Pelvic Organ Prolapse

Pathophysiology

Pelvic organ prolapse is the abnormal descent or herniation of the pelvic organs from their normal attachment sites or their normal position in the pelvis. The pelvic structures that may be involved include the uterus (uterine prolapse) or vaginal apex (apical vaginal prolapse), anterior vagina (cystocele), or posterior vagina (rectocele). Many parous women may have some degree of prolapse when examined; however, most prolapses are not clinically bothersome without specific pelvic symptoms, and they may not require an intervention.

Disease statistics

A World Health Organization (WHO) study indicated that half of the women in Lebanon had at least 1 type of prolapse. ‘Guestimates’ indicate that there are 34 million women worldwide with POP and studies frequently estimate that up to 50% of the female population has POP. The reality is we truly don't know what the real figures are-there has been no accurate stat capture to date.Vaginal childbirth and menopause are the 2 leading causes of pelvic organ prolapse;nearly every woman has at least 1 hash mark on her risk factor profile. Women with POP typically have multiple risk factors, but even 1 damaging child birthing experience can be sufficient to cause problems that evolve into pelvic organ prolapse. Women in every age demographic experience pelvic organ prolapse.

Treatment

If you do not have any symptoms or if your symptoms are mild, you do not need any special follow-up or treatment beyond having regular checkups. If you have symptoms, prolapse may be treated with or without surgery. Often the first nonsurgical option tried is a pessary. This device is inserted into the vagina to support the pelvic organs. Targeting specific symptoms may be another option. Kegel exercises may be recommended in addition to symptom-related treatment to help strengthen the pelvic floor. Weight loss can decrease pressure in the abdomen and help improve overall health. If your symptoms are severe and disrupt your life, and if nonsurgical treatment options have not helped, you may want to consider surgery.

Research

Research conducted by the Pelvic Floor Disorders Network, an initiative funded by the National Institutes of Health, has revealed that the long-term success rates of a surgery to treat pelvic organ prolapse are lower than expected. Nearly one-third of women develop anatomic or symptomatic treatment failure within five years of undergoing sacrocolpopexy for pelvic organ prolapse.