Pelvic organ prolapse (POP) may not be a topic that comes up in everyday conversation, but trust us, it is more common than you think. If you are unfamiliar with this condition, you are not alone. In fact, many women suffer from it without realizing what is going on. POP happens when one or more of the pelvic organs slip out of their normal position and bulge into the vaginal canal. And while it can sound a bit alarming, there are plenty of treatments available to manage it—everything from simple exercises to surgery. Read more to explore what pelvic organ prolapse is, why it happens, and how you can treat or prevent it with the help of a urogynae in Singapore.
What is pelvic organ prolapse?
Pelvic organ prolapse is essentially when your pelvic organs—like the bladder, uterus, rectum, and even the small intestine—move from their usual spot and begin to sag or bulge into the vaginal canal. Imagine a pillowcase that is holding too much stuffing. If the pillowcase (the pelvic floor muscles and tissues) cannot hold everything in place, the organs shift and fall. This can happen gradually over time, or it may occur suddenly after childbirth or other strain on the pelvic area.
There are four main types of prolapse, each involving a different organ:
- Cystocele – This is when the bladder drops and pushes against the front wall of the vagina. It can cause symptoms like urinary incontinence (leakage) or the frequent need to urinate.
- Rectocele – In this case, the rectum drops into the vaginal wall, which can lead to constipation or difficulty having a bowel movement.
- Uterine prolapse – This happens when the uterus slips down into the vaginal canal. It is more common in women who have had multiple vaginal births or are post-menopausal.
- Enterocele – This is a prolapse of the small intestine that pushes into the vaginal wall. It is less common but can cause a heavy sensation in the pelvic area.
No matter the type, prolapse can be a bit uncomfortable and frustrating, but it is also treatable. So, if you are dealing with symptoms like a feeling of heaviness or bulging, you are not alone—and it is worth seeking help to understand your options.
What causes pelvic organ prolapse?
The key culprit in pelvic organ prolapse is weakened pelvic floor muscles. These muscles act like a hammock to support your pelvic organs, and when they weaken, it can cause the organs to sag. But what leads to this weakening? There are a few factors that can play a role:
Childbirth
Childbirth, especially vaginal deliveries, is one of the most common causes of pelvic organ prolapse. The pressure and stretching during labor can weaken the pelvic floor muscles. The more babies you have had, the higher the risk. And if you had a particularly large baby, or a long or difficult labor, you might be more prone to prolapse.
Age
As we get older, our bodies naturally lose some muscle tone and elasticity. This includes the pelvic floor. Hormonal changes, particularly after menopause, can make these muscles even more prone to weakness.
Obesity
Extra weight puts additional pressure on your pelvic muscles. If you are carrying extra weight, especially around the belly, it can cause the pelvic floor to stretch and weaken, increasing your risk of prolapse.
Chronic strain
Straining over time, from chronic constipation or a chronic cough, puts constant pressure on the pelvic area. If you are frequently lifting heavy objects, especially without proper form, this can also contribute to pelvic organ prolapse.
Genetics
Some women are just more predisposed to weak pelvic floor muscles due to their genetic makeup. If your mother or grandmother had pelvic organ prolapse, there is a higher chance that you could experience it too.
Hysterectomy
A hysterectomy, or removal of the uterus, can increase the risk of vaginal vault prolapse — when the top of the vagina drops due to the lack of support from the uterus. This type of prolapse is especially common in women who have had their uterus removed.
How do you know if you have pelvic organ prolapse?
The symptoms of pelvic organ prolapse can vary widely depending on the type and severity. But in general, women with POP often experience:
- A sensation of heaviness or pressure: If you are feeling like something is “falling out” of your vagina, that could be a sign of prolapse. Some women describe it as feeling like they have a heavy weight or bulge in their pelvic region.
- Visible bulge or protrusion: In more severe cases, you may notice a bulge at the vaginal opening, which might be more noticeable when you stand or strain. This is usually the case in cystocele (bladder prolapse) and rectocele (rectal prolapse).
- Urinary problems: If your bladder is prolapsed, you might experience frequent urinary urges, urinary leakage (incontinence), or difficulty emptying your bladder completely. You might also leak urine when you cough, sneeze, or laugh.
- Bowel issues: With a rectocele, you might have trouble having a bowel movement, or you may feel like your bowel is not fully emptying. Some women also experience constipation or a feeling of pressure in the rectal area.
- Sexual discomfort: Prolapse can, sometimes, make sex uncomfortable. You may feel pressure, a sensation of looseness, or pain during intercourse, particularly with uterine prolapse.
- Back or pelvic pain: Persistent pelvic or lower back pain is common in women with prolapse, especially if the prolapse has been left untreated for a long time.
Diagnosing pelvic organ prolapse
If you think you exhibit symptoms of pelvic organ prolapse, it is important to see a doctor for a proper diagnosis. A urogynae in Singapore will usually perform a pelvic exam to assess the severity of the prolapse. They may also ask you to bear down (similar to how you would push during childbirth) to see how the pelvic organs shift.
In some cases, imaging tests like ultrasound or MRI may be used to assess the degree of prolapse. For bladder-related prolapse, a cystoscopy might be done to check for damage to the bladder, while urodynamics testing could be used to test bladder function.
Treatment options for pelvic organ prolapse
There are various options available to treat pelvic organ prolapse. The best choice will be based on the status of your condition, your age, overall health, and whether you have already had children.
If your prolapse is mild to moderate, there are several non-invasive treatments you can try:
- Pelvic floor exercises (Kegels): These exercises help strengthen the muscles that support your pelvic organs. Regular Kegel exercises can make a huge difference in reducing symptoms and preventing further prolapse.
- Pessaries: A pessary is a small, removable device inserted into the vagina to support the prolapsed organs and hold them in place. It is a good option for women who are not ready for surgery or for those who have mild prolapse.
- Lifestyle changes: Maintaining a healthy weight, managing constipation, and avoiding heavy lifting can all help reduce the pressure on your pelvic floor. You may also benefit from working on posture and strengthening your core muscles.
- Estrogen therapy: For post-menopausal women, estrogen creams or hormone therapy can help improve the strength and elasticity of pelvic tissues, potentially reducing the severity of prolapse.
If conservative treatments do not help or if the prolapse is severe, surgery might be necessary. The type of surgery depends on which organs are affected:
- Anterior and posterior repair: This surgery repairs prolapses in the bladder (cystocele) or rectum (rectocele) by tightening the vaginal walls.
- Hysterectomy: For uterine prolapse, a hysterectomy may be performed to remove the uterus. After this surgery, the vagina may be reconstructed to help support the pelvic organs.
- Sacral colpopexy: This is a type of surgery used to treat vaginal vault prolapse, where the vaginal walls are supported with a mesh or synthetic material.
- Minimally invasive surgery: Laparoscopic and robotic-assisted surgeries are newer methods that use small incisions to repair prolapse, which means faster recovery and less scarring.
Aster Gynaecology – Dr. Ng Kai Lyn
Address: 38 Irrawaddy Road, #06-58
Mount Elizabeth Novena Specialist Centre, Singapore
Contact: +65 6635 2100
Website: www.drngkailyn.com
