When one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina, it is called a pelvic organ prolapse. The organs could be the womb (uterus), bowel, bladder or top of the vagina.
Obstetrician and gynaecologist Dr Duru Shah, Director, Gynaecworld, Mumbai, Maharashtra, told Happiest Health that the prolapse usually occurs into or outside of the vaginal canal.
“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,” said Dr Shah, adding that there are multiple types of prolapse.
In medical terms, cystocele is a condition in which supportive tissues around the bladder and vagina weaken and stretch, causing vaginal wall and bladder to fall into vaginal canal.
“Any muscle defect in the ‘floor’ of the vagina can lead to rectocele, causing the rectum to bulge into the vagina,” informs Dr Shah.
Pelvic organ prolapse causes
Shah said pelvic organs are held in place by the pelvic floor muscles forming a hammock-like structure. Prolapse occurs when these muscles and tissues can no longer 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,” she listed out.
Pelvic organ prolapse is seen in the age group of 40-60 years – that is in the premenopausal or postmenopausal age group. As women age, the likelihood of a pelvic floor disorder increases.
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,” says Dr Shah.
“Clinical features before actual prolapse include a sensation of weakness in the perineum (area between anus and vulva),” says Dr Singh.
Dr Singh adds that rectal symptoms are not so marked. “The affected person always feels heaviness in the rectum and a constant desire to defaecate (excrete) and piles could also develop from straining.”
Congestive dysmenorrhoea (painful cramps during 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 are the best way to minimise the chances of the prolapse, advises Dr Shah.
“Exercise helps to keep muscles and ligaments more flexible. Lifestyle changes and losing weight can help relieve mild symptoms.”
“If the prolapse is more severe or your symptoms are affecting your daily life, there are several treatment options to consider. These include hormone treatment and pelvic floor exercises,” informs Dr Singh.
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 (e.g., removal of uterus via hysterectomy). Attaching the uterine ligaments to the top of the vagina further supports it from dropping down,” says 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 to 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.