What is pelvic organ prolapse?

Pelvic organ prolapse (POP) is a topic that is not commonly discussed. Some women may feel ashamed or confused regarding the condition and its treatments. Additionally, many women may not have even heard of it.

Pelvic organ prolapse happens when one or more pelvic organs slip from their original position. The affected organs can include the uterus (womb), vagina, bowel, bladder, urethra, and rectum. This condition is common and affects approximately 1 in 10 women over age 50.

What are the different types of pelvic organ prolapse?

Various types of prolapse can occur depending on which pelvic organ is protruding into the vagina, and it is common for individuals to experience more than one type of prolapse simultaneously.

• Anterior vaginal wall prolapse (cystocele or cystourethrocele): The bladder bulges into the front wall of the vagina.

• Posterior vaginal waSll prolapse (enterocele): The bowel bulges forward into the back wall of the vagina.

• Uterine prolapse: The protrusion or descent of the uterus into the vagina.

• Vault prolapse: After a hysterectomy, some women may experience vaginal prolapse, where the upper part of the vagina droops downwards.

What are the stages of pelvic organ prolapse?

Pelvic organ prolapse is typically categorised on a scale ranging from 1 to 4 to indicate its severity, with 4 representing a severe prolapse.

What are the symptoms of pelvic organ prolapse?

Symptoms will vary depending on the type and severity of the prolapse. Some women may not experience any symptoms of pelvic organ prolapse. Symptoms of pelvic organ prolapse include:

• A bulge or dragging sensation in the vagina. Symptoms may worsen if standing for too long.
• Incontinence (leaking urine) or needing to pass urine more frequently.
• May leak urine when laughing or coughing.
• Difficulty with emptying bowel or constipation.
• Uncomfortable sex or a lack of feeling during intercourse.

What are the risk factors of pelvic organ prolapse?

Pelvic organ prolapse occurs when the group of muscles and tissues responsible for supporting the pelvic organs, known as the pelvic floor, becomes weakened and is unable to securely maintain the organs in their proper positions.

Several factors can contribute to the weakening of the pelvic floor and increase the risk of developing pelvic organ prolapse. These factors can collectively impact the strength and integrity of the pelvic floor, potentially leading to pelvic organ prolapse.

These factors include:

• Pregnancy and childbirth, particularly in cases of prolonged or difficult labour, the delivery of a large baby, or multiple births.
• Ageing and going through menopause.
• Overweight.
• Chronic constipation or a long-term health condition that leads to frequent coughing and straining.
• Undergoing a hysterectomy.
• Engaging in a profession that involves heavy lifting.

How is pelvic organ prolapse diagnosed?

Your doctor will conduct a pelvic examination, which includes an internal examination of your vagina.

The internal examination is similar to a cervical smear test, where your doctor would insert a speculum into your vagina to hold and see if there is a prolapse. It typically takes only a few minutes. Your doctor will discuss with you should you require further tests.

How is pelvic organ prolapse treated?

The treatment for pelvic organ prolapse is determined by various factors, including the type of prolapse, severity of symptoms, age, underlying health issues, and sexual activity status.

If pelvic organ prolapse is not causing you significant discomfort, treatment may not be necessary. There are some self-help measures you can consider to potentially improve your well-being or functionality, such as:

• Increase dietary fibre and stay well-hydrated for more effortless bowel movements.
• Weight loss to alleviate pressure on the pelvic organs.
• Engage in exercises (yoga and Pilates) to build core strength.

Other treatments include:

• Vaginal pessary
  • A silicone device that is inserted into the vagina to support pelvic organs. This can be used to alleviate the symptoms of moderate or severe prolapses, and they serve as an alternative for individuals who cannot or would prefer not to have surgery.
  • It is necessary to replace or remove, clean, and reinsert the pessary every 4 to 6 months, which can be done by a doctor, nurse, or yourself.
• Pelvic floor exercises
  • Kegel exercises help strengthen the pelvic floor muscles and provide some form of relief to symptoms.
  • Pelvic floor muscle exercises are also beneficial for women with both pelvic organ prolapse and urinary incontinence.
• Vaginal hormone treatment (oestrogen)
  • It is recommended for menopausal women as tablets, cream or a ring that is inserted into the vagina to reduce discomfort.

Surgery may be considered if non-surgical treatment does not improve symptoms of prolapse. However, surgical procedures should be delayed in women who still wish to have children, as childbirth after surgery may increase the chance of a prolapse returning.

• Obliterative surgery (colpocleisis)
  • In this surgery, your doctor would close off the vaginal opening.
  • It is typically considered for women with advanced prolapse after other interventions have proven ineffective and when they are confident that they no longer wish to engage in sexual activity in the future.
• Reconstructive surgery
  • It is the most common type of surgery for pelvic organ prolapse. The objective of reconstructive surgery is to restore pelvic organs to their original position.
  • Certain types of reconstructive surgery are performed via a vaginal incision, while others involve incisions in the abdomen or with laparoscopy.

How to prevent pelvic organ prolapse?

While researchers are actively exploring methods to prevent pelvic organ prolapse, there are some steps you can take to lower your risk of developing pelvic organ prolapse.

• Maintain a healthy weight or work towards weight loss if you are overweight. 
• Include fibre-rich foods in your diet. Fibre helps prevent constipation and reduces the need to strain during bowel movements, potentially lowering the risk of pelvic floor prolapse.
• Avoid smoking. Smoking can lead to chronic coughing, which places strain on the pelvic floor muscles.

Make an appointment at Pantai Hospitals

It is crucial to break the silence surrounding pelvic organ prolapse. Prioritise your pelvic health and seek regular check-ups with your doctor. Early diagnosis and intervention can make a significant difference.

If you or someone you know is experiencing symptoms of pelvic organ prolapse or is seeking more information, speak to your doctor.

A dedicated and expert team of Obstetricians and Gynaecologists at Pantai Hospital is available for consultation to provide the best care and assistance. Get in touch with us to book an appointment today if you have any concerns or questions regarding your reproductive health.

For health screening appointments, please contact the Health Screening Centre at your nearest Pantai Hospital.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.