When Things Aren’t Right “Down There”-Pelvic Organ Prolapse

This is a common condition that affects millions of American women. It is a condition that occurs when one of the pelvic organs such as the uterus, bladder, intestines, or rectum protrudes through the vagina. Prolapse ranges from mild to severe levels where mild prolapse is found by the doctor at the time of a pelvic exam and a severe condition when the organs protrude the vaginal opening and is visible and can be felt by the women when she is in the standing position.

Prolapse is caused by a weakness in the muscles and support structures in the vagina that normally hold the pelvic organs in place and when weakened allows one of the organs such as bladder or uterus to drop into the vagina and when severe protrudes through the vaginal opening. The process of childbirth through the vagina stretches the vaginal muscles and supporting structures and weakens the vagina and allows the organs to drop into the vagina. Each additional vaginal delivery adds more stretch and leads to the potential for more prolapse. Also aging and the accompanying estrogen deficiency also promotes weakness of the vaginal muscles and promotes prolapse. Less common causes include obesity, asthma, bronchitis and other pulmonary conditions that are associated with chronic coughing.

Symptoms of Prolapse?

The most common symptom of prolapse is a feeling of pressure in the vaginal or rectal area. Women often describe a sensation as if they have a ball in the vagina. If the prolapse is severe, the woman can see the lump protruding from the vagina. If the protrusion is present all the time, the tissue can be come irritated and be associated with a discharge or bleeding. With more severe degrees of prolapse it may be difficult to urinate because the urethra, the tube that transports urine from the bladder to the outside of the body, becomes kinked causing the women to strain in order to empty the bladder. In rare situations the woman may be unable to urinate and have to go to the emergency room to have a catheter inserted. Occasionally, prolapse is associated with urinary incontinence especially when the woman coughs and sneezes. Sexual problems include irritated vaginal tissues and painful intercourse. When the rectum prolapses through the vagina, there may be a problem of constipation and the woman may have to insert her finger in the vagina to express the stool. With very severe prolapse the tubes from the kidney to the bladder or the ureters are kinked and can cause obstruction and lead to kidney failure if the prolapse is not repaired.

Treatment of Prolapse

There are two treatment options for prolapse especially if the prolapse is producing significant symptoms. These are the insertion of a pessary or surgical correction.

A pessary is a device that is usually made out of a plastic substance and is usually in the shape of a donut or ring. It is placed in the vagina, like a tampon, to restore the organs to their normal position. Pessaries are quite safe, although in some patients they seem to be associated with recurring bladder infections.

If a pessary works, and it is comfortable, it can be a lifetime treatment. It can be left in place for several months at a time, however, it needs to be removed and cleaned and then reinserted.

Surgery to correct prolapse is indicated if there are significant symptoms such as a protrusion that is uncomfortable or causes vaginal bleeding, for women who have difficulty with urination such as straining to urinate or urinary incontinence, or chronic constipation. If the uterus is prolapsed it may be necessary to have a hysterectomy as well as repair the prolapse. In addition, it may be necessary to repair incontinence. Most of the surgery is performed through the vagina and can be done on a one-day stay basis or with one overnight stay in the hospital. Women have to avoid heavy lifting for 4-6 months after the surgery and must abstain from sexual intercourse for a similar time period. The surgery is successful in most cases and restores the quality of life to those who suffer from this common condition.

For additional information please visit my website, www.neilbaum.

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2 Responses to “When Things Aren’t Right “Down There”-Pelvic Organ Prolapse”

  1. Sherrie Palm Says:

    It is so important to make information like this available for young women who are of childbearing age; they need to be aware of the potential for POP to occur and should be know the causes and symptoms of POP so they recognize it at the earliest possible stage so treatment can be less aggressive.

  2. neilbaum Says:

    Thanks for your note. You and I should become the messengers to women of all ages. Any suggestions would be welcomed.

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