Our urogynecologists treat common women’s bladder and bowel problems, as well as other pelvic floor disorders including prolapse.
Pelvic organ prolapse (POP) is a collapse of the pelvic floor (i.e. the group of muscles that form a hammock-like shape across the lower pelvis). Normally, these muscles and the tissues surrounding them keep a woman’s pelvic organs in place. These organs include a woman’s bladder, uterus, vagina, small bowel, and rectum. When a prolapse happens, however, any or all of the pelvic floor organs can begin to descend, causing those organs to drop into the vaginal area or even bulge outside.
Prolapse can be quite painful. However, many women do not seek treatment for this condition, due to confusion or shame. With that in mind, here are some important things to know.
Many elements can lead to a weakening of the muscles and ligaments of the pelvic floor. Women who have had a vaginal birth (especially multiple births) have probably the biggest risk of developing POP just owing to the mechanics of natural delivery, according to Kelly M. Kasper, MD, a gynecologist at Indiana University Health, who says other predisposing factors include menopause and decreasing estrogen levels, hysterectomy (if care is not taken during the surgery to prevent prolapse), obesity, abnormalities of connective tissue and nerves, and prolonged strenuous physical activity.
The symptoms a woman might experience will largely be predicated on what organ or organs are drooping. In general, however, Dr. Kasper says that a woman may experience vaginal or pelvic pressure, a “bulge” at the opening of the vagina or protruding beyond the opening of the vagina, pain with intercourse, pelvic or vaginal pain, difficulties emptying the bladder or having a bowel movement, recurrent urinary tract infections, urinary incontinence, and/or constipation.
POP is often discovered when a woman goes in for a routine checkup, like for her pap smear. If your doctor suspects you might have a pelvic floor disorder, you’ll probably be sent for further testing to confirm the diagnosis, such as an MRI, CT scan or ultrasound of the pelvis.
Again, this will be dependent on the severity of the prolapse and which organs are involved. However, Dr. Kasper says the two most effective treatments are surgery (to repair the damaged muscles/tissues, or remove the prolapsed organ as in the case of a hysterectomy) or the insertion of a pessary (which is a plastic device that is placed in the vagina to hold the organs in place; it is fitted in a doctor’s office and once in, a woman can't feel it). In milder cases, pelvic floor physical therapy may be prescribed, or estrogen therapy which may lessen symptoms and/or prevent them from worsening.
Fortunately, not every woman will develop prolapse. Maintaining a healthy body-mass index and avoiding chronic constipation will help prevent weakening of the muscles of the pelvic floor. Also, don’t forget about Kegel exercises (yet another reason to do those little internal vaginal contractions). “If a woman has a strong family history of prolapse, has had multiple vaginal births, has had a hysterectomy or repeatedly must lift heavy objects, maintaining pelvic floor strength can help minimize future prolapse,” says Dr. Kasper.
-- By Kimberly Dawn Neumann