Pelvic Organ Prolapse Explained by Dr. Carolyn Best, OBGYN

Understanding Pelvic Organ Prolapse

• 💡 Prolapse is defined as pelvic organs descending or falling down towards the vaginal opening, or even outside the body.
• 🎯 The pelvic floor acts as a diaphragm of muscle supporting pelvic organs, and its reduced tone can lead to prolapse.
• 🔑 Common structures that can prolapse include the bladder, rectum, and the vaginal walls themselves.

Symptoms and Diagnosis

• 📌 The most common symptom is a general sense of pressure or a feeling of something sitting in or falling out of the vagina.
• ⚡ Many individuals with prolapse experience no symptoms at all, but if present, symptoms can impact quality of life, sexual function, and bowel/bladder function.
• 🧠 Prolapse can cause bladder dysfunction by creating a sensation of needing to urinate urgently or leading to incomplete emptying due to urethral kinking.
• 🔍 A pelvic exam by a healthcare provider or pelvic floor physiotherapist is typically used for diagnosis, sometimes aided by a speculum exam for detailed assessment.

Causes and Risk Factors

• ⚠️ The primary risk factor for prolapse is pregnancy, especially vaginal births, with two or more vaginal births being strongly associated.
• 📈 Other contributing factors include chronic constipation, being overweight, jobs involving heavy lifting, and genetic connective tissue disorders like Ehlers-Danlos syndrome.
• ⏳ Prolapse occurs due to the breakdown or inadequacy of support structures like muscles and ligaments, exacerbated by gravity over time.

Treatment Options

• 🛠️ Lifestyle modifications are crucial, focusing on managing constipation through diet, water intake, and fiber.
• 💪 Pelvic floor muscle training with a specialized physiotherapist can strengthen support from below and may reverse early-stage prolapse.
• 🩺 A vaginal pessary is a wearable support device that can provide instant relief by holding organs in place and may prevent prolapse from worsening.
• 🏥 Surgery is an option to restore anatomy and improve quality of life, with procedures tailored to the specific prolapsing organs and often performed minimally invasively.

Surgical Considerations and Medications

• ⚠️ Surgery is elective and its recurrence rate is estimated between 20-30%, though quality of life improvements are significant.
• 🤰 It's generally recommended to complete childbearing before prolapse surgery, as subsequent pregnancies can impact results.
• 🚫 There is no role for medications or supplements in directly treating prolapse; treatments are primarily physical.
• 🍎 Maintaining a healthy diet with adequate fiber is important for preventing constipation, a key risk factor for prolapse.