For women pelvic organ prolapse refers to the dropping of the pelvic organs caused by the loss of normal support of the vagina. This can be any combination of the bladder, rectum, uterus, or top of the vagina and the vaginal skin over lying them. This is typically a slow process that gradually worsens over many years with many different contributing causes. Some of the contributing causes include pregnancy, vaginal birth, obesity, heavy lifting, smoking, chronic cough, constipation, and genetics. That being said there is usually not a lone cause for any one woman.
The symptoms of pelvic organ prolapse can range from none at all to significant discomfort and urinary retention (not being able to completely empty your bladder). In many causes women report some low back discomfort especially if a vaginal bulge is visible. Due to the effects of gravity, these symptoms can worsen throughout the day with standing or physical activity and improve at night when laying down. In the most severe cases the vaginal bulge will remain present at all times.
There is a wide range of treatments for pelvic organ prolapse. The first being observation and home exercises. Strengthening the pelvic floor musculature can stop the prolapse from worsening and in some cases even reverse some of the effects. To ensure that you are performing these exercises correctly it is always a good idea to consult a Physician. In our office we also offer pelvic floor muscle rehabilitation with biofeedback. Several studies have shown over a 50% improvement in symptoms when using biofeedback technology for pelvic floor exercises to treat many pelvic floor conditions including pelvic organ prolapse.
If exercises do not work or your symptoms are more severe there is a nonsurgical therapy that can provide immediate relief. This is called a pessary. A pessary is a silicon vaginal insert that is fitted to your specific anatomy like a shoe for your foot. Pessaries come in many sizes and shapes, once the right shape and size is found you should not even know it is there. These vaginal inserts do require some maintenance, at least once every three months they should be taken out and cleaned either by you or your physician. Some woman are concerned that these inserts can cause infections but this is not true. In fact, in some cases they are help to prevent bladder infections. Pessaries can cause some increase in normal vaginal discharge and if not cleaned can cause odor and vaginal irritation. This is an excellent option for someone with symptomatic pelvic organ prolapse who does not want surgery.
For many active woman with symptomatic prolapse a pessary is not a practical option. In these cases surgery may become the right option. There is a wide array of surgeries for pelvic organ prolapse. There is no “one size fits all” when we talk about these surgeries. The right one is dependent on many factors. They can range from a surgical repair with your own tissue and suture to a surgical repair through the vagina with mesh to a laparoscopic robotic repair with mesh or suture. Because of the wide array of surgeries there are many risks and benefits to each individually. It is important to discuss all these options with your physician.
Ultimately treating pelvic organ prolapse is about improving your quality of life. If you do not have symptoms or your symptoms are only mild observation and exercise may be the right choice. If you have more severe symptoms that dramatically impact your quality of life you may consider a more direct therapy like a pessary or surgery. Pelvic organ prolapse in itself does not ever require therapy, the choice to pursue any of these options is always yours.
