Pelvic Organ Prolapse

Pelvic Organ Prolapse (or POP) is a common condition where the pelvic organs—the bladder, uterus, bowel, or rectum—slide down from their normal position. These organs are held in place by the pelvic floor, a group of muscles inside your body. When these muscles weaken or become damaged, these organs can slide out of their normal position and into your vagina. This can cause a bulge or lump in your vagina (called a prolapse). The most common types of Pelvic Organ Prolapse are:

• Cystocele, or bladder prolapse
• Rectocele, or rectum prolapse
• Enterocele, or small bowel prolapse
• Uterine prolapse

Gynecologists often use a grading system to determine how severe your condition is,

• Grade 1: mild prolapse; can’t be seen or felt
• Grade 2: more severe; can be seen or felt
• Grade 3: severe prolapse; can be seen outside of your body

Prevalence of Pelvic Organ Prolapse

The pelvic floor consists of muscles, ligaments, and nerves that support the bladder, cervix, uterus, vagina, and rectum. Pelvic Organ Prolapse occurs when the pelvic floor muscles weaken or become damaged and can no longer provide adequate support for these organs. One or more organs may “slip” down into or bulge into the vagina. According to the American Urogynecologic Society, POP affects about 1 in 9 women. It is a common condition—more common than you probably think. It is estimated that between 5-20% of women will have a prolapse during their lifetime.

Symptoms of Pelvic Organ Prolapse

Symptoms of POP can include,

• Problems with urination, such as leaking or having to push organs out of the way to urinate
• Pressure in the vagina or pelvis
• Abnormal sensations, such as a pulling feeling, in the vagina and/or pelvis
• Soreness in the vagina
• Problems with bowel movements, including constipation or incomplete emptying of stool
• Lower back pain
• Low back pain that gets worse when you’re standing for long periods, coughing, or lifting things

Causes for Pelvic Organ Prolapse

The most common cause of POP is pregnancy and childbirth. However, other factors can contribute, including:

• Hysterectomy
• Menopause
• Chronic constipation
• Heavy lifting
• Aging
• Chronic coughing or straining for prolonged periods
• Being overweight
• Family history of prolapse

Risk Factors for Developing Pelvic Organ Prolapse

While some women are more predisposed to developing POP, several lifestyle factors can increase your risk for this condition. These include,

Age: As people age, the muscles and tissues in their bodies often weaken and break down. This natural process can affect the pelvic floor and lead to POP.

Pregnancy and Childbirth: Pregnancy often causes rapid growth of the uterus, which puts increased pressure on the pelvic floor muscles. These muscles expand even more dramatically during childbirth as the baby passes through the birth canal. This can cause weakness and damage to pelvic floor tissues, leading to a higher risk of prolapse

Genetics: Some women have weaker connective tissues than others, causing them to be more susceptible to developing POP over time

Menopause: As estrogen levels drop during menopause, there is a natural decline in collagen production by the body

Diagnosis of Pelvic Organ Prolapse

POP is diagnosed using one or more of the following tests:

Pelvic Exam. The doctor will be able to feel if there are bulges in your vagina that could indicate a prolapse of the uterus, bladder, rectum, or small bowel. Your pelvic floor muscles will also be checked for strength and tone.

Urinary Tract Evaluation. If your doctor suspects you have a prolapsed bladder, you may be asked to urinate and cough to check for urine leakage. Urine can be tested for signs of infection, and you may be asked to record how many times you use the bathroom over 24 hours and how much fluid you drink during that time. You may also need additional imaging tests such as an ultrasound or cystoscopy, in which a tube with a camera at the end is inserted into the urethra to view inside the bladder.

Imaging Tests. If your doctor suspects a prolapsed uterus, they may order imaging tests such as an ultrasound to assess the size of your uterus and rule out intrabdominal organ or growth pushing the uterus down.

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