Pelvic Organ Prolapse (POP)
What is a vaginal (pelvic organ) prolapse?
Your pelvic organs include your bladder, uterus (womb) and rectum (back passage). These organs are held in place by tissues called 'fascia' and 'ligaments'. These tissues help to join your pelvic organs to the bony side walls of the pelvis and hold them inside your pelvis.
Your pelvic floor muscles also hold up your pelvic organs from below. If the fascia or ligaments are torn or stretched for any reason, and if your pelvic floor muscles are weak, then your pelvic organs might not be held in their right place and they may bulge or sag down into the vagina.This is known as a pelvic organ prolapse (POP).
What are the signs of prolapse?
There are a few signs that you may have a prolapse. These signs depend on the type of prolapse and how much pelvic organ support has been lost. Early on, you may not know you have a prolapse as there will be no symptoms, but your doctor or nurse might be able to see your prolapse when you have your routine Pap smear test.
When a prolapse is further down, you may notice things such as:
urinary tract infections might be reoccurring, or
it might be hard for you to empty your bowel.
a heavy sensation or dragging in the vagina
something ‘coming down' or a lump in the vagina
a lump bulging out of your vagina, which you see or feel
sexual problems of pain or less sensation
your bladder might not empty as it should, or your urine stream might be weak
These signs can be worse at the end of the day and may feel better after lying down. If the prolapse bulges right outside your body, you may feel sore and bleed as the prolapse rubs on your underwear.
What causes a prolapse?
Childbirth is the main cause of a prolapse. On the way down the vagina, the baby can stretch and tear the supporting tissues and pelvic floor muscles. The more vaginal births you have, the more likely you are to have a prolapse.
Other things that press down on the pelvic organs and the pelvic floor muscles that can lead to prolapse are:
chronic coughing (such as smoker's cough or poorly controlled asthma)
heavy lifting (washing baskets, supermarket bags or children), and
constipation - chronic straining to empty the bowel can cause prolapse.
What are the different types of prolapse?
Pelvic organs may bulge through the front wall of the vagina (called a cystocele), through the back vaginal wall (called a rectocele or an enterocele) or the uterus may drop down into the vagina (uterine prolapse). More than one organ may bulge into the vagina.
Who is likely to have a prolapse?
Prolapse tends to run in families. It is more likely after menopause or if you are overweight. But it can happen in young women right after having a baby.
Prolapse can also happen in women who haven’t had a baby, mainly if they cough, strain on the toilet, or lift heavy loads.
Even after surgery to mend prolapse, one in three women will prolapse again.
Prolapse can also happen in women who have had their womb removed (that is, had a hysterectomy). In a case like this, the top of the vagina (the vault) can prolapse.
What can be done to treat prolapse once it has happened?
Prolapse can be dealt with simply, with laser; ProlapLase™ or with surgery depending on the level of prolapse.
The Simple Approach
Prolapse can often be treated without surgery, chiefly in the early stages, and when the prolapse is mild.
The simple approach can mean one of the following treatments:
- Pelvic floor muscle training - Where a program of treatment is planned to suit your individual needs, with the advice of a pelvic floor physiotherapist or continence nurse advisor
- Lifestyle changes - Learning what caused your prolapse, and making needed lifestyle changes, such as improving your diet, fluid intake, exercising and losing weight.
- Being aware - Being aware of good bowel and bladder habits to avoid straining on the toilet, or having a pessary (a plastic or rubber device that fits into your vagina) carefully measured and placed into the vagina to provide inside support for your pelvic organs.
ProlapLase™ is a non-invasive Er:YAG laser therapy for the treatment of prolapse, based on non-ablative photothermal stimulation of collagen neogenesis, shrinking & tightening of vaginal mucosal tissue and endopelvic fascia, and subsequently improvement of prolapse
To discuss treatment options please contact Alcedonia for an appointment with our Gynaecologist Dr Colin Sabau