Pelvic Organ Prolapse

What is pelvic organ prolapse?

The pelvic organs,  which include the bladder, uterus, vagina and rectum, rely on integral system of  active pelvic floor muscles, healthy connective tissues and strong ligaments,  and intact hormonal, blood,  nerve supply to remain in normal position and to function properly . Any damage to this intricate system can cause pelvic organs to herniate onto the vaginal wall and/or to malfunction.

What are the types of prolapse? 

Prolapse can affect the front wall of the vagina, causing prolapse of the bladder (cystocoele), or the urethra (urethrocoele). When prolapse affects the back of the vagina, this can cause prolapse of the  rectum (rectocoele) or the small intestine (enterocoele) to occur. When prolapse affects the top of the vagina, this can result in  prolapse of the uterus (uterine prolapse), or of the vaginal vault in women having undergone hysterectomy.   

Why do some women develop prolapse while others don’t ?

Prolapse occurs as a result of factors or conditions that result in weakening of tissues and ligaments that support the pelvic organs. The common underlying factors include:

• Childbirth – particularly long labour, large baby, forceps delivery
• Aging
• Menopause
• Chronic or repeated increases intra-abdominal pressure – work or exercise-related heavy lifting, straining due to constipation, chronic coughing
• Hereditary or congenital connective tissue weakness 

Often, multiple aetiological factors are at play and hence women who develop prolapse often have more than one type of prolapse at the same time or develop prolapse in multiple sites over a period of time. 

What are the symptoms of pelvic organ prolapse?

Pelvic organ prolapse is often asymptomatic in the early stages and only discovered on routine check-up.  Common symptoms which may raise suspicion of pelvic organ prolapse include a visible lump through the vagina, heavy dragging sensation with or without disturbance to bladder, bowel or sexual functions.

While the development of pelvic organ prolapse is often gradual, when severe, prolapse can affect a woman’s body image, her self– confidence and quality of life, particularly if  there is loss of bladder, bowel control or sexual function is affected.