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Pelvic Organ Prolapse

Conditions We Treat

Pelvic Organ Prolapse

Female pelvic organ prolapse (POP) is a condition in which the pelvic organs (bladder, uterus, rectum, and small bowel) descend or protrude into the vaginal canal due to weakening of the pelvic floor muscles and connective tissues. This condition is common, particularly in women who have experienced childbirth, are postmenopausal, or have other risk factors such as obesity or chronic constipation.
Causes of Pelvic Organ Prolapse:
• Childbirth: Vaginal delivery, particularly multiple births, can stretch and damage pelvic floor muscles and ligaments.
• Aging and Menopause: Reduced estrogen levels after menopause contribute to weakening of pelvic tissues.
• Obesity: Excess weight puts additional pressure on the pelvic floor.
• Chronic constipation or coughing: Frequent straining can contribute to pelvic floor damage.
• Genetic factors: A family history of pelvic floor problems may increase risk.
• Hysterectomy: Removal of the uterus can weaken pelvic support structures.
Types of Pelvic Organ Prolapse:
1. Cystocele (bladder prolapse): The bladder sags into the vaginal canal.
2. Rectocele (rectal prolapse): The rectum protrudes into the back of the vagina.
3. Uterine prolapse: The uterus drops into or out of the vaginal canal.
4. Enterocele (small bowel prolapse): The small intestine pushes into the upper vaginal wall.

Symptoms:

  • Feeling of pelvic pressure or fullness
  • Urinary symptoms: Frequent urination, urinary incontinence, or difficulty emptying the bladder.
  • Bowel symptoms: Difficulty with bowel movements, constipation, or a sensation of incomplete evacuation.
  • Vaginal bulging: A bulge or “lump” that can be felt or seen at the vaginal opening, particularly after standing or straining.
  • Sexual dysfunction: Painful intercourse or a sensation of vaginal looseness.

Diagnosis:

  • Medical History and Physical Exam: A detailed history and pelvic exam to assess the degree of prolapse.
  • Pelvic Floor Examination: Often done in different positions (lying, standing, or straining).
  • Ultrasound or MRI: Imaging may be used to assess organ displacement in more complex cases.

Treatment Options:

Conservative Management:

  1. Pelvic Floor Exercises (Kegel Exercises): Strengthening the pelvic floor muscles can help improve support and alleviate symptoms.
  2. Pessary: A device inserted into the vagina to support the prolapsed organs. This is often used in women who are not candidates for surgery or prefer a non-surgical option.
  3. Lifestyle Modifications: Weight loss, managing chronic cough, and avoiding constipation can reduce strain on the pelvic floor.
  4. Hormonal Therapy: Estrogen therapy may help improve the strength of the vaginal tissues, particularly in postmenopausal women.

Surgical Treatments:

  1. Anterior and Posterior Colporrhaphy: Repair of the vaginal walls (for cystocele or rectocele).
  2. Hysterectomy: Removal of the uterus in cases of uterine prolapse.
  3. Sacral Colpopexy: A procedure where the vagina is surgically attached to the sacrum to provide support (for uterine or vaginal vault prolapse).
  4. Vaginal Mesh: Sometimes used to reinforce prolapsed organs, although its use has decreased due to safety concerns.

When to Consider Surgery:

  • If the prolapse is severe or causing significant symptoms that affect quality of life.
  • When conservative treatments have failed.
  • In cases of recurrent prolapse after previous surgery.

Prevention:

  • Pelvic Floor Exercises: Regularly performing Kegel exercises can help maintain pelvic floor strength.
  • Healthy Weight: Avoid excessive weight gain to reduce pressure on the pelvic floor.
  • Avoid Heavy Lifting: Proper lifting techniques can prevent straining.
  • Treating Chronic Cough or Constipation: Managing these conditions can reduce the risk of prolapse.

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