Living with pelvic prolapse (POP)

Pelvic organ prolapse (POP) is a herniation of the pelvic organs such as the uterus, cervix, bladder and rectum through the vagina. It occurs due to loss of pelvic floor support from the muscles and fascia, usually secondary to childbirth injury.
 

Around one in 12 women report symptoms of pelvic organ prolapse with a lifetime risk of surgery of 12-19 per cent. The prevalence of POP increases with age, and there are suggestions that prevalence increases by 40 per cent with each decade of life.
 

We spoke to Mrs Monika Vij, a leading consultant gynaecologist based in Swansea, to understand more about pelvic organ prolapse, how you can treat it and what lifestyle changes are needed to help keep it under control.

What are the risk factors for pelvic organ prolapse?

Factors that can increase your risk of pelvic organ prolapse (POP) are:
 

• Higher parity (many pregnancies)
• Vaginal childbirth and forceps delivery
• Advancing age obesity
• Chronic constipation
• Occupations involving heavy lifting
• Connective tissue disorders such as those associated with variation of collagen type1 gene (COL1A1)

What are the symptoms of pelvic organ prolapse?

The principal symptom manifested in pelvic organ prolapse is the feeling of a bulge within the vagina that can be seen or felt.

A significant proportion of women might also complain of a dragging sensation or pelvic pressure.

Other associated symptoms include:
 

• Urinary incontinence
• Overactive bladder
• Voiding difficulty position change to start or complete voiding
• Incontinence of flatus or faeces (liquid or solid)
• A feeling of incomplete emptying
• Faecal urgency
• Dyspareunia (pain during sex)
• Decreased sensation or pain in the vagina, bladder or rectum

Women can present with a single or combination of symptoms. Other than the vaginal bulge, none of the symptoms is specific for POP and considerable overlap exists with other pelvic floor disorders.

How is pelvic organ prolapse managed?

Prolapse is best managed by a urogynaecologist along with a physiotherapist and continence nurse specialists specialising in pelvic floor dysfunction.

The treatment options for the management of POP include both conservative and surgical management. The conservative management strategies are pelvic floor muscle training (PFMT) and insertion of a vaginal pessary along with lifestyle advice such as reducing weight and avoiding constipation.

How can you treat pelvic organ prolapse with lifestyle changes?

If you feel that you have developed pelvic organ prolapse or have developed symptoms associated with prolapse, you should start undertaking the following lifestyle measures.
 

1. Exercise - maintaining your general fitness is important however, avoid high impact/high-intensity workouts as these can aggravate your symptoms after exercise. Pelvic floor friendly exercises are swimming, aqua aerobics, yoga and pilates. Adapt activities like strenuous gardening, lifting, pushing shopping trolleys and vacuuming. When lifting, do not forget to pull up your pelvic floor as you lift.
 

2. Maintain healthy bowel movements and avoid constipation - avoid straining when you go to the toilet as this puts pressure on your pelvic floor muscles. Make sure you eat plenty of fibre from fruit and vegetables and drink enough water.
 

3. Avoid irritants - try not to overload with fluid and stay away from irritants like caffeine, tea, alcohol, fizzy drinks, citrus foods and tomatoes as these may increase the overactivity of the bladder.

4. Lose excessive weight and stop smoking - the heavier you are, the more likely you are to have a pelvic floor disorder. You should aim to keep your BMI under 30. If you are also a smoker, you should stop smoking as it increases your risk of a chronic cough which can then lead to the weakening of your pelvic floor muscles. The chemicals in cigarettes can also irritate your bladder and cause urge incontinence.

5. Do pelvic floor exercises - firstly, it is really important to find your pelvic floor muscles. You can feel them by tightening the muscles as if you were holding a wee or stopping yourself from passing wind from the back passage. Lift these muscles upward and forward and release them fully. The aim is to enable your muscles to have the ability to respond quickly, so hold on for a short period and then let go completely. You need to perform both fast and slow contractions. You should be repeating these exercises 4-6 times a day. Supervised pelvic floor muscle training is advised to be undertaken for at least 12-16 weeks.

You can also find a list of effective pelvic floor exercises with demonstrational videos here.
 

If home treatments fail, what other treatment options are available?

If home treatments for pelvic organ prolapse fail, then you could either have a vaginal pessary or undergo pelvic organ surgery.
 

Vaginal pessaries are mechanical devices that you insert into the vagina to reduce the prolapse. There are different type of pessaries such as Gellhorn, ring, shelf, etc. Various complications encountered with pessary were bleeding, extrusion, pain and vaginal discharge.
 

Surgery may also be a good option to treat pelvic organ prolapse if conservative treatments fail and/or you have stage 2 POP or beyond. The aim of surgical treatment for POP is not only to restore anatomy but also to improve bowel, bladder and sexual function. The risks associated with surgery include haemorrhage, recurrence, trauma to bladder, bowel, internal organs and dyspareunia.

If you feel that you have developed pelvic organ prolapse and would like to see a specialist, head to Mrs Monika Vij’s Top Doctors profile to book an appointment