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Pelvic organ prolapse is a group of conditions in which one or more pelvic organs drop from their original position into or out of the vagina. Normally, the pelvic organs are held in place by the pelvic floor muscles. Prolapse happens when these muscles are weakened and can no longer offer proper support. A prolapse can be of different degrees, ranging from mild to severe. More than one organ may be affected at the same time.
Most commonly, the pelvic floor muscles weaken as a result of pregnancy and childbirth, especially vaginal birth, but the impairment can also be caused by aging, obesity, previous pelvic surgeries, and conditions that increase abdominal pressure on a regular basis, such as chronic coughing, or constipation.
Common types of prolapse include:
– Prolapse of the urinary bladder, called cystocele
– Prolapse of the uterus, or uterine prolapse
– Prolapse of the rectum, called rectocele
– And dropping of the top portion of the vagina toward vaginal opening, called vaginal vault prolapse. This type commonly happens after surgical removal of the uterus, which normally holds the vaginal vault in place.
A prolapse can be very uncomfortable and may cause pain or pressure in the pelvis or lower back. Depending on the organ that is affected, symptoms may also include urinary problems, constipation, or painful sex.
Treatments usually start with pelvic floor exercise, such as Kegel exercise, to strengthen the muscles. Biofeedback techniques may be used to help patients identify and squeeze the right muscles.
In post-menopausal women, low estrogen levels may be responsible for the weakening of pelvic floor muscles. In this case, a vaginal estrogen supplement can be effective as treatment.
A silicone device called a pessary can be deployed vaginally to hold the prolapsed organs in place. Pessaries are available in a variety of sizes and shapes. They are removable and should be cleaned regularly.
Surgeries may be performed to repair the tissue bulge, but recurrent prolapse is common after a surgery, because it doesn’t repair the underlying weakened muscles. There are several types of surgeries, for different types of prolapse. The most commonly performed are: removal of the uterus to correct uterine prolapse; and attachment of the vaginal vault to certain structures in the pelvis, to repair vaginal vault prolapse.