The pelvic organs include the uterus, urethra, bladder, rectum and the vagina. These organs are all supported by the muscles of the pelvic floor and connective tissue called fascia.
Prolapse occurs when this support structure is weakened through various factors, like direct muscle trauma, neuropathic injury, disruption or stretching. In most cases, a combination of factors causes this damage.
The descent of one or more pelvic organs results in a protrusion of the uterus and/or vaginal wall, which may manifest as urinary, bowel, sexual or pelvic symptoms.
Most women complain of the sensation of ‘a lump coming down’ or a feeling of discomfort or heaviness within the pelvis. The symptoms tend to worsen with prolonged standing and towards the end of the day.
Other complaints include pain during intercourse and chronic backache. Urinary symptoms like urgency, frequency of urination and a sensation of incomplete emptying may be experienced if the bladder is affected.
If the rectum is involved, women may complain of difficulty in opening the bowels and having to reduce the prolapse manually before passing motion.
Pelvic floor exercises taught and practised early, before menopause, can help in reducing the incidence of prolapse. Other preventive strategies include avoiding factors that will result in chronic increased intra-abdominal pressure such as smoking, constipation and heavy lifting. It is also important to keep within the recommended body mass index to prevent obesity.
You will be referred to a urogynaecologist who will examine you and grade the degree of pelvic organ prolapse.
Additional tests may be needed, depending on the degree of prolapse and other additional symptoms noted by the patient. These include bladder urodynamics studies, a urethral pressure profile, and an ultrasound of the gynaecological organs or the urinary system.
The grading of pelvic organ prolapse is as follows:
Conservative management options include:
Surgical options vary according to the type and degree of prolapse:
There are a myriad of surgical techniques and this list is by no means exhaustive. The specific surgical procedure can only be advised by a urogynaecologist after assessing the patient.