Childbirth is one of the most wonderful miracles in the world and thanks to an army of incredible midwives, doctors and nurses, the experience can be exhilarating.
Despite the adrenaline and excitement that comes with giving birth, there are several accompanying health complaints which can take hold in the aftermath.
One of them is Pelvic Organ Prolapse, which occurs when one or more of the organs in the pelvis (the area of the lower tummy) fall out of their normal positions.
The organs in this area include; the urethra, bladder, uterus, vagina, rectum and small bowel. These organs in the pelvic region are usually well supported by muscles, ligaments, connective tissue and fascia, collectively known as the pelvic floor. However, if the pelvic floor is damaged or weakened, the pelvic organs can slip down and push against the wall of the vagina, or protrude through the vagina itself. This can lead to feelings of pain or discomfort.
Prolapse can affect anyone, but is most common in women who have experience difficult childbirth or those in menopause.
Causes of Prolapse
There are several factors that may lead to prolapse, these are a few of the most common:
● Hormonal changes at menopause
● Being overweight
● Frequent constipation (and therefore straining)
● Chronic illnesses (such as lung conditions which cause a lot of coughing) which raise pressure inside the tummy area
● Previous surgeries to the pelvic area (e.g surgery to remove your uterus)
Types of Prolapse
The type of prolapse is dependant on which organ has ‘dropped’:
● Rectocele: this happens when the back wall of the vagina prolapses, and the rectal wall pushes against the vaginal wall
● Cystocele: this occurs when the front wall of the vagina prolapses, and the bladder prolapses into the vagina
● Enterocele: when the front and back walls of the vagina separate, and the intestines push against the vagina
● Prolapsed uterus: there is a weakness at the top of the vagina, and the uterus falls out of its normal position above the vagina
● Vaginal vault prolapse: this commonly occurs following removal of the uterus, the top of the vagina falls through the vaginal opening
Due to the nature of prolapse, identifying the type may be difficult based on a written description,
However, if you feel that you may be suffering from prolapse a trip to the doctor will help you fully identify the issue.
Symptoms of Pelvic Organ Prolapse
Many women, especially those who are of an older age or who have had several (or difficult) childbirths, will have some degree of prolapse, however, this is generally not a cause for concern unless it becomes uncomfortable or symptomatic. Some symptoms to look out for include:
● A sensation of pressure from the prolapsed organ pressing against the vagina, which is often described as “something coming down”
● Feeling very full in your lower tummy region
● Seeing or having the sensation of something falling out of your vagina
● Feeling a dragging or stretching sensation in your lower tummy
● Pain in the vagina during intercourse
● Urinary incontinence or urgency (releasing urine without meaning to, or lacking control over the urge to urinate)
● Bowel problems, such as constipation
Diagnosis of a Pelvic Organ Prolapse
Many women delay seeking help or treatment for a prolapse due to embarrassment or worry about the condition. However, it occurs in around 30-40% of women who have been through menopause, a hysterectomy or have experienced a difficult childbirth, so it is not uncommon.
A physical exam of the area will be carried out, which will include an internal exam. The doctor may carry out tests to evaluate the strength of your pelvic floor muscles. In some cases, imaging techniques such as an ultrasound may be used to aid diagnosis but this will be decided after an initial consultation.
Further decisions about treatment will be made based on the type and severity of the prolapse, whereby the patient will be involved at every stage. Sometimes, the symptoms of a prolapse can be mistaken for a more serious condition, so getting checked out is the best bet for your overall health.
Treatment of a Pelvic Organ Prolapse
Without treatment or surgery, the prolapsed structures can fall further into the vagina or even fall through the vaginal opening, making them visible to the naked eye.
But if your symptoms are not causing you any undue distress or pain, there are some simple measures you can take to make yourself feel better. These include:
● Staying at a healthy weight
● Trying Kegel exercises – toning exercises that help your pelvic floor stay strong
● Avoid heavy lifting, as this stresses your pelvic floor muscles
● Stop smoking
If you have tried some of these measures and they haven’t worked, the prolapse is more severe or
you’d prefer to undergo further treatment, your Doctor may fit you with a pessary. This is a removable silicone device that is inserted into the vagina, holding the structures at risk of prolapse in place. Topical oestrogen cream is often used along with a pessary.
Some people opt for surgery to treat the prolapse and this can be done under general anaesthesia (you are completely asleep) or local anaesthesia (you are awake, but the area is numbed). Newer laparoscopic techniques using small cuts in the skin and slim instruments mean that these procedures are likely to be minimally invasive, and have a fast recovery time.
Other treatment options include physical therapy and biofeedback, but identifying the best treatment option for each individual should be discussed with a GP.
Dr Seth Rankin is founder of London Doctors Clinic