About Pelvic Floor Prolapse
Pelvic floor prolapse occurs when the pelvic organs, such as the bladder, uterus, or rectum, fall from their normal positions. Causes of pelvic floor prolapse include:
- Pregnancy and vaginal delivery: The process of pregnancy and giving birth can weaken the pelvic floor muscles and stretch or tear important muscles and tissues.
- Aging: As we age, the pelvic floor muscles naturally weaken. Additionally, a decrease in estrogen levels during menopause can contribute to muscle weakness.
Non-modifiable risk factors are risk factors that cannot be changed. Non-modifiable risk factors of pelvic floor prolapse:
- Genetic muscle weakness: Some individuals are born with weak pelvic floor muscles, making them more susceptible to prolapse.
- Race: Certain races, such as Black individuals, may have a higher risk of developing pelvic floor prolapse. However, it's important to note that race is a non-modifiable risk factor.
- Age: women are at higher risk after menopause.
Modifiable risk factors are risk factors that can be changed or influenced. Modifiable risk factors of pelvic floor prolapse:
- Increased pressure on the abdomen: Putting unnecessary pressure on the pelvic floor muscles can lead to weakening. This can occur due to activities like heavy lifting or chronic coughing.
- Obesity: Being overweight or obese can directly affect the symptoms of pelvic organ prolapse. The increase in intra-abdominal pressure and other factors related to obesity can contribute to pelvic floor dysfunction.
- Occupation: Certain occupations that involve heavy lifting or prolonged standing may increase the risk of pelvic floor prolapse.
- Smoking: Smoking has been associated with an increased risk of pelvic organ prolapse. It is believed that smoking affects blood flow and collagen production, which can weaken the supportive tissues in the pelvis.
- Pregnancy: The risk of pelvic floor prolapse increases with multiple pregnancies.
It's important to note that while some risk factors are modifiable (such as obesity and smoking), others are not (such as genetic muscle weakness and race). By understanding these risk factors, individuals can make informed choices to reduce their risk of developing pelvic floor prolapse.
The symptoms of pelvic floor prolapse can vary depending on the severity of the condition. Early symptoms of pelvic floor prolapse may include:
- Pressure on the pelvic floor or vagina
- Mild discomfort
- Increased urinary urgency
As pelvic floor prolapse progresses to higher stages or severity, additional symptoms may occur. These symptoms can include:
- Feeling or seeing a bulge in the vagina
- Never feeling like the bladder has completely emptied
- Frequent voiding of the bladder
- Frequent urinary tract infections
- Urinary incontinence or leaking
- Frequent urge to pass urine
- Not feeling relief right after voiding
- Painful sexual intercourse
- Pressure or heaviness in the vaginal area
- Tissue sticking out from the vagina that may be bleeding or tender
- Pain in the lower abdomen, pelvis, lower back, groin, or vagina
It's important to note that symptoms of pelvic floor prolapse are not always consistent and can vary from person to person. Factors such as physical activity and standing for long periods of time can worsen symptoms. If you experience any of these symptoms or if they worsen, it is recommended to schedule an appointment with a doctor for an examination. They will be able to provide a proper diagnosis and discuss treatment options with you.
To diagnose pelvic floor prolapse, several examinations, tests, and procedures are commonly performed. These include:
- Routine history, general, and gynecological examinations: These examinations involve assessing the overall health of the patient. They may include blood and urine tests, coagulation series, infectious indexes, electrocardiogram, and chest x-ray to evaluate the function of important organs and determine if the patient can tolerate surgery.
- Clinical evaluation: The doctor will conduct a physical exam, focusing on the pelvic area. They may try to feel for any swelling near the ovaries. They will also take a full history to learn about any symptoms or contributing factors related to your condition.
- Urological ultrasound: This test uses sound waves to create images of the urinary tract to rule out the presence of any anal and rectal lesions.
- Rectal examination: This examination is performed to check for any abnormalities in the rectum and anus.
To determine the stage or severity of pelvic floor prolapse, additional examinations, tests, and procedures may be conducted. These include:
- Pelvic organ prolapse quantification (POP-Q) examination: This examination helps in measuring and staging pelvic organ prolapse by assessing the position of specific pelvic organs.
- Quality of life assessment: Questionnaires like the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) may be used to assess a patient's quality of life before surgery and during follow-up.
- Visual analogue scale (VAS) pain score: This score is recorded 24 hours after surgery to evaluate pain levels after surgery.
These examinations, tests, and procedures help healthcare professionals diagnose and determine the stage or severity of Pelvic Floor Prolapse accurately.
The goals of treatment for pelvic floor prolapse are to improve the quality of life for patients and reduce the risk of recurrence after surgery. Here are the different types of treatments and how they work to achieve these goals:
- Nonsurgical treatments:
- Pelvic floor exercises: These exercises, also known as Kegels, help strengthen the muscles surrounding the urethra, vagina, and rectum. By contracting and relaxing these muscles, pelvic floor exercises can improve the support of pelvic organs and reduce symptoms of prolapse.
- Pessary: A pessary is a removable device that is inserted into the vagina to provide support for prolapsed pelvic organs. It helps alleviate symptoms and can be an effective nonsurgical treatment option.
- Surgical treatments:
- Native tissue repair (NTR): This surgical procedure uses a patient's own fascia to repair the pelvic floor and correct pelvic organ prolapse. However, NTR may have higher recurrence rates.
- Synthetic implants: Synthetic implants are used to restore pelvic floor function by improving the integrity of compromised tissue. These implants induce a favorable host response and aim to create a mechanically self-sufficient and functional tissue.
- Health behavior changes:
- Changing eating habits: If bowel problems are present, doctors may recommend increasing fiber intake in the diet. Fiber helps prevent constipation and straining during bowel movements, which can worsen symptoms of prolapse.
It's important to note that not every woman with pelvic floor prolapse will require surgery. The choice of treatment depends on factors such as the type of prolapse, symptoms, age, overall health, and sexual activity.
Each treatment option aims to improve symptoms, provide support for prolapsed organs, and enhance overall quality of life for individuals with pelvic floor prolapse. The specific treatment recommended will depend on an individual's unique circumstances and should be discussed with a healthcare provider.
Pelvic floor prolapse is a common condition that affects many women, especially as they age. The natural progression of this condition can vary from person to person, but it generally worsens over time if left untreated. The severity of symptoms and the impact on daily life can also increase as the condition progresses.
Complications that commonly occur with pelvic floor prolapse include:
- Urinary and bowel symptoms: Pelvic floor prolapse can cause issues with urinary function, such as urinary incontinence (leaking urine) or difficulty emptying the bladder completely. It can also lead to bowel symptoms like constipation or difficulty emptying the bowels.
- Sexual dysfunction: Prolapse can affect sexual function and lead to discomfort or pain during sex.
- Quality of life: The impact of this condition on a person's quality of life can be significant. It can cause physical discomfort, emotional distress, and limitations in daily activities.