaesthesia.
This is the most common approach as the pelvic organs are drooping out from the vagina. If the uterus is prolapsed, there is no plans for more children and the woman has no desire to keep her uterus, a vaginal hysterectomy will be performed. The ovaries can be conserved if they are normal.
Surgery for prolapse in the other compartments (pelvic floor repair) involves making a cut in the vagina and separating the prolapsed organ away from the vaginal wall. Stitches or mesh are used to strengthen the defect in the supporting tissue, and the vaginal skin is closed to reduce the bulge.
If this is done for the bladder, it is known as an anterior repair or colporrhaphy. If this is done for the rectum, it is known as a posterior repair or colporrhaphy. In some cases, additional permanent sutures may be placed to hitch the top of the vagina to a strong ligament in the pelvis to provide additional support (sacrospinous ligament fixation/SSLF). Overall, there are no cuts on the abdomen.
This is an option for women with previous hysterectomy and an apical prolapse (top of vagina collapsing downwards out of the vaginal opening). It involves making cuts in the abdomen and using a permanent synthetic mesh to hitch the vagina up to the sacrum, which is a large triangular bone at the base of the spine.
In a few instances, vaginal closure surgery may be recommended for women with severe prolapse who are medically unfit for vaginal pelvic reconstructive surgery and are not sexually active. This surgery involves pushing the prolapsed organs back into the vagina and stitching the vaginal walls together.
70% of women will have a long-term cure after undergoing surgery for POP. For those with permanent implantation of synthetic mesh, the success rate goes up to 90%.
It is important to note that the limitation of pelvic reconstructive surgery lies in working with ageing/weakened tissues. Hence, pelvic organ prolapse typically recurs due to persistent risk factors that caused the initial prolapse. Although ageing cannot be reversed, lifestyle modifications like maintaining a healthy body mass index (BMI), avoiding chronic cough, constipation and lifting heavy loads remain essential.
