Type Of Pelvic Organ Prolapse

Overview

Pelvic organ prolapse (POP) happens once one or a lot of organs in your pelvis—your female internal reproductive organ, vagina, urethra, bladder or rectum—shifts downward and bulges into or perhaps out of your channel canal. In the United States, 24 percent of women have some sort of POP.

Just one symptom that can be associated with the condition—urinary incontinence—costs the country more than $20 billion annually in direct and indirect medical costs, while surgeries to correct POP cost more than $1 billion annually. Approximately 200,000 surgeries are done each year in the United States to correct POP.

The condition is poised to become much more common in the United States and other Western countries with the aging of the Baby Boomers (women ages 45-63). In fact, an estimated 11 to 19 percent of women will undergo surgery for POP or urinary incontinence by age 80 to 85, and 30 percent of them will require an additional surgery to correct the problem.

Many women don’t have any symptoms of POP. Those who do might expertise a sense of channel or girdle fullness or pressure or feel as if a tampon is separation. They may additionally expertise incontinence, uncomfortable intercourse, pain in the pelvic area unrelated to menstruation, lower back pain and difficulty getting stools out.. Some women also complain of not being able to totally void stools and of faecal dirtying of their undergarment.

Treatments embrace manner choices, such as exercises to strengthen the pelvic floor, devices designed to support the pelvic organs, physical therapy and surgery to repair damaged ligaments and reposition the prolapsed organs. For women not about to have intercourse, obliterative surgeries, which close off the vaginal opening, are also an option.

Risk factors for POP include pregnancy (particularly pregnancies that have ended with a vaginal birth, especially a forceps-assisted birth), genetic predisposition, aging,obesity, estrogen deficiency, connective tissue disorders, prior pelvic surgery and chronically increased intra-abdominal pressure from strenuous physical activity, coughing or constipation. In several cases, women with POP have at least two or more risk factors.

Having been pregnant with and born to a child—particularly 2 or a lot of children—is a major risk issue. According to the National Association for Continence, as many as 50 percent of women who have ever given birth have some degree of POP.

While cesarean section delivery reduces the risk of POP and urinary incontinence, there is still no good evidence to support elective cesarean sections for preventing POP. Having a cutting out can also increase your risk of POP, depending on how the surgery was performed and how well the surgeon reattached the ligaments that typically hold up the uterus to the top of the vagina, where the cervix used to be.

Genetic factors also contribute to your risk of POP. If attainable, refer to your mother, granny, aunts and sisters regarding any girdle organ issues they’ve had. Also ask about urinary and fecal incontinence; although it’s embarrassing to talk about, both are often associated with POP.

Diagnosis

The most common symptoms related to girdle organ prolapse (POP) ar associated with excretion. You may have feelings of urgency, in which you suddenly have to urinate, find yourself urinating more often than normal, experience urinary incontinence or have difficulty urinating and completely emptying your bladder.

Some girls expertise painful intercourse, issues reaching climax and reduced desire or sexual desire. Although prolapse doesn’t directly interfere with physiological property, it should have an effect on self-image. Data shows that women with urge incontinence have the most problems with sexuality and that POP interferes with sexuality more than any other form of incontinence. Some girls avoid sex as a result of they’re embarrassed regarding the changes in their girdle anatomy, and a few worry that having sex can “hurt” one thing or cause a lot of injury.

You may also experience problems in the rectal area. Some girls with POP have pain and/or straining throughout intestine movements, and a few expertise anal incontinence, within which they unknowingly unharness stool.

Other symptoms embrace feeling as if a tampon is detachment. In fact, if the cervix has descended into the vagina, you may find you can’t use a tampon at all.

However, doctors may have trouble diagnosing the condition because many symptoms can be related to situations and medical conditions unrelated to POP. The following questions can help alert your doctor to the possibility that you may have POP:

  • Do you ever have to push tissue back in the vagina to urinate?
  • Do you have to use your fingers in the vagina, on the perineum (the area between the anus and vagina) or in the rectum to have a bowel movement?
  • Do you ever feel a bulge or that something is “falling out” of your vagina? Or do you feel like you’re sitting on an egg?

Let your doctor know if you answered yes to any of these questions.

Diagnosing POP begins with a complete medical history and physical examination. The doctor can fastidiously examine your female genitalia and canal for any lesions or ulcers and can perform an enclosed examination to spot any prolapsed organs. The doctor also will conduct a body part examination to check for the resting tone and contraction of the anal muscle and to seem for any abnormalities therein region. The doctor may also examine you while you’re standing (to see if gravity brings the organs down) and may ask you to strain as if you were urinating or having a bowel movement. A check of the nerves and reflexes in this area may be included.

POP refers to a displacement of 1 of the girdle organs (uterus, vagina, bladder or rectum). These displacements are typically graded on a scale of 0 to 4, with 0 being no prolapse and 4 being total prolapse (called procidentia). Your doctor can verify which sort of prolapse you’ve got. The different types include the following:

  • Bladder prolapse (cystocele). In this form, the bladder falls toward the vagina, creating a bulge in the vaginal wall. Usually the urethra also prolapses with the bladder, called urethrocele. The two together are called cystourethrocele. Symptoms include stress incontinence (when you urinate a little when you sneeze, cough, jump, etc.) or problems urinating.
  • Rectal prolapse (rectocele). In this form, the bladder falls toward the vagina, creating a bulge in the vaginal wall. Usually the urethra also prolapses with the bladder, called urethrocele. The two together are called cystourethrocele. Symptoms include stress incontinence (when you urinate a little when you sneeze, cough, This is a very common form of POP. It occurs when the ligaments that hold the uterus in place weaken, like a rubber band that’s been stretched too often. This causes the uterus to fall, weakening the back walls of the vagina.
  • Vaginal vault prolapse. This form happens once the duct supports weaken and therefore the canal drops into the duct canal once a ablation. It may conjointly occur once the front and back walls of the canal separate, allowing the intestines to push against the vaginal wall in a form of prolapse called enterocele. Enterocele might occur with a womb in situ, but vaginal vault prolapse occurs only after hysterectomy when the uterus no longer supports the top of the vagina.

Tests

Your doctor may order several tests to confirm a diagnosis of POP. These include:

  • Urinary tract infection screening. You pee in a cup and your urine is evaluated for the presence of bacteria.
  • Postvoid residual urine volume test. This determines if any urine remains in your bladder after voiding. After urinating, the doctor or nurse inserts a tube, or skinny tube, into the canal to live ANy remaining body waste or uses an ultrasound to spot any body waste remaining in the bladder.
  • Urodynamic testing. This test uses special sensors placed in the bladder and rectum or vagina to measure nerve and muscle response.

If you have problems with bowel movements, your doctor will likely refer you to a gastroenterologist for a thorough evaluation, including a colonoscopy to rule out colon cancer, which can cause constipation and straining. You may also have pressure testing of the rectum known as manometry.

Treatment

Pelvic organ prolapse (POP) is not a dangerous medical condition. Treatment options range from doing nothing and observing your condition over time to surgery to correct the prolapse. The choice of treatment typically depends on how your POP affects your quality of life, on your overall health and on your physician’s expertise.

Nonsurgical options

  • Observation. If you’re not having symptoms, or your symptoms are not interfering with your quality of life, you should choose a wait-and-see approach. Every year, you bear an entire examination to guage your POP. Just ensure you contact your health care skilled if your condition changes throughout the year. If you’ve got no symptoms, treatment cannot improve your quality of life and may be avoided.
  • Addressing symptoms. Another option is to handle any symptoms you’ve got while not truly “fixing” the underlying prolapse. For instance, if you are experiencing urinary or feculent incontinence, your doctor could advocate Kegel exercises (described below) or medication. If you are constipated and straining with bowel movements, then changing your diet, adding fiber supplements or taking medications such as laxatives may help.
    • Kegel exercises. Theseexercises strengthen your girdle floor, which might facilitate strengthen your organs within the girdle region and will relieve pressure from prolapse. To make sure you know how to contract your pelvic floor muscles correctly, try to stop the flow of urine while you’re going to the bathroom. If you can do this, you’ve found the right muscles. But do not do the actual exercises while stopping the stream of urine or you may develop a voiding dysfunction.To do Kegel exercises, empty your bladder and sit or lie down. Contract your girdle floor muscles for 3 seconds, then relax for 3 seconds. Repeat 10 times. Once you’ve perfected the three-second contractions, try doing the exercise for four seconds at a time and then resting for four seconds, repeating 10 times. Gradually work up to keeping your pelvic floor muscles contracted for 10 seconds at a time, relaxing for 10 seconds in between. Aim to complete a set of 10 exercises, three times a day.
  • Pessaries. Pessaries are diaphragm-like devices placed within the canal to support the girdle organs. They are commonly used in women with POP to reduce the frequency and severity of symptoms, delay or avoid surgery and prevent the condition from worsening. Most pessaries are made from silicone, plastic or medical-grade rubber. Silicone is probably best, since it is nonallergenic, doesn’t absorb odors or secretions, can be repeatedly cleaned and is pliable and soft. You typically remove the pessary at bedtime and replace it in the morning, although you can arrange to remove it less often or have it removed and cleaned at your doctor’s office. Most doctors visit channel steroids with a contraceptive diaphragm in biological time ladies to forestall any irritation of the channel walls.

Surgery

An calculable eleven to nineteen p.c of girls can bear surgery for POP or enuresis by age eighty to eighty five. The goal of surgery for POP is to improve your symptoms by addressing the underlying cause. Surgery is constructive, which corrects the prolapsed vagina while maintaining or improving sexual function and relieving symptoms, or obliterative, which moves the organs back into the pelvis and partially or totally closes the vaginal canal.

Surgery could involve repairs to any girdle organs, as well as the assorted components of the canal, the perineum (the region between your vagina and anus), bladder neck and anal sphincter (anus). The goal of surgery is to reposition the prolapsed organs and secure them to the encircling tissues and ligaments. Sometimes artificial mesh is employed to carry the organs in situ.

Although hysterectomy is still commonly performed in women with symptomatic POP, several other surgical procedures are available. Which your doctor recommends depends on your condition and the specific type of prolapse. Surgeries can be performed through an abdominal incision, vaginally or laparoscopically, with or without robotic assistance, through small incisions in your belly.

Studies find that the vaginal or laparoscopic approach results in fewer wound complications, less postoperative pain and shorter hospital stays than with open abdominal surgery. Today, a large number of POP surgeries are performed vaginally, laparoscopically or robotically. However, all forms carry a risk of relapse.

In terms of the surgery itself, procedures vary depending on the type of prolapse. In most cases, surgery for POP is performed under general or regional anesthesia (epidural or spinal), and patients may stay in the hospital overnight.

Here’s an overview of the surgical procedures used to treat the various forms of POP:

  • Rectal prolapse (rectocele). Surgery to repair a proctocele, or prolapse of the body part, is performed through the canal. The medico makes AN incision within the wall of the canal and secures the rectovaginal septum, the tissue between the body part and therefore the canal, in its proper position using the patient’s connective tissue. The gap of the canal is customized to the suitable dimension, and extra support is reinforced between the anal opening and the vaginal opening.
  • Bladder prolapse (cystocele). Surgery to correct bladder prolapse, or cystocele, is usually performed through the vagina. The surgeon makes an incision in the vaginal wall and pushes the bladder up. He or she then uses the connective tissue between the bladder and the vagina to secure the bladder in its proper place. If urinary incontinence is also a factor, the surgeon may support the urethra with a sling made out of a special nylon like material.
  • Prolapse of the uterus (uterine descensus).In postmenopausal women or women who do not want more children, prolapse of the uterus is often corrected with a hysterectomy. In ladies WHO need additional youngsters, a procedure called uterine suspension may be an option. Some doctors now use laparoscopic surgery or vaginal surgery to repair the ligaments supporting the uterus so that hysterectomy is not necessary. This operation requires only a short hospital stay, has a quicker recovery time and involves less risk than a hysterectomy. The long-run results, however, are still being studied, so talk to your health care professional about what’s right for you. If you have heavy bleeding or other uterine problems, you may want to consider hysterectomy, but if there are no other problems than prolapse, the ligament repair may be preferable. Generally, surgery for prolapse isn’t suggested till when you’ve got completed childbearing as a result of physiological condition will build it worse.
  • Vaginal vault prolapse and herniated small bowel (Enterocele). Vaginal vault prolapse and herniated small bowel (Enterocele). Vaginal vault prolapse and herniated little internal organ typically occur high within the canal, so surgery to correct the problems may be done through the vagina or the abdomen. There ar a variety of surgical procedures wont to treat these styles of POP. The most common involves channel vault suspension, in which the surgeon attaches the vagina to the sacrum. This can be done through AN incision within the abdomen, by laparoscopy (belly button surgery) or via robotic surgery. Robotic surgery takes several hours however accomplishes the surgery while not a giant incision. In the past, these surgeries have sometimes involved the placement of nylon mesh to suspend the vagina.However, in July 2011, the FDA issued a warning concerning the use of vaginally placed mesh to repair POP, stating that the surgical channel placement of mesh could expose patients to bigger risk than alternative surgical strategies as well as the abdominal placement of mesh, and that there is no evidence that surgeries involving mesh lead to better outcomes. Be sure to talk with your health care professional about the best approach for you.
Prevention

Preventing girdle organ prolapse (POP) begins in your teens. Get within the habit of active Kegels or girdle tilts as wiped out yoga many times every day, till doing them becomes as routine as brushing your teeth.

When you get pregnant, make sure you’re aware of the risks and benefits of a forceps delivery in case one is necessary. A obstetrical delivery creates a really high risk for incontinence and prolapse. Talk to your health care skilled concerning the choices of a vacuum delivery or a delivery.

Maintaining a healthy weight and quitting smoking might also facilitate forestall girdle floor issues, together with POP.

You should also avoid straining during bowel movements and when lifting heavy items, and if you have a chronic cough, get it checked out. Chronic coughing creates the kind of straining that can lead to POP.

Facts to Know

  1. Pelvic organ prolapse (POP) occurs when one or more organs in your pelvis—your uterus, urethra, bladder urethra bladder or rectum—shifts downward and bulges into your vagina. In the United States, about 24 percent of women have some for of POP.
  2. Pelvic organ prolapse is poised to become much more common in the United States and other Western countries with the aging of the Baby Boomers.
  3. Symptoms of POP embrace a sense of girdle fullness or pressure; feeling as if a tampon were falling out; incontinence; uncomfortable intercourse; girdle pain (not menstrually related); lower back pain; and difficulty getting stools out. However, many women don’t have any symptoms.
  4. Causes of POP embrace maternity, childbirth, aging, obesity and menopause. Straining with bowel movements, lifting heavy items and chronic cough can also contribute to POP. In some cases, hysterectomy can increase the risk, while a cesarean section may reduce it. The condition also has a genetic component.
  5. Urinary symptoms are the most common symptoms associated with POP. These include feelings of urgency, frequent urination, urinary incontinence or difficulty urinating.
  6. Diagnosing POP begins with a whole medical record and physical examination, including an internal exam and an anal examination. Tests to evaluate the health of your urinary system and bladder may be performed.
  7. There are four stages of POP, ranging from 0 (no prolapse) to 4 (total prolapse).
  8. There are several types of POP, including bladder prolapse, or cystocele; rectal prolapse, or rectocele; uterine prolapse, or uterine descensus; and vaginal vault prolapse.
  9. Treatment for POP depends on the type of prolapse. Treatment options range from doing nothing and observing your condition over time to surgery to correct the prolapse.
  10. Kegel exercises help strengthen your pelvic floor and may relieve pressure from prolapse. They are an excellent way to treat and prevent POP.

Key Q&A

  1. If I have stress incontinence, does that mean I have pelvic organ prolapse (POP)?No, you can have stress incontinence without having POP. However, stress incontinence is usually related to some weakness in the pelvic floor. It often occurs in conjunction with POP.
  2. My doctor says I have some bladder prolapse, but I don’t have any symptoms. How is that possible?Pelvic organ prolapse can be mild to severe and often doesn’t have any symptoms. If you don’t have any symptoms, you don’t have to do anything if you don’t want to, although incorporating pelvic floor exercises into your daily routine to strengthen your pelvic region is a good idea.
  3. I’ve been diagnosed with POP. Do I need surgery?That depends on your personal condition. If you don’t have any symptoms and your condition is manageable with lifestyle changes, then you don’t need surgery. Surgery is not foolproof; the prolapse could recur. So try to avoid surgery until your activities of daily living are affected. If you are scheduling your life around your prolapse symptoms, it is time to address them.
  4. I’m not sure if I’m doing Kegel exercises properly. How can I tell?A physical therapist or biofeedback expert is your best option when it comes to ensuring that you’re doing Kegels properly. Physical therapists can give you vaginal cones that you place in your vagina. The squeezing pressure you use to keep the cone in the vagina teaches you which muscles to use for Kegels. Biofeedback can also be used to teach you which muscles to exercise. Talk to your health care practitioner about a referral to a physical therapist or a nurse practitioner with this expertise. There also are electrical stimulators that can help to identify and contract the correct muscles.
  5. I think I might have vaginal prolapse. Which doctor should I see?While your gynecologist can most likely manage your condition, you might also consider seeing a urogynecologist, a gynecologist who specializes in the care of women with pelvic floor dysfunction.
  6. What is the best type of surgery for POP?Again, that depends on the type of prolapse you have and your surgeon’s comfort level with various surgical techniques.
  7. Is there any way to prevent POP?Maintaining a healthy weight is important, since there is evidence that being overweight significantly increases your risk of POP. Also, straining when you go to the bathroom, lifting heavy items and chronic cough can contribute to POP.
  8. What are the risks involved in not repairing POP?Generally, none. POP won’t shorten your life or lead to other health conditions. In some situations, the prolapsed organs can irritate the vaginal wall, creating ulcers. The greatest risk is that it creates genital, urinary and rectal problems that significantly affect your quality of life. The only emergency situation is if the uterus descends to such a degree that the bladder cannot empty and acute urinary retention occurs. This is rare but requires immediate medical attention.