Pelvic Organ Prolapse

A pelvic organ prolapse is a descent of the bladder, uterus or bowel against the vaginal walls or into the vagina.

Causes

  • A prolapse can be caused by childbirth particularly if forceps are used; a history of chronic constipation or respiratory illnesses; regular heavy lifting or having a high body mass index (BMI).

Signs & Symptoms

  • If you have prolapse you may feel a lump or bulge in your vagina; or a heavy/dragging sensation.

  • Other symptoms can be back pain or abdominal discomfort due to prolapse.

  • Some women find it difficulty to empty their bladder and open their bowels due to the angle of their prolapse against the urethra or rectum.

Differential Diagnosis

  • Pelvic floor muscle tension

PROmotion Assessment 

  • Management includes strengthening your pelvic floor muscles to help support the organs as well as learning to contract your pelvic floor when you cough, sneeze and lift heavy objects.

  • Another component is avoiding strain down through the organs, therefore learning how to correctly open your bowels and manage constipation is important, as well as maintaining a healthy weight and managing any respiratory conditions. Techniques can also be taught to allow for easy and complete emptying of your bladder and bowel.

  • A silicone support pessary can be used to give additional support to the prolapse and can be helpful for women wanting to return to high impact sports and/or wanting to avoid or delay surgery.

How to Manage

  • Management includes strengthening your pelvic floor muscles to help support the organs as well as learning to contract your pelvic floor when you cough, sneeze and lift heavy objects.

  • Another component is avoiding strain down through the organs, therefore learning how to correctly open your bowels and manage constipation is important, as well as maintaining a healthy weight and managing any respiratory conditions. Techniques can also be taught to allow for easy and complete emptying of your bladder and bowel.

  • A silicone support pessary can be used to give additional support to the prolapse and can be helpful for women wanting to return to high impact sports and/or wanting to avoid or delay surgery.

References

  1. Dumoulin C, Hunter KF, Moore K, Bradley CS, Burgio KL, Hagen S, et al. Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th international consultation on incontinence. Neurourol Urodyn. 2014;  DOI:10.1002/nau.22677.

  2. Brækken IH, Majida M, Engh ME, Bø K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. American Journal of Obstetrics & Gynecology. [cited 2015/04/20]; 203(2):170.e1-170.e7.  DOI:10.1016/j.ajog.2010.02.037.

  3. Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP–Q) – a new era in pelvic prolapse staging. Journal of Medicine and Life. 2011; 4(1):75-81. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056425/.