Pelvic organ prolapse is a common issue that affects 1 in 10 women over the age of 50.1 It occurs when one or more pelvic organs, such as the womb, bladder or top of the vagina, slip from their normal position and bulge into the vagina. For some patients, prolapse is mild and doesn’t cause symptoms, meaning treatment is not always necessary,1 however, for some, pelvic organ prolapse can cause a significant reduction in quality of life.
Pelvic organ prolapse is a major worldwide health issue, affecting up to 50% of postmenopausal women.2 Although it can occur in younger women, symptoms are most commonly experienced in women aged 70 to 79 years old.3
What is pelvic organ prolapse (POP)
Pelvic organs are usually held in place by the ligaments and firm supportive muscles, known as the pelvic floor. The muscles stretch like a trampoline across the bottom of the pelvis, from the pubic bone at the front, to the tailbone at the back.4 The opening of the bladder, vagina and rectum all pass through the pelvic floor, and these muscles relax when needing to pass urine or faeces.4
A prolapse occurs if the pelvic floor is weakened by overstretching and therefore no longer able to support the pelvic organs, causing them to bulge from their natural positions into the vagina, occasionally protruding outside the vagina if the prolapse is severe enough.1
Prolapses are becoming more common due to increasing life expectancies and childbearing in low-resourced areas.5 Whilst not usually life-threatening, they can result in a deterioration in quality of life as they are associated with the bladder, bowel and sexual dysfunction.6
There are different types of prolapse; however, the four most common types are:
Cystocele: This is known as an anterior vaginal wall prolapse, as it occurs when there is a loss of support from the front of the vagina. The bladder drops down, which can cause the vaginal tissue to bulge from the opening.7
Rectocele: This type of prolapse happens when there is a loss of support to the back wall of the vagina, which can cause the rectum or intestines to drop down and vaginal tissue to bulge.7
Uterine: This causes the uterus to slip down into or protrude out of the vagina.8,9
Vaginal Vault: This type is more common for women who have undergone hysterectomies. It causes the top of the vagina or cervix to sink.9
Prolapse symptoms
Pelvic organ prolapses are not always symptomatic. Two-thirds of women who have given birth have anatomical evidence of a prolapse but have no symptoms.11 It has been reported that in a general population, 40% of women aged between 45 and 85 years were found to have a prolapse on examination, but only 12% were experiencing symptoms.11
Although often asymptomatic, pelvic organ prolapses can lead to discomfort in the vagina and reduced bladder and bowel function for some women, which can significantly affect their quality of life.5
The main symptoms include a feeling of heaviness and an awareness of a bulge in the vaginal opening, which is most often worse at the end of the day or after long periods of standing or exercise.
Other symptoms include10:
Prolapse is caused by the weakening of the connections between the pelvic organs and the ligaments and muscles that support them. Anything that weakens the pelvic floor or puts increased pressure on the abdomen can put a person at risk of prolapse. Common causes include:
Grades are used to measure the severity of a prolapse. One method of measuring the extent to which a prolapse has occurred, is the Baden Walker System13 :
Grade 0 - Normal position for each respective site, no prolapse
Grade 1 - Descent halfway to the hymen
Grade 2 - Descent to the hymen
Grade 3 - Descent halfway past the hymen
Grade 4 - Maximal possible descent for each site13
While grading is useful to understand the severity of a patient’s prolapse, it’s important to focus on the patient’s symptoms vs their grade when providing treatment.
There are several different options for treating prolapse, including self-management and lifestyle changes, the use of pessaries and pelvic floor surgery. The treatment selected will depend on the type and severity of the prolapse.
Your doctor will discuss all treatment options with you, in most cases, doctors will start with a more conservative approach. This approach will include lifestyle changes such as losing weight if you’re overweight, avoiding heavy lifting and preventing or treating constipation to ensure ease of bowel movement.10
If your prolapse is affecting your everyday life, there are several treatment options, such as kegal exercises to strengthen the pelvic floor muscles, hormone treatments or vaginal pessaries.10 In more serious cases, surgery may be considered, however, this is normally later in treatment if needed.
Pessaries are removable intravaginal devices, provided to support vaginal tissue and organs displaced by a prolapse; these can either provide support or be space-filling.14
Support pessaries, such as ring pessaries, are often the first choice for patients with milder prolapses due to their ease of insertion and removal. However, there are a number of styles available to treat particular types of prolapse and different sizes available to fit each patient’s anatomy.
Mediplus provides a range of pessaries to support prolapse patients, including both support pessaries and space-filling pessaries. A ring pessary is the most commonly used pessary due to the ease it can be used by both the patient and healthcare provider.14
For more advanced prolapses, there are space-filling pessaries available including Gellhorn or shelf pessaries.
POPYTM is a shelf pessary which, made from silicone is a more flexible and comfortable option compared to other shelf pessaries.
You can see our full range of pessaries by visiting our
product page.
References:
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