Let's talk Pelvic Organ Prolapse
What is it?
The bladder, uterus and rectum are held in place inside the
pelvic cavity by ligaments and an extensive network of fascia (also known as
connective tissue because it connects things). A pelvic organ prolapse occurs
when the ligaments and connective tissue are stretched or disturbed and the
pelvic floor muscles are not supportive enough to hold the organs in place.
Essentially, either the bladder and/or rectum pushes into
the vaginal wall and toward the vaginal opening. In the case of the uterus, the
organ itself comes down into the vaginal canal and can push past the vaginal
opening.
Grades of Prolapse:
0 no
prolapsed present
1 slight
downward movement but not to the vaginal opening
2 Downward
movement of the organ up to the vaginal opening
3 Downward
movement of the organ past the vaginal opening
4 Most often
used to describe uterine prolapse where the uterus exits the vagina almost
entirely.
Risk
factors:
Body Mass
Index: when there is extra weight on the body that puts extra pressure on the
pelvic floor muscles, ligaments and fascia. Overtime these structures weaken
allowing the organ to move down in the pelvis.
A body mass
index of 25-30 was found to increase the occurance of uterine prolapsed by 31%,
rectal prolapsed by 38% and bladder prolapsed by 39%.
A body mass
index of greater than 30 increased the risk of uterine prolapsed 40%, rectal by
75% and bladder by 57%.
Having
children: One study of 2600 women who never had children 19% had prolapse. 14.9
% had bladder, 6.3% uterus and 6.5% rectal. The risk of prolapse increases
significantly with the first baby, with minor increases with each consecutive
baby.
Constipation:
Chronic constipation can increase the risk of prolapse due to the prolonged straining/pushing
on the toilet. Its the pushing and straining that can stretch the ligaments and
strain the muscles.
What can be
done?
Pelvic floor
physiotherapy has been shown to be effective in treating pelvic organ prolapse
in grades 1-2. In the case of grade 3-4 there are several different options
such as a pessary, which is a device that is inserted inside the vagina to hold
the organ in place. Pelvic floor muscle training is still important if opting
for a pessary because the muscles need to be strong enough to hold the pessary
in place so it doesn’t fall out.
There is
also surgical repair as an option. After a surgery, therapy might be required
to deal with any pain, scar tissue formation and in some cases the muscles
still need to be strengthened to reduce the risk of the prolapse happening
again even after repair.
The Pelvic Health Lady
References:
Hendrix et
al. 2002. Pelvic Organ prolapse in Women’s Health Initiative: Gravity and
gravidity. Am J Obstet Gynecol 186:1160-6.
Bø, Kari. 2012. Pelvic floor muscle
training in the treatment of female stress urinary incontinence, pelvic organ
prolapsed and sexual dysfunction. World journal of urology. 30:437-443.
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