Pelvic Organ Prolapse (POP) occurs when the muscles and connective tissues that support the pelvic organs—bladder, uterus, and rectum—become weakened or stretched, causing the organs to descend into the vaginal canal. It is more common in women, especially those over 50, but can affect anyone with pelvic floor dysfunction.
Risk Factors
Several factors can increase the likelihood of developing POP, including:
• Childbirth Trauma: Vaginal delivery, particularly with a large baby, multiple pregnancies, or forceps delivery, can weaken pelvic floor muscles and tissues.
• Aging: The pelvic floor naturally weakens with age, especially after menopause when estrogen levels drop.
• Hysterectomy: Removal of the uterus can alter pelvic organ support, increasing prolapse risk.
• Chronic Constipation: Straining during bowel movements puts pressure on the pelvic floor, leading to prolapse.
• Obesity: Excess weight increases pressure on the pelvic floor.
• Genetics: Some women are more predisposed to POP due to inherited tissue weaknesses.
Symptoms of Pelvic Organ Prolapse
The symptoms can vary depending on the type and severity of prolapse but commonly include:
• Pelvic pressure or a sensation of fullness.
• Urinary issues such as leakage, frequency, or difficulty fully emptying the bladder.
• Bowel problems, including constipation or incomplete bowel movements.
• A visible bulge in the vaginal area.
• Pain or discomfort during sexual intercourse.
Treatment and Management
Non-Surgical Options
• Pelvic Floor Exercises: Strengthening exercises, such as Kegel exercises, can help support the pelvic organs.
• Lifestyle Modifications: Weight management, dietary changes to prevent constipation, and avoiding heavy lifting can reduce strain on the pelvic floor.
• Pessaries: A pessary is a device inserted into the vagina to support the pelvic organs and prevent further prolapse. It’s often used in women who are not suitable candidates for surgery.
Surgical Options
In cases where non-surgical treatments are ineffective, or in more severe cases of POP, surgery may be necessary. The goals of surgery are to restore the organs to their normal position, improve symptoms, and prevent recurrence of prolapse. Some of the common surgical procedures include:
• Vaginal Repair: This surgery involves repairing the pelvic floor tissues through the vaginal canal. It is often performed to treat cystocele (bladder prolapse) or rectocele (rectal prolapse) and can be combined with other procedures.
• Hysterectomy: In cases where the uterus is prolapsed, a hysterectomy may be recommended, particularly if the prolapse is severe or the patient no longer wishes to retain the uterus. This can be combined with vaginal vault suspension to support the pelvic organs.
• Colposuspension or Sacrocolpopexy: These procedures involve attaching the vaginal vault or uterus to the ligaments in the pelvis or spine to provide long-term support. Sacrocolpopexy uses mesh or sutures for support and is often performed laparoscopically.
• Rectopexy or Cystopexy: Surgical procedures that involve attaching the rectum or bladder to the pelvic wall to prevent further descent.
• Robotic-Assisted Surgery: Some urologists may use robotic assistance for complex prolapse cases, offering more precision, smaller incisions, and quicker recovery.
Conclusion
Pelvic Organ Prolapse is a common and treatable condition. Although it can be uncomfortable and cause a variety of symptoms, there are several management options available, including pelvic floor exercises, pessaries, and surgery. For patients with severe prolapse, surgical intervention can restore function and improve quality of life. Early intervention and personalised treatment plans are crucial to achieving the best outcomes.
Dr. Bugwandin’s Expertise
Dr. Bugwandin visited Germany in 2024 to undergo surgical training in Advanced Pelvic Floor repairs, which has allowed him to improve his skills in the transvaginal surgical repair of pelvic organ prolapse/bladder prolapse. Furthermore, he is assisted locally by Dr Douw Steyn who has decades of experience in transvaginal surgery. With advanced training and extensive experience, Dr. Bugwandin provides expert care, ensuring that each patient receives the most appropriate and effective treatment for their specific condition.
