Pelvic Organ Prolapse

Pelvic organ prolapse (POP) develops when the muscle and ligaments supporting the organs surrounding the vagina weaken and lead to a bulge in the vagina. The organs involved include the bladder, uterus and bowel/rectum.

Pelvic organ prolapse is not an uncommon condition. Risks and factors leading to it include:

• Increased age
• Childbearing
• Genetics
• Injury to the pelvic floor during vaginal childbirth, radiation, pelvic trauma/fracture
• Removal of the female reproductive organ (hysterectomy) may lead to loss of pelvic floor support
• Obesity
• Constipation
• Tobacco use

Common symptoms include:

• Sense of fullness in the vaginal area
• Incomplete bladder emptying along with a weak urinary flow
• Recurrent urinary tract infection
• Pain with urination and bowel movement
• Bulge seen coming to or out of the opening of the vagina
• Constipation
• Urinary leakage
• Back pain

Diagnosis of pelvic organ prolapse includes:

• A detailed history and thorough physical examination focusing on the pelvic region.
• Cystourethroscopy and a urodynamic study are often performed as well.
• Occasionally, renal, bladder, and pelvic imaging is obtained using modalities such as ultrasound, computerized tomography or magnetic resonance imaging.

Treatment of pelvic organ prolapse depends on the degree of the condition.

Non-surgical options for pelvic organ prolapse:

• Conservative measure includes pelvic floor strengthening routines, weight loss, correction of constipation.
• Another non-surgical method of correction of POP is the use of a pessary. Vaginal pessary comes in all shapes and sizes depending on application. Our, nurse practitioner, is well versed in the fitting of these devices in patients who may choose this minimally invasive option.

Surgical options for pelvic organ prolapse:

• Surgery is an option for those individuals who have either failed or are not good candidates for conservative therapy.
• Surgical interventions have evolved from major abdominal procedures to trans-vaginal approaches using either synthetic mesh or commonly known as “lift-kits.”
• More recently, the transition has returned to a trans-abdominal approach by adopting the benefits of the DaVinci robotic surgical system and laparoscopy to perform a procedure called sacrocolpopexy.

Depending on the degree of prolapse and the organ structure involved, a urologist often works in conjunction with a gynecologist and/or colorectal specialist to correct the pelvic organ prolapse.