Pelvic Organ Prolapse — Symptoms, Causes & Treatment

Pelvic organ prolapse (POP) refers to a medical condition in which one or more of the pelvic organs, such as the bladder, uterus, or rectum, descend or bulge into the vaginal wall. This can occur when the supporting structures of the pelvis become weakened or damaged. Pelvic organ prolapse occurs when the pelvic floor muscles and tissues that support the organs become stretched, weakened, or damaged, leading to the descent of one or more pelvic organs into the vaginal canal.

The symptoms of POP vary depending on the patient's condition. Common symptoms of POP include:
1: Feeling of pressure or fullness in the pelvis or vagina.
2: Vaginal bulging or protrusion.
3: Pelvic discomfort or pain.
4: Urinary problems like incontinence or frequent UTIs.
5: Difficulty with bowel movements.
6: Sexual dysfunction.

The causes of pelvic organ prolapse are varied, a few of them include:
1: Childbirth: The strain of childbirth, especially multiple births, can weaken pelvic muscles and tissues.
2: Aging: As women age, hormonal changes and natural tissue weakening can occur.
3: Chronic coughing: Conditions like chronic bronchitis can increase abdominal pressure, contributing to POP.
4: Obesity: Excess body weight can strain the pelvic floor.
5: Hysterectomy: Surgical removal of the uterus can weaken pelvic support.


Pathology:
The exact pathology of POP involves weakening connective tissues, muscles, and ligaments that normally support the pelvic organs. Over time, this can result in the organs descending into the vaginal canal.

Physical Examination: Pelvic examination is a crucial part of the diagnosis. During this exam, the therapist will visually assess the pelvic area and may use a speculum to examine the vaginal walls. He/she will look for signs of prolapse, such as bulging of the vaginal walls or descent of pelvic organs.

Pelvic Organ Prolapse Quantification (POP-Q) Exam: This standardized assessment system is used to measure the extent of prolapse and its severity. It involves measuring specific points in the vagina and recording their positions relative to the hymen.

Voiding Diary: In some cases, your doctor may ask you to keep a voiding diary to track urinary symptoms like incontinence or frequency.

Imaging Studies: In some situations, imaging studies like ultrasound or magnetic resonance imaging (MRI) may be recommended to get a better view of the pelvic anatomy and assess the extent of prolapse.

Urodynamic Testing: If urinary symptoms are a significant concern, urodynamic testing may be performed to evaluate bladder function and identify any issues contributing to POP.

Cystoscopy or Sigmoidoscopy: Occasionally, a scope (cystoscope or sigmoidoscope) may be used to visualize the inside of the bladder or rectum to rule out other conditions or to assess the extent of prolapse.

Medications: Painkillers, antibiotics, suppositories. Etc.

Surgery: Surgical intervention may be necessary for more severe cases of POP. There are several surgical procedures available, including:

Vaginal Mesh Procedures: While these were once common, their use has become more restricted due to safety concerns.

Vaginal Repair Procedures: These involve repairing and reinforcing the pelvic floor tissues and may include procedures like anterior or posterior colporrhaphy.

Hysterectomy: In some cases, removing the uterus (hysterectomy) may be recommended to address POP, especially if the uterus is significantly prolapsed.

Breathing and Relaxation Techniques: Learning how to coordinate breathing with pelvic floor muscle contractions and relaxation can be helpful in managing POP symptoms.

Electrical Stimulation: Electrical stimulation, often delivered through vaginal or rectal probes, can help strengthen and re-educate pelvic floor muscles. It can be particularly useful for individuals who have difficulty activating these muscles voluntarily.

Pessary Fitting and Management: If appropriate, a physiotherapist can assess, fit, and provide education on the use and care of pessaries. Pessaries are devices that can support the prolapsed organs.

Pelvic Floor Muscle Exercises (Kegels): This is a fundamental component of pelvic floor rehabilitation. A physiotherapist can teach the patient on how to perform Kegel exercises correctly to strengthen the pelvic floor muscles, which can help support the pelvic organs and reduce symptoms of POP.

Biofeedback: Biofeedback involves using sensors and monitoring equipment to provide visual or auditory feedback about pelvic muscle activity. This can help individuals learn to contract and relax their pelvic floor muscles effectively.

Manual Therapy: Physiotherapists may use hands-on techniques to release tension in the pelvic floor muscles and other surrounding structures, improving muscle function and reducing discomfort.

Weight Management: Losing excess weight can reduce the strain on the pelvic floor.

Posture and Body Mechanics Training: Proper body mechanics and posture can reduce the strain on the pelvic floor. Physiotherapists can teach individuals how to move and lift objects safely to minimize the risk of worsening POP.

Lifestyle Modification: Physiotherapists provide guidance on lifestyle changes, including posture improvement, safe lifting techniques, and dietary recommendations, to reduce pressure on the pelvic floor.

Physiotherapists can educate individuals about pelvic floor anatomy, POP, and strategies for symptom management. They may also provide emotional support and counseling, as dealing with POP can be emotionally challenging. Physiotherapists often prescribe customized home exercise programs to reinforce the progress.