Thursday, 28 September 2017

Let's talk Pelvic Organ Prolapse


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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