Pelvic organ relapse is a condition that occurs when the organs of the pelvic region dip into the vaginal canal due to weakening muscles and tissues. The organs of the pelvic region include the bladder, rectum, vagina, uterus and small bowel.
Obstetrician and gynaecologist Dr Duru Shah, director, Gynaecworld, Mumbai, told Happiest Health that the prolapse usually occurs into or outside the vaginal canal.
There are many types of prolapse. “When the upper part of the vaginal canal loses its muscle tone, vaginal prolapse can take place. Sometimes the bladder can prolapse down through the ‘roof’ of the vagina, leading to a cystocele. A muscle defect in the ‘floor’ of the vagina can lead to rectocele, causing the rectum to bulge into the vagina,” said Dr Shah.
Pelvic organ prolapse causes
Shah said pelvic organs are held together by the pelvic floor muscles forming a hammock-like structure. Prolapse occurs when these muscles and tissues lose the ability to support the pelvic organs.
Dr Monika Singh, assistant professor of the department of obstetrician-gynaecologist from Noida International Institute of Medical Sciences, Uttar Pradesh, told Happiest Health that pelvic organ prolapse can occur due to erect posture that causes increased stress on muscles, nerves and connective tissue, smoking, ageing and oestrogen deprivation (following menopause).
Adding to it, Dr Shah said common causes include pregnancy, difficult labour/childbirth, obesity, chronic constipation, chronic coughing or lifting heavy objects. “The most cited risk factors are ageing, increased number of caesarean section deliveries and being overweight.”
Pelvic organ prolapse is seen in the age group of 40-60 years – the premenopausal or postmenopausal age group. Ageing increases the chances of one developing pelvic floor disorders.
Moreover, women who are overweight also have a greater possibility of having at least one pelvic disorder.
Pelvic organ prolapse symptoms
- Feeling of something bulging out of the vagina
- Feeling of pressure/fullness in pelvic region
- Urinary problems like increased frequency/leaking of urine
- Constipation or loss of bowel control
- Lower backache
“Symptoms depend on which organ has prolapsed. Severity also varies from person to person, depending on their childbirth history and obesity,” said Dr Shah.
“Clinical features before actual prolapse include a sensation of weakness in the perineum (area between anus and vulva),” pointed out Dr Singh.
Dr Singh added that rectal symptoms are not so marked. “The affected person always feels heaviness in the rectum and a constant desire to defecate [excrete]. Piles could also develop from straining.”
Congestive dysmenorrhoea (painful cramps during the menstrual cycle) and menorrhagia (menstrual periods with abnormally heavy or prolonged bleeding) are common symptoms.
Pelvic organ prolapse treatment
Behavioural treatments like Kegel exercises to strengthen pelvic floor muscles can minimise the chances of prolapse, said Dr Shah.
“Exercise helps to keep muscles and ligaments more flexible. Lifestyle changes and losing weight can help relieve mild symptoms.”
Dr Singh noted that if the prolapse is severe or symptoms are affecting the quality of life, it should be treated. These include hormone treatment and pelvic floor exercises.
Mechanical treatment can include using pessaries to support the prolapse. A pessary is a doughnut-shaped device, which comes in different sizes, used to treat pelvic organ prolapse by providing support to the affected area.
“The last resort includes surgeries either to support the organ prolapsed or to remove the organ (eg: removal of uterus via hysterectomy). Attaching the uterine ligaments to the top of the vagina further supports it from dropping down,” said Dr Shah. “Nowadays, synthetic mesh is also being used to support the weakened areas.”
Exercise and lifestyle changes
“Losing weight, in case one is overweight, avoiding lifting heavy objects and preventing or treating constipation could be helpful for women with prolapse,” said Dr Singh.
Dr Shah suggested that following a healthy diet full of whole grains, fruits and vegetables would not only help relieve constipation but also help one maintain a healthy weight. “Chronic cough should also be treated early to avoid putting extra strain on the pelvic muscles,” she added.
Daily Kegel exercises help maintain good muscle strength in the pelvic regions. Kegels can be done by squeezing the gluteal or buttock muscles, holding and releasing the muscles every 2-3 seconds. A set of 10-20 contractions are recommended three times a day.
