What is pelvic organ prolapse, and what's the best treatment for it?

Pelvic organ prolapse (POP) occurs when one or more pelvic organs such as the bladder, uterus, rectum, or vagina, descend from their normal position into or outside the vaginal canal. This is caused by the weakening of the pelvic floor muscles and connective tissue. It can cause discomfort, affect daily activities and impact quality of life. While common among women, especially after childbirth or menopause, POP varies in severity and treatment options are tailored to each individual's needs.

What causes pelvic organ prolapse?

Several factors can contribute to the development of POP:

• Pregnancy and childbirth: Vaginal delivery, especially with prolonged labour or large babies, can weaken pelvic tissues.
• Ageing and menopause: Decreasing oestrogen levels weaken pelvic support structures.
• Chronic pressure: Conditions such as chronic coughing, obesity or constipation increase strain on the pelvic floor.
• Genetic predisposition: Some women have naturally weaker connective tissue.

What are the symptoms of pelvic organ prolapse?

Symptoms depend on the type and severity of the prolapse and may include:

• A feeling of heaviness or pressure in the pelvic area.
• A noticeable bulge or protrusion in or outside the vagina.
• Discomfort or pain during intercourse.
• Difficulty urinating or passing stool.
• Urinary incontinence or a feeling of incomplete bladder emptying.

What are the treatment options for pelvic organ prolapse?

The best treatment for POP depends on the severity of symptoms, the type of prolapse, and individual preferences. Treatments range from conservative measures to surgical interventions:

Lifestyle modifications

• Maintaining a healthy weight to reduce pelvic pressure.
• Treating chronic conditions such as cough or constipation.

Pelvic floor exercises

• Supervised pelvic floor physiotherapy or Kegel exercises can strengthen the muscles supporting pelvic organs and help alleviate mild symptoms.

Vaginal pessaries

• A pessary is a removable device placed in the vagina to provide structural support and relieve symptoms. It is a non-surgical option suitable for many women, especially those not ready for surgery.

Hormone therapy

• Local oestrogen creams or pessaries may improve tissue strength and elasticity, especially in postmenopausal women.

Surgery

• Surgical repair is recommended for moderate to severe cases or when symptoms significantly affect quality of life. Options include:
  • Anterior or posterior repair: To correct bladder or rectal prolapse.
  • Uterine suspension or hysterectomy: For uterine prolapse.
  • Vaginal vault suspension: For post-hysterectomy prolapse.
  • Mesh procedures: In certain cases, synthetic mesh may be used to reinforce weakened tissue, although risks and benefits should be discussed thoroughly with your surgeon.

Pelvic organ prolapse is a manageable condition with a variety of effective treatments. Consulting a healthcare provider, such as a gynaecologist or urogynecologist, ensures the best course of action is chosen based on your specific needs and lifestyle. Early intervention can prevent further complications and significantly improve quality of life.