Understanding Pelvic Organ Prolapse (POP)

Pelvic organ prolapse (POP) is a common condition that affects many women. It’s a type of hernia involving the pelvic organs, where tissues and organs move into spaces they wouldn’t normally occupy. This article will help you understand the types of prolapse, symptoms, diagnosis, and treatment options available.

Types of Pelvic Organ Prolapse

POP is a general term that encompasses several specific types of prolapse:

Cystocele: Prolapse of the bladder
Rectocele: Prolapse of the rectum
Enterocele: Prolapse of the small intestine
Urethrocele: Prolapse of the urethra
Uterine Prolapse: Prolapse of the uterus
Cervical Prolapse: Prolapse of the cervix
Vaginal Vault Prolapse: Prolapse of the top of the vagina in women who have had a hysterectomy

Multiple Types of Prolapse Often Occur Together

It’s common for patients to experience more than one type of pelvic organ prolapse simultaneously. For instance:

About 70% of patients with a cystocele (bladder prolapse) also have ‘apical’ prolapse involving the uterus, cervix, or vaginal cuff.

The combination of different types of prolapse can affect symptoms and treatment approaches.

A comprehensive evaluation by a urogynecologist is crucial to identify all affected areas and develop an effective treatment plan.

Understanding the full extent of your prolapse is key to ensuring that all issues are addressed in your treatment strategy.

Symptoms of Pelvic Organ Prolapse

While POP is not typically dangerous, it can cause considerable discomfort and bothersome symptoms, including:

Feelings of pelvic pressure, fullness, pulling, or tugging (especially with heavy lifting)
Sensation of sitting on an egg or ball
Visible or palpable bulge at the vaginal opening
Difficulty with vaginal intercourse
Urinary symptoms (frequency, urgency, or incontinence)
Spraying during urination
Difficulty with bowel movements
Abnormal vaginal bleeding (Note: Always consult a doctor for abnormal bleeding)

Diagnosis of Pelvic Organ Prolapse

Diagnosis of POP is typically made through a comprehensive pelvic exam, which includes:

Internal and external examination
Use of a speculum
Asking the patient to bear down, push, or cough to make the prolapse more pronounced

Doctors often use the POP-Q (Pelvic Organ Prolapse Quantification) system to stage the prolapse on a scale from 0 to 4, where 0 is no prolapse and 4 is complete prolapse.

POP-Q Staging

Treatment Options for Pelvic Organ Prolapse

Treatment for POP ranges from conservative management to surgical intervention. The choice of treatment depends on the severity of symptoms, the degree of prolapse, and the patient’s preferences.

1. Watch and Wait (Expectant Management)

For mild cases with minimal symptoms, observing the condition over time may be appropriate.

2. Home Exercises

Kegel exercises to strengthen pelvic floor muscles, often combined with core strengthening and postural changes, can help alleviate symptoms.

3. Pelvic Floor Physical Therapy

Specialized physical therapists can provide targeted exercises, hands-on therapy, and support for managing POP.

4. Pessary

A pessary is a device worn inside the vagina to support the pelvic organs. It’s a non-surgical option that can be managed either by the patient at home or by a healthcare provider in the office.

5. Surgical Options

When conservative treatments aren’t effective, surgery may be considered. Surgical options include:

Vaginal Repair This involves surgery performed entirely through the vagina, using the patient’s own tissues and sutures to restore normal vaginal support.
Laparoscopic Repair This minimally invasive approach uses small abdominal incisions to access and support the vagina, either using the patient’s own tissues or synthetic mesh.

Choosing the Right Treatment

The choice of treatment depends on various factors, including:

The severity and type of prolapse
The patient’s symptoms and how they affect quality of life
The patient’s overall health and medical history
The patient’s goals for treatment (e.g., preserving sexual function)
The patient’s lifestyle and occupation

Using Decision Aids

One of the best ways to help you decide if you need or want surgery for pelvic organ prolapse is to use a decision aid. These tools, such as the “Should I Have Surgery?” guide, provide detailed information about the condition, treatment options, and potential outcomes. They typically include:

Key points to remember about the condition
Frequently asked questions about prolapse and its treatments
Comparisons of surgical and non-surgical options
Personal stories from other patients
Questions to help you reflect on what matters most to you
Facts about the risks and benefits of different treatments

Considering this information before your initial consultation can help streamline the process and expedite treatment. It allows you to come to your appointment better informed and with a clearer idea of your preferences and concerns. This can lead to more productive discussions with your healthcare provider and ultimately a treatment decision that aligns well with your values and goals.

Take the time to go through these materials carefully, and don’t hesitate to discuss any questions or concerns that arise with your doctor.

Conclusion

Pelvic organ prolapse is a common condition that can significantly impact a woman’s quality of life. However, with proper diagnosis and a range of treatment options available, many women find relief from their symptoms. If you’re experiencing symptoms of POP, it’s important to consult with a healthcare provider to discuss your options and develop a personalized treatment plan.

Remember, you’re not alone in dealing with POP, and help is available. With the right care and management, you can improve your pelvic health and overall well-being.

Frequently Asked Questions

What is pelvic organ prolapse (POP)?

Pelvic organ prolapse (POP) is a common condition in women where pelvic tissues and organs move into spaces they wouldn't normally occupy, essentially a type of hernia involving the pelvic organs.

What are the types of pelvic organ prolapse?

There are several types of POP including cystocele (bladder prolapse), rectocele (rectum prolapse), enterocele (small intestine prolapse), urethrocele (urethra prolapse), uterine prolapse, cervical prolapse, and vaginal vault prolapse.

What are the common symptoms of pelvic organ prolapse?

Common symptoms include feelings of pelvic pressure or fullness, sensation of sitting on an egg or ball, visible or palpable bulge at the vaginal opening, difficulty with vaginal intercourse, urinary symptoms, difficulty with bowel movements, and in some cases, abnormal vaginal bleeding.

How is pelvic organ prolapse diagnosed?

POP is typically diagnosed through a comprehensive pelvic exam, which includes internal and external examination, use of a speculum, and asking the patient to bear down or cough. Doctors often use the POP-Q system to stage the prolapse on a scale from 0 to 4.

What are the treatment options for pelvic organ prolapse?

Treatment options range from conservative management to surgical intervention. They include watch and wait approach, home exercises, pelvic floor physical therapy, use of a pessary device, and surgical options such as vaginal repair and laparoscopic repair with or without mesh/graft augmentation.

Can pelvic organ prolapse be treated without surgery?

Yes, non-surgical treatments such as pelvic floor exercises (Kegels), physical therapy, and the use of a pessary device can often be effective in managing symptoms.

What factors are considered when choosing a treatment for POP?

Factors considered include the severity and type of prolapse, patient's symptoms and their impact on quality of life, overall health and medical history, patient's goals for treatment, and lifestyle and occupation.

Is it common to have multiple types of prolapse at once?

Yes, it's common for patients to experience more than one type of pelvic organ prolapse simultaneously. For example, about 70% of patients with a cystocele also have 'apical' prolapse involving the uterus, cervix, or vaginal cuff.

How can I prepare for my initial consultation about pelvic organ prolapse?

To prepare for your initial consultation, consider the following steps: 1) Keep a symptom diary noting when and how your symptoms affect you. 2) Write down any questions you have about your condition and treatment options. 3) Make a list of your current medications and any previous treatments you've tried. 4) If possible, gather any relevant medical records (such as past surgeries) or test results. 5) Consider bringing a family member or friend for support and to help remember information.