Urinary Incontinence
Pelvic organ prolapse (POP) is a term to describe a condition that occurs when the pelvic organ(s) such as your uterus, vagina, bladder or rectum, “falls” (prolapses) out of its normal position. With this condition, one organ may prolapse or several at one time. Bladder prolapse is most common.
Symptoms of Pelvic Organ Prolapse
Many women describe a “bulge,” a feeling of fullness or as if something is actually falling out of the vagina, vaginal pressure, and painful sex. There may be vaginal discharge or bleeding. Others experience leaking of urine or stool, also known as incontinence. Some women say, “It just doesn’t feel right down there.”
Symptoms can worsen over time, particularly with jumping, lifting or standing activities. They usually are relieved when lying down. Whatever the symptom(s), it’s important that you honestly talk with your provider about what you are experiencing even if it is embarrassing. We are here to listen and help you.
Causes
Pelvic organ prolapse typically occurs in women who have had a baby or babies vaginally, who are over the age of 50, have had a hysterectomy, or who experience chronic straining, such as with constipation or excessive lifting. Over time, the muscles and soft tissues that support pelvic organ structures weaken, allowing the organs to move or fall out of place.
Lifestyle behaviors, such as smoking or being overweight, are also linked to POP.
Risk Factors for POP
Pelvic organ prolapse is common in many women, particularly those who have had children or are 50 years of age or older. Other risks factors include:
- General aging of tissues
- Family history: POP tends to run in families.
- Genetics: Caucasian women are more likely to experience POP.
- Smoking: Smoking weakens soft tissues inside the pelvis.
- Chronic constipation, straining
- Chronic coughing
- Hysterectomy
- Menopause
- Repetitive, heavy lifting
- Nerve and muscle (neuromuscular) conditions
- Obesity or being overweight
- Estrogen deficiency of vaginal tissues
Pelvic Organ Prolapse Diagnosis
The first step to determine if you have POP is an office exam. Our team will talk with you about your symptoms and the location of any pain. Your medical and family history is carefully considered.
Following, your provider will perform a pelvic exam, which is the definitive way to diagnose POP. He or she will look for and feel for prolapsed organs and accompanying abnormalities.
Other exams help diagnose POP. These include:
- Urodynamic testing is a process to evaluate how the body stores and empties urine.
- Pelvic ultrasound: State-of-the-art 3D and 4D ultrasound imaging “make a picture” of the inside of your pelvis.
- MRI (magnetic resonance imaging): Magnetic waves produce images of the inside of your uterus. Based on the exam and test results, your provider will work with you to determine next steps, which may include non-surgical and surgical options.
Based on the exam and test results, your provider will work with you to determine next steps, which may include non-surgical and surgical options.
Non-surgical Treatment of POP
Many women with POP may not have symptoms, or the symptoms aren’t bothersome enough to warrant surgery. We use the latest non-surgical POP treatments. Following a thorough health history and exam, our team works with you to create a care plan and carefully evaluate your progress over time.
- Behavioral and lifestyle interventions: These interventions include managing fluid consumption and activities of daily living, lifting ergonomics, preventing constipation with diet, smoking cessation, weight management, and bladder retraining.
- Pelvic floor muscle rehabilitation: ObGyn physical therapy: in-clinic and at-home training and education to teach you how to use your pelvic floor muscles correctly and increase pelvic floor muscle strength. Chronic constipation is also addressed at this time.
- Vaginal pessaries: Pessaries are made of plastic or silicone and are another option to help strengthen the pelvic floor.
- Hormone Therapy: Estrogen may be effective in treating symptoms of POP by helping to preserve or strengthen support tissues inside the pelvis.
Office-based Procedures
- Botox: This treatment uses an injection to relax the bladder muscles and decreases bladder spasms. Botox may reduce symptoms for up to six months and is repeated every few months as necessary.
Surgical Options for POP
Surgery options depend on which organs inside your pelvis are involved in your condition. Based on your symptoms, age, plans for more children, and your health, our gynecologic surgeons will recommend an option(s) that best suits you. When possible, we use reconstructive minimally-invasive surgery techniques with or without robotics.
- Sacral Neuromodulation and posterior tibial nerve stimulation. Similar to a pacemaker for the heart, these treatments target the communication problems between the brain and the nerves that control the bladder and your bowels.
- InterStim II and Axonics Modulation technologies are devices we use to improve this communication and better control bladder and bowel contractions.
- Posterior tibial nerve stimulation is a repetitive office-based procedure that also affects the nervous stimulation of the bladder.
- Suspension or fixation: This surgery is generally performed through your vagina and returns your organ(s) to its normal position using surgery technique(s) called an uterosacral ligament suspension and sacrospinous fixation.
- Anterior Repair with or without grafts: When the bladder begins to bulge through the vagina, it is called “cystocele” and an anterior repair surgery can help to repair the wall between the bladder and the vagina. A “graft”made of a pliable, biologic material may be recommended to help strengthen the wall and provide support for the pelvic floor muscles.
- Posterior Repair, with or without a graft: A bulge can form between the vagina and the rectum, which is caused by weakness in the wall between the vagina and the rectum, or a “rectocele”. Surgical repair involves correcting this bulge using either your own tissues or graft options depending on the size of the bulge.
- Sacrocolpopexy: This surgical treatment helps to repair the prolapse and reduce symptoms. This may be done laparoscopically with or without robotics.
- Hysterectomy: For some women who have a prolapsed uterus, a hysterectomy to remove the uterus along with suspension procedures may be included. Your gynecologic surgeon will discuss hysterectomy options with you.