What is Pelvic Organ Prolapse? Warning signs women shouldn’t ignore
Pelvic organ prolapse is the descent of the uterus or vaginal wall due to weakened pelvic support. It often follows childbirth trauma, inadequate recovery, or aging. Risk factors include multiple deliveries, chronic illness, and obesity. Symptoms range from pelvic discomfort to urinary and bowel issues. Treatment involves prevention, exercises, or surgery.
Position and Support of the Uterus The uterus is the female reproductive organ that lies in the pelvic region. Under normal circumstances, it is in an anteflexed and anteverted position, and is placed between the bladder and the rectum. It is supported by many muscles and ligaments in a three-tier system to keep it in place and prevent its descent.
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What Is Pelvic Organ Prolapse? The uterus is fixed to one place, however, minor variations in its position can occur when changing the posture, on straining or due to a full bladder or the rectum. When the uterus, or vaginal wall descends in a hernial fashion, it is known as pelvic organ prolapse. There are multiple factors, predisposing as well as aggravating, that can lead to genital prolapse.
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Risk Factors During Childbirth Predisposing factors include overstretching of the ligaments supporting the uterus by premature straining before full cervical dilatation during a vaginal delivery. Vaginal delivery assisted with forceps and prolonged labour can also lead to prolapse, because of overstretching of the perineum (the area between the anus and the genitals).
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Postpartum Vulnerability After the delivery, the supporting structures may be unable to return to their original structure in women who are ill-nourished and asthenic or those who resume daily activities too early, without adequate rest. Multiple childbirths with less time between the birth of consecutive kids can also be a predisposing factor.
Anatomical and Postural Contributors Anatomical factors that can cause prolapse include the gravitational pressure that occurs because of the human posture involving two lower limbs, the forward inclination of the pelvis and the stress of vaginal delivery that can cause damage to the fibres of supporting muscles.
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Tissue Damage and Degeneration During vaginal delivery, there may be tears or breaks in the ligaments, fascia, muscles or even nerves, especially in women who have undergone multiple childbirth. Other factors include postmenopausal atrophy of the uterus, slow/inadequate repair of collagen tissue and increased pressure in the abdomen.
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Aggravating Medical Conditions These factors may be aggravated by the presence of diseases like chronic obstructive pulmonary disease, constipation and undernutrition. Women in jobs that involve weight lifting, or those who have obesity, or have addictions like smoking are more prone to developing pelvic organ prolapse, provided the genital organs are already weak.
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Types of Prolapse There may different types of pelvic organ prolapse. In case of the vagina, laxity of the anterior vaginal wall can cause herniation of the bladder through this wall (cystocele). Posteriorly, the rectum may herniate through, leading to rectocele. The uterus may descend downwards and can even protrude out of the introitus.
Symptoms of Prolapse The person may feel something coming out of the vagina, and can also feel some discomfort while walking due to this. Backache or pain in the pelvic region can be experienced, along with pain during intercourse and some urinary symptoms in case of cystocele. Bowel symptoms are also seen in prolapse. There may be some difficulty in voiding urine, increased frequency of urination, and painful micturition in case of infection. Difficulty in passing stool and fecal incontinence are features of rectocele. White or blood stained discharge through the vagina may be observed.
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Examination and Preventive Strategies A complete examination is required, including checking the body mass index and any features of lung diseases. Some preventive measures include avoiding injury to the supporting structures during a normal delivery and steering clear of strenuous exercises. Pelvic floor exercises may be recommended. Depending on the factors surgical treatment can be advised.
Rajeshwaari Kalla is a freelance health and wellness writer
