Pelvic organ prolapse

Pelvic organ prolapse, a type of pelvic floor disorder, affects many women. In fact, about one-third of all women who have had children are affected by prolapse or similar conditions over their lifetime.

What is a pelvic floor disorder?

The "pelvic floor" is a group of muscles that form a kind of hammock across your pelvic opening. Normally, these muscles and the tissues surrounding them keep the pelvic organs in place. These organs include your bladder, uterus (womb), vagina, small bowel and rectum.

Sometimes these muscles and tissue develop problems. Some women develop pelvic floor disorders following childbirth. As women age, pelvic organ prolapse and other pelvic floor disorders become more prevalent.

When pelvic floor disorders develop, one or more of the pelvic organs may stop working properly. Conditions associated with pelvic floor disorders include:

• Pelvic organ prolapse
• Urinary incontinence
• Faecal incontinence

What is pelvic organ prolapse?

"Prolapse" refers to a descending or drooping of organs. Pelvic organ prolapse refers to the prolapse or drooping of any of the pelvic organs, including:

• Bladder
• Uterus
• Vagina
• Small bowel
• Rectum

These organs are said to prolapse if they descend into or outside of the vaginal canal or anus. You may hear them referred to in these ways:

• Cystocele: Prolapse of the bladder into the vagina; this is the most common condition
• Urethrocele: Prolapse of the urethra (the tube that carries urine)
• Uterine prolapse: Prolapse of the uterus
• Vaginal vault prolapse: Prolapse of the vagina
• Enterocele: Small bowel prolapse
• Rectocele: Rectum prolapse

What causes pelvic organ prolapse?

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

• Pregnancy, labour 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)

Genetics may also play a role in pelvic organ prolapse. Connective tissues may be weaker in some women, perhaps placing them more at risk.

What are the symptoms of pelvic organ prolapse?

Some women notice nothing at all, but others with pelvic organ prolapse report these symptoms:

• 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 recurrent urge to urinate
• Constipation or faecal incontinence
• Spotting or bleeding from the vagina

Symptoms depend somewhat on which organ is drooping. If the bladder prolapses, urine leakage may occur. If it is the rectum, constipation and uncomfortable intercourse often occur. A backache as well as uncomfortable intercourse often accompanies small intestine prolapse. Uterine prolapse is also accompanied by backache and uncomfortable intercourse.

How is pelvic organ prolapse diagnosed?

Your doctor may discover pelvic organ prolapse during a routine pelvic examination, such as the one you get when you go for your smear test. Your doctor may order a variety of tests:

• Urinary tract X-ray (intravenous pyelography)
• CT scan of the pelvis
• Ultrasound of the pelvis
• MRI scan of the pelvis