Pelvic Organ Prolapse (POP)- 02

1- What Is Pelvic Organ Prolapse?

2- Pelvic Organ Prolapse Symptoms
3- How Do I Know If I Have Pelvic Organ Prolapse?

4- Types of Pelvic Organ Prolapse
5- How Is Pelvic Organ Prolapse Treated?
6- Treating Pelvic Organ Prolapse at Home

7- Physical Therapy for Pelvic Organ Prolapse
8- Kegel Exercises (Pelvic Floor Exercises)

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4- Types of Pelvic Organ Prolapse

What Are the Types of Pelvic Organ Prolapse?

There are a few different types of pelvic organ prolapse (POP). They’re named after where they happen in your body and what organs are involved.

Anterior Vaginal Wall Prolapse

“Anterior” means front. An anterior prolapse can happen if you’ve had your uterus taken out (hysterectomy). There are two types of prolapses that can occur in the front side of your vagina, and they’re the most common kinds of pelvic organ prolapse. They are:

• Bladder. This is also called a “cystocele.” It happens when your bladder drops down into your vagina. A cystocele can be mild, moderate, or severe, depending on how far your bladder drops.
• Urethra. When your bladder prolapses, the tube that carries pee out of your body (the urethra) can prolapse, too. Your doctor might call this a “urethrocele.” If both your bladder and urethra prolapse, it’s called a “cystourethrocele.”

As these prolapses get worse, you might feel -- and see -- them bulging out of your vagina.

Posterior Wall Prolapse

“Posterior” means back. These prolapses happen when the tissue between your vagina and rectum (the end of your large bowel) stretches or separates from the bones in your pelvis. There are two kinds of posterior wall prolapse:

• Rectocele. Doctors also call this a “rectal wall prolapse.” It happens when your rectum drops down and forward and then bulges into the back wall of your vagina.
• Rectal prolapse. This is different than a rectocele or rectal wall prolapse. With a rectal prolapse, part of your rectum turns inside out and pokes out through your anus. At first, you might think it’s a big hemorrhoid.

Apical Prolapse

“Apical” means near the apex, or top. There are three kinds of apical prolapse:

• Enterocele. If you have this, it means your small intestine has dropped down and is bulging into the upper part of the back wall of your vagina. This can also happen at the top of your vagina, where the intestine sits on top and sinks down into it.
• Uterine. This is when your uterus (womb) drops into your vagina. Uterine prolapses are the second most common kind of prolapse. Your risk goes up as you get older.
• Vaginal vault. If you’ve had your uterus taken out (hysterectomy), your vagina may drop down toward its opening between your legs. That’s because the uterus provides support for the top of the vagina. If it’s removed during surgery, there’s nothing for the vagina to hold on to. In severe cases, your vagina could turn inside out and fall through the vaginal opening.

5- How Is Pelvic Organ Prolapse Treated?

What Are the Treatments for Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) happens when organs like the bladder, uterus or rectum drop down and press against the vagina. It can be shocking when this happens to you, but take heart: there are several ways to treat this condition -- both with and without surgery.

Nonsurgical Treatments

• Pessary. This is probably one of the first treatments your doctor will recommend if you have symptoms of POP. A pessary is a device (it looks like a ring) that’s inserted into your vagina. It helps to support, or hold up, your pelvic organs. You’ll need to be fitted for one in your doctor’s office. It’s a lot like being fitted for a diaphragm.
• Kegel exercises . These strengthen your pelvic muscles. They’re very easy to do. Imagine you have to pee, but instead of letting it out, you squeeze to hold it. Do this for 5 seconds, relax, then do it again. Do 10 sets of these up to 15 times per day. Over time, your prolapse may get better or disappear altogether.
• Biofeedback therapy. This treatment combines teaching you how to contract your pelvic muscles with proper breathing techniques and abdominal control.

Surgical Treatments

If your symptoms are severe and nonsurgical treatments haven’t helped, you may want to consider surgery. There are two types of prolapse surgery: obliterative and reconstructive.

Obliterative surgery narrows or closes off part or all of the vagina. The goal is to provide more support to the organs that have dropped out of their normal positions and are pressing against the walls of the vagina. This may be an option if surgery hasn’t worked and you can’t tolerate another procedure. After this operation you will no longer be able to have sex.

Reconstructive surgery aims to repair the pelvic floor and return organs to their original position. This can be done with cuts either in the vagina or the abdomen. It can also be done using laparoscopic surgery, in which a surgeon makes smaller cuts in the abdomen and uses special instruments.

There are a number of reconstructive surgeries your doctor can perform to restore the appearance and function of your pelvic organs. They include:

• Sacrospinous fixation and uterosacral ligament suspension. This procedure is designed to improve the support to the uterus or vaginal vault. Your own tissue (or vaginal mesh, discussed below) is used to fix or suspend the sagging pelvic organs. Your surgeon will make a cut in the vagina and use stitches to attach the vaginal vault to a ligament in the pelvis. The stitches may be permanent or dissolve over time.
• Anterior and posterior colporrhaphy. The goal here is to make the tissue that holds the pelvic organs in place tighter and stronger. Anterior repair is used when the bladder drops and presses against the front of the vagina. Posterior repair is used when the rectum drops and pushes into the back of the vagina. This procedure is also done through the vagina by using your own tissues or vaginal mesh to repair the prolapse.
• Sacrocolpopexy and sacrohysteropexy. These procedures use surgical mesh to fix and anchor organs that have dropped down. Sacrocolpopexy is used to repair prolapse of the vaginal vault. Sacrohysteropexy is used to fixed prolapse of the uterus. These operations are done with cuts in the abdomen. They can also be done laparoscopically.
• Vaginal mesh repairs prolapse by putting mesh under the vaginal skin to help lift sagging organs into place.

Does Surgery Really Work?

The success rate for sacrospinous fixation and uterosacral ligament suspension is 80% to 90%. Sacrocolpopexy and sacrohysteropexy have about the same success rate. Studies show vaginal mesh surgery works about 80% to 95% of the time. But even then, there’s a chance another part of the vagina may prolapse.

What Can I Expect After Surgery?

Recovery time depends on the type of surgery you have. In general, you should plan to take a few weeks off from work. You should also avoid sexand vigorous exercise or activity for at least 6 weeks. It typically takes longer to recover from abdominal surgery than it does from vaginal surgery.

With vaginal surgery, you may get a creamy white discharge for 4 to 6 weeks afterward. This is because of the stitches in the vagina.

What Are the Risks of Surgery?

You may have:

• Pain during sex
• Pelvic pain
• Trouble holding your pee (urinary incontinence)

Pelvic organ prolapse surgery also carries the same risks as most operations: infection, bleeding and blood clots. Your doctor could also injure nearby organs during the procedure.

With mesh placed in the vagina, there’s a risk of pain and infection, and also that the mesh will erode. In 2016, safety concerns prompted the FDA to classify vaginal mesh for pelvic organ prolapse as a “high-risk device.” You probably would only have this procedure if:

• You’ve tried other prolapse surgery without success.
• Your tissues are too weak to repair.
• You can’t have abdominal surgery.

6- Treating Pelvic Organ Prolapse at Home

What Can I Do to Take Care of My Pelvic Organ Prolapse?

If you have pelvic organ prolapse, you probably wonder what can be done to treat it. While medical procedures are available, there are things you can do on your own that may help you to feel better from day to day.

Pelvic Floor Muscle Exercises

Kegel exercises can help to strengthen your pelvic floor muscles. When you have pelvic organ prolapse, your pelvic organs -- your bladder, uterus, and rectum -- are weak. They can drop down toward your vagina. Kegels can help make those muscles stronger and keep your prolapse from getting worse.

To do a Kegel, go through the motions like you’re going to pee. Then, instead of letting it out, squeeze your muscles to stop the flow of urine midstream. Tighten those muscles for 5 seconds. Then release them for five seconds. Repeat this process five times. Work up being able to hold for 10 seconds and then release for 10 seconds. Try to do 20 repetitions at a time, and repeat three times per day.

At first, Kegels may feel a little strange. But as your pelvic muscles get stronger, you’ll find they’re easier to do.

Stay Regular

Constipation can cause pelvic organ prolapse. It’s also a symptom that happens because of it. Try to avoid constipation and the need to strain when you poop. Simple diet changes can help you stay regular:

• Drink lots of water throughout the day.
• Eat plenty of fruits and veggies.
• Eat high-fiber foods like beans and whole-grain cereal.
• If you’re constipated, avoid foods that are low in fiber -- cheese, ice cream, meat, and fast food.

Take a Load Off

If you have pelvic organ prolapse, avoid things that could make it worse. That means don’t lift, strain, or pull.

If possible, try not to be on your feet for long periods of time. Some women find that they feel more pressure when they stand a lot. If your symptoms become worse after a workout, try other activities that may be gentler on your body.

Don’t smoke. Smoking weakens the tissues around your pelvic muscles. It also makes you cough, which can make your symptoms worse. And if you’re overweight, try to lose a few pounds. Extra weight puts pressure on your pelvis.