Pelvic Organs Displacement – Causes Symptoms and Treatment of Pelvic Organ Prolapse

Pelvic Organs Displacement – Causes Symptoms and Treatment of Pelvic Organ Prolapse

Fourty-four year old Shreya’s health began to deteriorate when she started developing severe constipation. Her condition worsened further when she faced excessive strain while bowel movement. She also experienced problems such as urinary incontinence and repeated bowel movements that further raised her concern. The doctor later diagnosed her with a condition known as pelvic organ prolapse.

With the age, our body organs go through several changes. It is especially a cause of concern for women whose body undergoes wear and tear several times during her course of life. Conditions such as pregnancy and labor can cause undesirable changes in her body. This is not confined to external changes, but internal organs can also bear the impact.

Pelvic Organ Prolapse

The term ‘prolapse’ means drooping or falling of organs. Normally, pelvic floor muscles hold your pelvic organs in place. In pelvic organ prolapse, these muscles and ligaments become weak or stretched to some extent that it let the pelvic organs drop or displace from its original position down in the pelvis. This often creates bulge or prolapse in the vagina. The condition is also known as by the term pelvic floor disorder. This can affect any of the pelvic organs be it uterus, bladder, vagina, bowel or rectum.

Is pelvic organ prolapse common?

Yes, it’s one of the common disorders affecting woman of every age. In fact, one-third of all the women will suffer some kind of prolapse in their lifetime. The cases of pelvic organ prolapse increases with the age. According to Proctosurgeon Ashwin Porwal, Poona Hospital and Research Centre, 50 percent of women aged 50 and above complains of symptomatic prolapse.

She further says that out of all vaginal hysterectomies, approximately 81 percent are conducted for prolapse. And percentage of these surgeries increases in the age group of 65-69. Most commonly, women develop this condition year after childbirth, after a surgery (hysterectomy) and after menopause.

Types of pelvic organ prolapse

There are basically five types of pelvic organ prolapse.

  1. Cystocele – This is the most common type of prolapse. Cystocele occurs when front walls of the vagina weaken, resulting in drooping or falling of the bladder into the vagina. Sometimes the urethra may also droop or herniate from its normal position. This condition is known as urethrocele. When both bladder and urethra droop, it is called as cystourethrocele.
  2. Rectocele – When posterior or back wall of the vagina weakens, it causes the rectum to hang down to the vagina, a condition known as rectocele.
  3. Enterocele – In this condition the front and back walls of the vagina separates and let the small bowel herniate or droop into the vagina. This condition is more common after hysterectomy.
  4. Vaginal vault prolapse – When uterus stops providing support to the upper portion (vault) of the vagina, it can result in prolapse.
  5. Uterine Prolapse – This condition occurs when the ligaments supporting the upper part of the vagina becomes weak, leading to drooping down of the uterus into the vagina. In severe cases, the uterus protrudes out of the vagina.

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What causes pelvic organ prolapse?

The condition is most often linked to strain during childbirth. Typically, the muscles and tissues keep pelvic organs in place in the belly. During the labor or after childbirth these muscles get strained. If they don’t recover on their own, they won’t be able to support pelvic organs.

Some other causes or risk factors of pelvic organ prolapse are:

  • Age 40 and above
  • Menopause
  • Frequent constipation
  • Long lasting cough
  • Obesity
  • Pelvic organ tumors
  • Surgical removal of the uterus (hysterectomy)
  • Pelvic surgery

Signs and symptoms of pelvic organ prolapse

Many women suffering from pelvic organ prolapse might not notice anything. But in some others, following symptoms can occur:

How pelvic organ prolapse is diagnosed?

During the routine pelvic examination such as pap smear, the doctor can detect the prolapse. The doctor may also suggest different tests to confirm the condition. These are:

  1. Pyelography – The doctor will inject an iodinated contrast material into the veins and take an X-Ray of different parts of the urinary system.
  2. Cystoscopy – A fine tube containing a camera (scope) is inserted through the urethra to examine the interior structures that are not clearly observed in X-ray.
  3. CT Scan – This technique creates cross sectional images to view the pelvic region in detail.
  4. MRI – Magnetic resonance imaging can give clear pictures of the inside of the pelvic region.

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How pelvic organ prolapse is treated?

The treatment will depend how bad the symptoms of prolapse are. Following can be recommended:

  1. Lifestyle changes - If the symptoms are mild, you may be able to ward them off at your home by changing your lifestyle. These include eating healthy food to remain at healthy weight. Try pelvic floor exercise such as Kegel. This exercise relaxes pelvic floor muscles through repeated contraction and strengthens them. Also avoid lifting heavy things or strenuous exercises that will put unnecessary pressure on the pelvis.
  2. Pessary – If you are still not improving, the doctor may suggest you to fit a device called pessary. This silicone based device is inserted into the vagina to support pelvic organs. This device is removable, cost effective and safe.
  3. Surgery – For serious prolapse, surgery is also an option. The surgery can be done through various procedures depending on the condition. For minor prolapse, repairing the tissue that supports prolapsed organ or repairing vagina can work for many. For severe cases, hysterectomy (removal of the uterus) and vaginal obliteration (sealing the opening of the vagina) can be conducted.

Remember, pelvic organ prolapse can come back again. So, for women who are planning to have children, can talk to the gynaecologist and delay the surgery. Doing pelvic floor exercises can also help you recover fast from surgery.

Glossary
Proctosurgery - Surgery related to colon, rectum or anus.

Sources

1. Kuncharapu I, et al.(2010, May 01).Pelvic Organ Prolapse read more
2. Doshani A, et al.(2007, October).Uterine prolapse read more
3. Giarenis and Robinson (2014, September). Prevention and management of pelvic organ prolapse
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