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Health sense: Pelvic organ displacement on the rise
Pelvic organ prolapse (POP) is a common condition experienced particularly by older women, and with a growing aging population, the number of cases will likely increase
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elvic organ prolapse (POP) is a common condition experienced particularly by older women, and with a growing aging population, the number of cases will likely increase.
It is estimated that 50 percent of all women experience mild prolapse and 10 percent of them have moderate to severe prolapse.
However, many women are reluctant to seek the attention of a doctor on account of embarrassment, or they are unaware that the condition can cause problems and that treatment is readily available.
So what is POP? It occurs when an organ displaces beyond its normal position, such as occurs with a hernia. This can happen when the muscles that hold the pelvic organs in place weaken or stretched from childbirth or surgery such as a hysterectomy. It can be uncomfortable and painful, however, it usually is not a big health problem and it doesn't always get worse. With some women, it can get better with time.
More than one pelvic organ can prolapse at the same time. The organs that are involved are the bladder, which is the most common POP ' this prolapse is called a cystocoele ', rectum (called a rectocoele), urethra (called a urethrocoele), uterus (called a uterine prolapse), vagina (called a vaginal vault prolapse), small bowel (called a rectocoele).
Symptoms of prolapse
The condition could further worsen with chronic cough, asthma, frequent constipation, carrying heavy loads, pelvic organ tumors, or obesity. Older women are at higher risk and it also tends to run in the family.
Symptoms of prolapse include feeling the pressure from pelvic organs pressing against the vaginal wall, feeling as if something is falling out of your vagina, having incontinence or needing to urinate a lot, experiencing pain in the vagina during sex, lower backache or a pull or stretch in the groin area, abnormal vaginal discharge or bleeding and having problems with your bowels or constipation. In extreme cases, there may be difficulty urinating or walking due to the prolapse causing a physical obstruction.
When you visit your doctor, he will ask you about your symptoms and will do a physical exam, including a pelvic exam. The treatment will be based on which pelvic organs have prolapsed and how bad your symptoms are.
If your symptoms are mild, you may be able to do some things at home to make you feel better. This includes doing Kegel exercises to strengthen your pelvic muscles and ligaments, cutting down your smoking, maintaining a healthy weight and eating a high-fiber diet to prevent constipation and avoid lifting heavy objects.
Your doctor may also consider fitting you with a device called a pessary to help with the pain and pressure of POP.
The removable device comes in different shapes and sizes to specifically fit you. However, there are complications and side effects from pessary use. Some pessaries may interfere with sexual intercourse, but a ring pessary may be left in place during sex if it's comfortable for you. Some women also experience a bad-smelling discharge when they use a pessary. Some people are allergic to latex or develop allergies after using latex products. It is best to inform your doctor promptly if you experience any of these situations.
Going the surgery route
For those who have severe POP, surgery is an option. The types of surgery for POP include: surgery to repair the tissue that supports a prolapsed organ; surgery to repair the tissue around your vagina; surgery to close the opening of your vagina; or surgery to remove the uterus (hysterectomy).
However, even after surgery, POP can still occur. In cases of utero-vaginal (which is a combination of the uterus and vagina) prolapse, a vaginal hysterectomy (VH) can be performed.
If the patient prefers to keep her uterus, a Manchester's operation can remove the prolapsing cervix whilst retaining the uterus. In cases of cystocoele and/or rectocoele, repair of the herniating organ is achieved by an anterior and posterior colporrhaphy or a pelvic floor repair (PFR).
In severe utero-vaginal prolapse (after the vaginal hysterectomy) or vault prolapse, a sacrospinous ligament fixation (SSF) attaches to the top of the vagina to a ligament in the pelvis with non-absorbable sutures. These operations are frequently done in combinations.
Some of the surgery for POP uses synthetic or animal based mesh to help strengthen the vaginal wall and hold the prolapsed organ in place. However, with recent reports of complications with mesh, some companies have stopped production. Currently, natural tissue repairs appear safest, and have a low complication rate if done by experienced specialists.
After surgery, it is then recommended to do Kegel exercises, which will help make your pelvic muscles stronger as well as hasten your recovery from surgery.
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Dr Arthur Tseng is a consultant obstetrician and gynaecologist, who sub-specializes in urogynaecology and pelvic reconstructive surgery at Gleneagles Hospital.
