Pelvic Organ Prolapse

Pelvic Organ Prolapse (POP) is the Phenomenon of loss of support of the pelvic organs (uterus, vagina, bladder and rectum) with subsequent Bulging out of the organs.

Causes

The following factors may predispose women to pelvic organ prolapse:

• Pregnancy & childbirth: e.g. multiparity, difficult labor and traumatic delivery
• Aging: pelvic muscles weakness, decrease in elasticity of ligaments
• Menopause: weakening and loss of tissue tone due to hormone deficiency
• Chronic increase in intra-abdominal pressure: e.g. obesity, repetitive heavy lifting, chronic cough and chronic constipation, etc
• History of pelvic surgery: e.g. Hysterectomy with poor support from the vaginal vault, Cystectomy

Symptoms

Depends on the site and severity of prolapse，Common symptoms include:

• A bulge felt over introitus and the feeling of heaviness
• Low back pain
• Coital difficulty
• Urinary problems, e.g. incontinence, urinary retention or infection
• Defecation difficulty

Types

• Anterior compartment prolapse = cystocele
• Posterior compartment prolapse = rectocele / enterocele
• Middle compartment prolapse = uterus / vault prolapse (no uterus)

Investigation

• Vaginal Examination
  Further investigations e.g. Ultrasound, MRI, Urodynamic Study or Cervical Screening may be needed for diagnosis.

Treatment

Non-surgical:

• Pelvic floor exercise
  To Strengthen the pelvic floor muscle

• Ring pessary
  • Suitable for patients who have early stage prolapse, those who plan for future pregnancy and those who are medically unfit for surgery.
  • Provide temporary relief
  • Need to replace the pessary every 3-6 months
  • Prolonged use may lead to ulceration and coital problem

Surgical:

• Vaginal Hysterectomy
• Pelvic Floor Repair
• Sacrospinous ligament Fixation
• Vaginal Mesh Suspension
• Manchester operation