What to do about pelvic organ prolapse (IPWHRM)

One of the most uncomfortable and awkward conditions that afflicts women is pelvic organ prolapse. Normally, the pelvic organs the bladder, uterus, vagina, and rectum are supported and held in place by a group of muscles and tissues called the pelvic floor. When these muscles weaken over time, the pelvic organs can drop down and bulge out of the vagina.

In addition to the sensation of feeling an uncomfortable bulge in the vagina, you can experience symptoms such as

• pain or pressure in the pelvis, the lower back, or both
• urinary problems, like urine leaking or the feeling that you need to constantly urinate
• constipation
• Painful sex.

In pelvic organ prolapse, the pelvic floor muscles weaken, causing one or more of the pelvic organs to fall downward into or out of the vagina. Sexual and other physical maturation that happens during puberty results from hormonal changes.

What is pelvic organ prolapse?

How prolapse is named depends on which organ is affected:

• Cystocele is when the bladder protrudes into the vagina, creating a bulge. It's the most common form of prolapse.
• Rectocele is when the rectum bulges into the back wall of the vagina.
• Uterine prolapse involves the uterus dropping into the vagina.

Most of the time, pelvic organ prolapse is the result of carrying and vaginally delivering children, which weakens the pelvic floor. "The baby's head going through the vaginal canal stretches out the connective tissues," says Dr. May Wakamatsu, assistant professor at Harvard Medical School and division director of Female Pelvic Medicine and Reconstructive Surgery at Massachusetts General Hospital. Getting older, being overweight, and having a condition that involves frequent coughing (which increases pressure in the abdomen and pelvis) also make a woman vulnerable to prolapse. In pelvic organ prolapse, the pelvic floor muscles weaken, causing one or more of the pelvic organs to fall downward into or out of the vagina.

Pelvic prolapse symptoms

If you have pelvic organ prolapse, you'll notice a bulge at the opening of the vagina. The bulge isn't dangerous, but it can be very uncomfortable.

When the prolapse pulls the bladder downward, it bends the ureter (the tube through which urine exits the body). As a result, you might have trouble urinating fully. "It's like bending a garden hose," Dr. Wakamatsu says. Likewise, if the prolapse pulls the rectum downward, it can cause constipation. As embarrassing as pelvic organ prolapse can be to talk about, it's something you need to discuss with your primary care physician or gynecologist. Letting it go can leave urine in your bladder, which can lead to urinary tract infections.

How to prevent pelvic organ prolapse

"Women should lose weight if they're overweight. They should stop smoking because it can lead to repetitive coughing," Dr. Wakamatsu says. "And they should protect their pelvic floor by pulling in their lower abdominal muscles and tightening their pelvic floor muscles when they lift heavy objects."

Journal of Women’s Health and Reproductive Medicine is an interdisciplinary journal that explores clinical, medical, social and economic aspects of female reproductive health and medication worldwide.

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Journal of Women’s Health and Reproductive Medicine
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