What is Pelvic Organ Prolapse?
Pelvic organ prolapse is a very common condition, particularly among women after menopause. It’s estimated that half of women who have children will experience some form of prolapse in later life. But because many women don’t seek help from their doctor, the actual number of women affected by prolapse may even be higher.
Pelvic Organ Prolapse may also be called uterine prolapse, genital prolapse, uterovaginal prolapse, pelvic relaxation, pelvic floor dysfunction, urogenital prolapse or vaginal wall prolapse.
In prolapse of the uterus (procidentia), the uterus drops down into the vagina. It usually results from weakening of the connective tissue and ligaments supporting the uterus. The uterus may bulge only into the upper part of the vagina, into the middle part, or all the way through the opening of the vagina, causing total uterine prolapse. Prolapse of the uterus may cause pain in the lower back or over the tailbone, although many women have no symptoms.
Total uterine prolapse, which is obvious, can cause pain during walking. Sores may develop on the protruding cervix and cause bleeding, a discharge, and infection. Prolapse of the uterus may cause a kink in the urethra. A kink may hide urinary incontinence if present or make urinating difficult. Women with total uterine prolapse may also have difficulty having a bowel movement.
In prolapse of the vagina, the upper part of the vagina drops down into the lower part, so that the vagina turns inside out. The upper part may drop part way through the vagina or all the way through, protruding outside the body and causing total vaginal prolapse. Prolapse of the vagina occurs only in women who have had a hysterectomy.
Total vaginal prolapse may cause pain while sitting or walking. Sores may develop on the protruding vagina and cause bleeding and a discharge. Prolapse of the vagina may cause a compelling or frequent need to urinate. Or it may cause a kink in the urethra. A kink may hide urinary incontinence if present or make urination difficult. Having a bowel movement may also be difficult.
Diagnosing Pelvic Organ Prolapse
Doctors can usually diagnose pelvic floor disorders by performing a pelvic examination, using a speculum (an instrument that spreads the walls of the vagina apart). A doctor may insert one finger in the vagina and one finger in the rectum to determine how severe a rectocele is.
A woman may be asked to bear down (as when having a bowel movement) or to cough while standing. She may be examined while standing. The resulting pressure in the pelvis may make a pelvic floor disorder more obvious.
Procedures to determine how well the bladder and rectum are functioning, such as urine tests, may be performed. These procedures help doctors determine whether drugs or surgery is the best treatment. If a woman has a problem with the passage of urine or urinary incontinence, doctors may use a flexible viewing tube to view the inside of the bladder (a procedure called cystoscopy) or the urethra (a procedure called urethroscopy).
Also, the amount of urine that the bladder can hold without leakage and the rate of urine flow may be measured. Doctors may determine whether prolapse of the uterus is preventing the diagnosis of urinary incontinence.