Understanding Pelvic Organ Prolapse: Causes, Symptoms, and Treatment Options
Doctor explains key facts about pelvic organ prolapse, including causes, symptoms, and treatment options. Learn how to identify and manage this condition with expert advice and practical tips.
Disclaimer
The medical information in this content is for educational and entertainment purposes only. While Doctor O'Donovan Medical Education Limited always aims to provide accurate information, it does not replace professional medical advice from your own doctor or health provider. Always consult your own healthcare professional for medical concerns.
Doctor O'Donovan Medical Education Limited can not provide individual advice. Never ignore professional medical advice from your own health provider because of something you have read or watched here. Educational resources created by Doctor O'Donovan Medical Education Limited are not a substitute for professional medical advice, diagnosis or treatment.
Topic Breakdown
In this video, we're going to cover key things that you need to know about pelvic organ prolapses, which is where one or more of the organs in the pelvis, such as the uterus, bowel, or bladder, slip down from their normal position and bulge into the vagina. We're going to be covering the following information, which is split into sections and deserves a timestamp for you to navigate your way around the video.
First of all, what causes a pelvic organ prolapse? A pelvic organ prolapse occurs when the pelvic floor, which is a group of muscles and tissues that normally supports the pelvic organs, becomes weakened and can't hold the organs in place. Some scenarios that might lead to this are childbirth, menopause, being overweight, lifting heavy objects repeatedly, and long-term constipation or a health condition that causes you to strain.
There are four main types of prolapses. The first is the bladder bulging into the front wall of the vagina, known as an anterior prolapse. The second is the womb bulging or hanging down into the vagina, called a uterine prolapse. The third is the top of the vagina sagging down, which happens to some women after they've had surgery to remove their womb. The fourth is the bowel bulging forward into the back wall of the vagina, called a posterior wall prolapse. It's important to note that it's possible to have more than one of these types of prolapses at the same time, and the severity of the prolapse will be graded on a scale from one to four.
So, what are the symptoms that might indicate you have a prolapse? There are several different symptoms that a woman could have, including a feeling of heaviness around your lower tummy and genitals, a dragging discomfort inside your vagina, feeling like there's something coming down into your vagina (for example, it might feel like you're sitting on a small ball), or feeling or seeing a bulge or lump coming out of the vagina. You may also notice discomfort or numbness during sex, problems peeing such as feeling like your bladder is not emptying fully, needing to go to the toilet more often, or incontinence, which is where you can't control when you go to the toilet. It's also possible to have no symptoms and for the condition to be discovered on a routine examination.
If you believe that you've got one of these symptoms or more, then you should schedule an appointment with your health professional. During this appointment, your doctor or the specialist nurse will likely ask if they can do an internal pelvic examination. This will require you to undress from the waist down and lie back on an examination bed. The health professional will then feel for any lumps in your pelvic area and will also feel inside your vagina. They may insert a speculum into your vagina, which is a smooth plastic instrument, to better see and assess the situation. This procedure might be slightly uncomfortable but shouldn't be painful. You can ask for the examination to be done by a female doctor or nurse, and if you like, you can bring someone you trust along with you for support. If you're alone, you're also more than entitled to ask for a chaperone. This is a trained professional who can be present in the same room at the same time to make sure that you're comfortable with the procedure being carried out.
Let's move on now and discuss different treatment options. If you have a mild prolapse, you might not require any medical treatment, and the situation may resolve with some lifestyle changes such as losing weight, avoiding heavy lifting or activities that cause you to strain, or treating constipation if this is the underlying reason for your prolapse. This is really important because often constipation and straining or pushing down on the toilet is the reason for many prolapses. It may also be helpful to do pelvic floor exercises to strengthen the muscles in the area, and I've included a link in the description box of a video on how to do pelvic floor exercises, as well as descriptions from trusted websites. Most of these you can do at home in your own time.
If the prolapse is more serious or it's a more severe grade, then your health provider may advise several different treatment options. These can include hormone treatment, vaginal pessaries, or even surgery. Hormone therapy, which would include a treatment of estrogen, may be advised by your health provider if you've got a mild prolapse and you've been through menopause. The treatment can be a cream that you can apply inside your vagina, a tablet that you can insert into your vagina, or an estrogen-releasing vaginal ring. This treatment option isn't always suitable for everyone, so a discussion with your doctor before starting this would be strongly advised.
If you have a moderate to severe prolapse and you're considering getting pregnant in the future and you don't wish to have surgery, you could discuss vaginal pessary treatment with your GP. Vaginal pessaries are a device made of latex or silicone that's inserted into the vagina and left in place to support the vaginal walls and pelvic organs. They come in different shapes and sizes depending on your needs and should be removed, cleaned, and replaced regularly. There are some potentially mild side effects to using vaginal pessaries, including unpleasant-smelling vaginal discharge, some irritation and sores inside the vagina, bleeding, stress incontinence (which means you lose control of your bladder, for example, when you cough), urinary tract infection or water infection, and sometimes interference with sex. However, most women can have sex without any problems. These side effects can usually be treated.
If you have a severe prolapse and other treatment options have been ineffective—for example, you've tried a pessary, you've tried doing the pelvic floor exercises, and they don't work—then you may wish to consider a surgical procedure. One surgical option is a surgical repair where your doctor uses stitches to make the existing tissue stronger or to lift and support the pelvic organs. This type of procedure is done under a general anesthetic, so you'd be asleep during the procedure. The recovery time after the operation is usually 6 to 12 weeks. As ever, surgery does come with risks, so you'd have to weigh up the risks and benefits of surgery with all of the different factors that are interplaying in your life to make the right decision for you. Your doctor can help you do this.
If you would like to have children in the future and you do have a prolapse, then your doctor may advise you to wait until you've finished having all of the children you wish to have before engaging in something like a surgical repair. That's because the prolapse can recur or happen again even if you've had a repair in the past. If you're no longer wanting to have children and you've been through menopause, then another surgical option might be having a hysterectomy. This is the surgical removal of the womb and can help to relieve pressure on the walls of the vagina and reduce the chances of future prolapses. The standard recovery time after a hysterectomy is going to vary from woman to woman, but usually, it's 6 to 12 weeks. Occasionally, an operation that closes part or all of the vagina may be an option. This treatment is only offered to women who've got advanced prolapses when other treatments haven't worked and they're sure they don't want to have children again in the future.
You may have heard of some women being offered mesh treatments, but some women have had serious complications following this procedure, including long-lasting pain, permanent nerve damage, incontinence, constipation, sexual problems, and mesh exposure through vaginal tissues, and occasionally injury to nearby organs such as the bladder or bowel. Your doctor should discuss all risks and possible complications of the various types of surgeries with you before you decide if one of these surgical options is right for you. If you've got any of the following symptoms after your surgery, then you'll need to let your surgeon or doctor know as soon as possible. These could be things like a high temperature, severe pain in your tummy, heavy vaginal bleeding, a stinging or burning sensation when you pee, or abnormal vaginal discharge, as these may be signs of an infection. You should also be offered a checkup six months after the surgery that includes a vaginal examination.
One common question that comes up is whether or not you can have sexual intercourse with a prolapse and if intercourse will actually worsen the condition. Research and clinical evidence show that sexual intercourse shouldn't exacerbate your prolapse. In fact, if you have a uterine prolapse, intercourse may actually push the cervix to sit higher within the vagina. Many women can continue to have normal intercourse despite having a mild or moderate vaginal prolapse. However, as always, you should listen to your own body, do what feels right, and talk to your doctor if you have any concerns. In the case of tampons, it may be possible to wear a tampon if your uterus is prolapsed, but it might lead to irritation. However, you shouldn't use a tampon as a solution for incontinence caused by a prolapse. If you've got any questions or concerns, you should always talk to your doctor.
If you found this information helpful and want to scale your medical brand on YouTube or are interested in sponsoring our videos with your products, feel free to book a consultation with us today.
Share this article
Partner with Dr. O Donovan
If you would like to partner on a healthcare related campaign, discuss a story or seek my expert opinion please don't hesitate to reach out.