Preventing and Managing a Prolapse

June 16, 2016

What is Pelvic Organ Prolapse?

Pelvic organ prolapse can occur when one or more of the pelvic organs (bladder, uterus, vagina, and rectum) fall and protrude out through the opening of the vagina. A prolapse can occur when the pelvic floor muscles weaken or become damaged and are not able to support the pelvic organs. It is not considered life-threatening but it can be uncomfortable and stressful.

Types of Pelvic Prolapse

There are different types of prolapse that can occur in a woman's pelvic area and these are divided into three categories according to the part of the vagina they affect and it is not uncommon to have more than one type of prolapse. These are: front wall, back wall or top of the vagina.

Uterine Prolapse or Fallen Uterus – This occurs when the womb falls down into the vagina. It is the second most common type of prolapse and is categorized into three evaluations depending on how far the womb has fallen. This condition may also cause discomfort and you could experience difficulty having bowel movements.
Vaginal Prolapse - Even if women have had a hysterectomy it is still possible for the vagina itself to fall down although the uterus is no longer present. Enterocele (Bulging of small bowels) –
Enterocele - An entrocele occurs when a space between the vagina and rectum opens and small bowel bulges through
Rectocele - If the rectum falls it is called a rectocele. This condition may also cause discomfort and you could experience difficulty having bowel movements.
Cystocele or Fallen Bladder – This type of prolapse occurs when the bladder falls down into the vagina. When the bladder prolapses, it falls towards the vagina and creates a bulge in the front vaginal wall which may be uncomfortable and you could have difficulty in emptying your bladder.

Causes of Prolapse

Menopause - During menopause decreased estrogen may also contribute to an pelvic organ prolapse. During menopause, estrogen levels, collagen and certain connective tissue proteins decline.
Childbirth - During vaginal delivery a woman's muscles have to expand in order for the baby to move through the vagina. A vaginal delivery may cause a muscle to break as the baby's head comes through the pelvic floor. When this occurs the muscle does not contract as it should. In most women the damage is often minor, but in others enough muscle may be lost to the point that it can no longer hold the pelvic organs in place.

Obesity - Women who are overweight often have a higher rate of pelvic organ prolapse as weight contributes to an increased pressure in the abdomen.
Chronic Coughing – Women who have a chronic cough caused by smoking, asthma or bronchitis put increased pressure on the abdomen and pelvis floor muscles. Smoking alone reduces collagen and can increase the chances of a connective tissue tear.
Past Surgery of the Pelvic Floor - Surgery may cause damage to the support structureof the pelvic organs.
Neurological - Diseases affecting the nervous system such as Parkinson’s, multiple sclerosis etc may also increase the chances of developing pelvic organ prolapse.

Stages of Pelvic Organ Prolapse

Stage 1 – a very minor prolapse. The pelvic organs are still very well-supported by the ligaments in the pelvis
Stage 2 - the pelvic organs are not as well supported by the muscles and have begun to drop downwards. At this stage the organs are still inside the vagina.
Stage 3 - the pelvic organs are beginning to protrude towards or just below the opening of the vagina.
Stage 4 - the pelvic organs will now be completely outside of the vaginal opening.

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