Quick Facts About Pelvic Organ Prolapse
  Pelvic organ prolapse occurs when the pelvic floor muscles become weak and can no longer support the pelvic organs, allowing them to drop from their normal position.

The Causes:
Pelvic support comes from the pelvic floor muscles, fascia (connective tissue), and ligaments. As the pelvic floor muscles weaken, it creates a strain on the supporting ligaments and fascia causing the surrounding organs to drop. Factors contributing to the weakening of the pelvic floor include:

•    Pregnancy and childbirth
•    Ageing and menopause
•    Obesity
•    Large uterine fibroids
•    Chronic coughing or straining
•    Heavy lifting
•    Spinal cord conditions and injury
•    Previous pelvic surgery
•    Ethnicity  

•    Cystocele (bladder prolapse)
•    Rectocele (prolapse of the rectum or large bowel)
•    Enterocele (prolapse of the small bowel)
•    Uterine prolapse
•    Vaginal vault prolapse

Women with mild prolapse often have no symptoms. When symptoms do occur, patients may complain of a heavy sensation or bulging feeling in the vaginal area. Patients with pelvic prolapse may also complain of urinary and bowel symptoms, lower back and pelvic pain, pressure, or uncomfortable intercourse.

In addition to a complete pelvic exam, patients who also have urinary complaints are often evaluated with an additional urodynamics test.

Kegel Exercises
One of the most effective methods to reduce the risk of prolapse is for patients to properly exercise pelvic floor muscles using Kegels.  
Hormone Therapy
Local estrogen replacement therapy can increase blood supply and improve the healthiness of the
vaginal mucosa. This results in less vaginal dryness and reduction in prolapse symptoms.  
Vaginal Pessaries
A vaginal pessary is a removable insert placed in the vagina to elevate and support the pelvic floor and organs. These inserts can be made of rubber, plastic, or silicone-based material. Pessaries are changed regularly either by the patient or health care provider.
Surgical Treatments
The most definitive treatment for symptomatic prolapse is surgery. In the majority of cases, the most complicated procedures can be performed through the vagina eliminating the need for abdominal incisions and longer hospital and recovery times. The prolapse surgeons of Alliance Urology Specialists commonly use specialized grafts to help strengthen repairs improving long-term outcome. When appropriate, minimally invasive robotic-assisted sacrocolpopexy is performed to maximize success rates.  (See related article in this issue.)

In addition to performing Kegel exercises, certain lifestyle changes may decrease the chances of pelvic organ prolapse. Some suggestions for patients include:
•    Refrain from lifting heavy objects to reduce the strain on pelvic muscles
•    Eat food with high fiber
•    Avoid smoking to reduce coughing
•    Maintain a healthy weight to limit excessive pressure on the pelvic floor

To learn more about diagnosis and treatment of pelvic organ prolapse, call 336-274-1114.

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