Breaking the Silence: Talking About Pelvic Organ Prolapse

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse, or POP, is a type of hernia that occurs when the female pelvic organs (the Uterus, Bladder, or Rectum) press onto or into the soft tissue of the Vagina.

This condition can range in symptoms from very uncomfortable to completely symptom free. It is a condition that is often not spoken about in the general public, and can be very disconcerting or even embarrassing for those women who are suffering.

POP can lead to symptoms such as:

• Urinary Incontinence
• Fecal Incontinence
• Pain or constant pressure of the Pelvic Floor
• Painful Intercourse
• A bulging or heavy sensation of the Pelvic Floor

If you have been diagnosed with POP you are not alone:

• The prevalence of symptomatic POP affects approximately 5% of women.
• On vaginal exam POP was determined to be present in upwards of 50% of women.
• It has been stated that up to half of all women over 50 have some form of POP.

What Causes Pelvic Organ Prolapse?

The Pelvic Organs are supported by a network of muscles, ligaments, and fascia; this network is typically referred to as a “Hammock”. When the network is altered, either in terms of ligament/fascial laxity or muscular weakness, the organs can drop down leaving them in a less than ideal position.

The most common causes of POP are history of vaginal births (one or multiple) and menopause. Hormone changes in menopause tend to change the integrity of the pelvic floor tissue, making them more prone to laxity, while vaginal births create a mechanical stretching/weakening of the tissue from the baby passing through the birth canal.

There is said to often be a genetic component to POP, meaning a family history can leave one at higher risk of developing the condition.

A history of smoking and carrying excessive weight over time have also been named as risk factors.

How is Pelvic Organ ProlapseTreated?

Physiotherapy

Pelvic Floor Physiotherapists are certified in the assessment and treatment of the Pelvic Floor. Physiotherapy treatment can often help to reduce pain and provide advice on management of POP.

Physiotherapy treatment can include:

• Prescription of appropriate exercise
• Education on activities of daily living such as bathroom use, intimacy, and remaining active successfully
• Manual therapy treatment of the surrounding areas to help reduce pressure on the Pelvic Floor
• Modalities such as acupuncture and ultrasound to help reduce pain

Pessaries

Silicone devices, similar to a diaphragm used for contraception, are inserts for the vagina that help to lift and support the Pelvic Floor. These often help women to be more comfortable, reducing their symptoms and allowing them to be active.

Pessaries require regular follow up with a doctor to fit the device and check their integrity.

Consultation with a Specialist

Obstetrics, gynecology, urology, and urogynecology are areas of specialty where more severe case of POP are often referred on to.

These specialists can further assess the severity of POP and determine if surgery is appropriate.

References

• Barber MD, Maher C, Epidemiology and outcome assessment of pelvic organ prolapse, Int Urogynecol J. 2013 Nov;24(11):1783-90. doi: 10.1007/s00192-013-2169-9.
• Walker, G.J.A., Gunasekera P., Pelvic organ prolapse and incontinence in developing countries: review of
• prevalence and risk factors, Int Urogynecol Journal (2011) 22: Number 2, Page 127
• Slieker-ten Hove, M.C.P., Pool-Goudzwaard, A.L., Eijkemans, M.J.C. et al. Int Urogynecol Journal (2009)
• 20:1037. https://doi.org/10.1007/s00192-009-0902-1
• https://www.health.harvard.edu/womens-health/pelvic-organ-prolapse-youre-not-alone
• https://www.health.harvard.edu/womens-health/what-to-do-about-pelvic-organ-prolapse
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970401/