Pelvic organ prolapse

Condition

This condition is a common issue among adult women, characterized by the descent of pelvic organs into or out of the vagina. The prevalence of POP varies based on how it is defined - it's 3-6% when classified by bothersome symptoms and escalates to 50% when identified purely on an anatomical basis. The estimated lifetime risk for POP surgery stands at about 10%. Recognized risk factors for POP include childbirth, ageing, obesity, and vaginal delivery. While the exact cause of POP isn't fully understood, trauma to the pelvic muscles during childbirth is widely acknowledged as a key contributor to its development. Symptoms of POP can vary but often include a visible bulge or lump in or protruding from the vagina, discomfort or numbness during sex, and urinary problems such as a persistent feeling of a full bladder, increased frequency of urination, or leakage when coughing, sneezing, or exercising.

Treatment

Management of POP begins with conservative measures such as physiotherapy to strengthen the pelvic floor muscles and the use of pessaries. However, for more advanced stages of POP or when conservative measures fail, surgery becomes the treatment of choice. In the realm of managing POP, we're not just addressing a physical condition - we're helping women regain confidence and comfort, ultimately improving their quality of life.

F.A.Q.s

What Are the Symptoms of Pelvic Organ Prolapse?

A feeling of pressure or fullness in the pelvic area.
A backache low in the back.
Painful intercourse.
A feeling that something is falling out of the vagina.
Urinary problems such as leaking of urine or a chronic urge to urinate.
Constipation or loss of bowel control.
Vaginal bleeding

What Causes Pelvic Organ Prolapse?

Anything that puts increased pressure in the abdomen can lead to pelvic organ prolapse. Common causes include:

Pregnancy, labor, and childbirth (the most common causes)
Obesity
Respiratory problems with a chronic, long-term cough
Constipation
Pelvic organ cancers
Surgical removal of the uterus (hysterectomy)

What does a prolapse look like in a woman?

Prolapse ranges in severity from very mild (i.e., prolapse that can only be felt by your doctor on examination) to severe (where one or more of the pelvic organs actually protrude through the vaginal opening). A severe prolapse looks like a red ball protruding from the vagina.

What are the 4 stages of prolapse?

The four categories of uterine prolapse are:

Stage I – the uterus is in the upper half of the vagina.
Stage II – the uterus has descended nearly to the opening of the vagina.
Stage III – the uterus protrudes out of the vagina.
Stage IV – the uterus is completely out of the vagina.

The more advanced the stage of prolapse is, the less likely it is to respond to conservative management.

Is it appropriate to leave a prolapse untreated?

The bladder (which stores urine), urethra (which carries urine to outside the body), and rectum (muscle that controls bowel movements) may bulge out with the uterus. An untreated prolapse can cause sores on the cervix (opening to the uterus) and increase chances of infection or injury to other pelvic organs.

Is walking bad for a prolapse?

In the past, many forms of exercise were considered ‘unsafe’ and not recommended for women with prolapse. We know that low impact exercise is safe for all women who have a prolapse, regardless of the strength of their pelvic floor muscles. Some examples include:

Walking
Swimming
Seated cycling
Low intensity water aerobics
Low impact exercise classes
Seated light weights
Narrow squats and lunges

What should you not do with a prolapse?

Do not do activities that put pressure on your pelvic muscles. This includes heavy lifting and straining. Try exercises to tighten and strengthen your pelvic muscles. These are called Kegel exercises.

How bad does a prolapse have to be before surgery?

Consider surgery if the prolapse is causing pain, if you are having problems with your bladder and bowels, or if the prolapse is making it hard for you to do activities you enjoy.

What is Sacrocolpopexy surgical approach?

Regardless of the route, the sacrocolpopexy procedure is the same. Your surgeon attaches the top of the vagina to a strong ligament (connective tissue) along the sacral spine (between your lower back and tailbone) using a synthetic mesh.

Is prolapse surgery an open operation?

No, it is a laparoscopic/robotic operation. This allows the patient to have a faster recovery and reduce hospital stay.

Is prolapse surgery a major surgery?

Even if your surgery is done through a less invasive way, surgeries to repair prolapse tend to be major surgery.

How painful is prolapse surgery?

Usually the graft is anchored to the muscles of the pelvic floor. Generally this surgery is not very painful. You may feel as if you have been ‘riding on a horseback’. You will have some discomfort and pain,which is easily controlled with painkillers.

How long is recovery from sacrocolpopexy?

Most women feel better within the first week following surgery; however, do not lift, push or pull any heavy objects until after your doctor says it is OK. Full recovery takes six weeks to allow for internal healing.

What is the success rate of prolapse repair?

Success rates for posterior repair are 80-90%, however there is a chance that the prolapse may recur or another part of the vaginal wall may prolapse.