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Pelvic organ prolapse: Causes, Types, Symptoms, Diagnosis and Treatment

 What Is a Pelvic Floor Disorder?

The pelvic floor is a group of muscles that support your pelvic organs. Normally these muscles and the tissues surrounding them keep your bladder, uterus, vagina, small intestine, and rectum in place.

Some women develop problems with these muscles and tissues after childbirth or as they get older. Pelvic floor disorders, such as prolapse, are more common in women after childbirth.

If pelvic floor disorders develop, one or more of the pelvic organs may stop working properly. Conditions that can be associated with pelvic floor disorders include:

  • Pelvic organ prolapse

  • Urinary incontinence

  • Anal incontinence


Prolapse refers to a descending or drooping of organs. Pelvic organ prolapse refers to the drooping of any of the pelvic floor organs, such as the:

  • Bladder

  • Uterus

  • Vagina

  • Small bowel

  • Rectum

These organs may prolapse if they descend into or exit the vagina or anus. You may hear them referred to in these ways:

  • Prolapse of the bladder: This is the most common condition.

  • Urethroplasty: A surgery to fix a prolapse of the urethra.

  • Uterine prolapse

  • Vaginal vault prolapse: The collapse of the vagina.

  • Enterocele: Small bowel prolapse

  • Rectocele: Rectum prolapse


What Is a Pelvic Floor Disorder?



Explanation of medical terms and concepts Pelvic organ prolapse

When the muscles and ligaments supporting a woman's girdle organs weaken, the girdle organs will drop lower within the pelvis, making a bulge within the channel (prolapse). girls most ordinarily develop girdle organ prolapse years once parturition, once a cutting out or once biological time. If you have got symptoms, like a sense of pressure in your girdle space, see your health care supplier.

Pelvic organ prolapse occurs when one or more of the pelvic organs (bladder uterus and/or rectum) "fall" from their normal position into the vaginal canal The most common area for this to happen is the top of the vagina where the bladder sits But it can also occur farther down at the level of the cervix which connects with the womb (uterus) The female urethra comes out from each side of your bladder through a tube called a ureter Thus any falling down of these structures past your vaginal opening can affect your urethra and interrupt your ability to have an un

symptoms Pelvic organ prolapse symptoms vary among women but most develop a bulge protruding from the vaginal walls and into the vagina Pelvic organ prolapse is more common in women who have had several pregnancies or weighed significantly more than they do now Other risk factors include diabetes thyroid disease and multiple sclerosis Symptoms include feelings of pressure "something coming out of me," difficulty with urination and sexual intercourse burning sensations urinary incontinence and vaginal opening discomfort Surgery for pelvic organ prolapse removes excess tissue supporting the pelvic organs that are causing the problem so that gravity does not drag them down further and trap them.

What Causes Pelvic Organ Prolapse?

Anything that puts pressure on the abdomen (such as childbirth, a heavy meal, or straining during a bowel movement) can cause pelvic organ prolapse. Some common causes include:

  • Pregnancy and childbirth are the most common causes of labor.

  • Obesity

  • Chronic coughing can lead to respiratory problems.

  • Constipation

  • Pelvic organ cancers

  • A hysterectomy is a surgery that removes the uterus.

Genetics may play a role in pelvic organ prolapse. Some women may have weaker connective tissues, placing them at risk.

What are the symptoms of pelvic organ prolapse?

Some women do not experience any symptoms, while others report experiencing symptoms such as pelvic organ prolapse.

  • There may be a feeling of pressure or fullness in the pelvic area.

  • A backache low in the back

  • Painful intercourse

  • A feeling that something is coming out of the vagina.

  • Urinary problems can include leaking of urine or a chronic urge to urinate.

  • Not having a bowel movement is called constipation.

  • Spotting or bleeding from the vagina

The symptoms that a person experiences depend somewhat on which organ is drooping. If the bladder falls out, they may leak urine. If the rectum falls out, they may have constipation and trouble having intercourse. A backache and trouble having intercourse often accompany small intestine prolapse. Uterine prolapse also occurs. Having backache and difficulty during intercourse can both occur together.

Most symptoms usually begin mild in the morning but become more severe as the day goes on.

How Is Pelvic Organ Prolapse Diagnosed?

If you think you may have pelvic organ prolapse, talk to your doctor. They will ask about your medical history and examine your pelvic organs to see if there is a problem. If there is a problem, they may just need to see how strong your pelvic floor muscles are.

During a routine pelvic exam, your doctor may find pelvic organ prolapse. This is an abnormal condition in which the organs of the pelvis (such as the bladder and uterus) protrude from the opening at the bottom of the vagina.

Your doctor may order a variety of tests if they think you may have pelvic organ prolapse. They might also want to find out if more than one organ has shifted out of place, how severe the prolapse is, and whether you have any other related conditions. The tests might include: -A health check to determine if you have any health problems that could be causing the prolapse -Tests to see if more than one organ has moved out of place -Check

  • To test your bladder's function, doctors may perform tests that measure how well your bladder and surrounding structures work.

  • A urinary tract X-ray (intravenous pyelography) lets your doctor view your kidneys and bladder. This test can also show how well the kidneys are working.

  • A voiding cystourethrogram involves x-rays of your bladder before and after you go to the bathroom. This will help determine if there is something wrong with your urinary tract.

  • A CT scan of the pelvis can help your doctor rule out other health conditions.

  • An ultrasound of the pelvis will create an image of your pelvic organs so your doctor can determine if one or more organs have shifted out of their normal placement.

  • A MRI scan of the pelvis creates a three-dimensional image of pelvic organs and muscles. This can help your doctor confirm pelvic organ prolapse.

How Is Pelvic Organ Prolapse Treated?

Pelvic organ prolapse (POP) can be treated in a variety of ways, depending on how severe the symptoms are. Some treatments include:

  • Behavioral treatments such as physical therapy to strengthen your core and pelvic floor muscles can help improve your behavior.

  • Some women use a small plastic device called a pessary to help support their drooping organs.

  • Surgical intervention to repair or remove damaged tissue or an organ.

Can Pelvic Organ Prolapse Be Prevented?

Some risk factors for pelvic organ prolapse are out of your control. These include: -Age (older people are more likely to have prolapse) -Gender (women are more likely to have prolapse than men) -Weight (overweight people are more likely to have prolapse)

  • Family history

  • Advancing age

  • A difficult vaginal delivery

  • Having had a hysterectomy

Here are some ways to reduce the possibility of problems:

  • Kegel exercises are important to maintain good muscle strength in your pelvic area.

  • Maintain a healthy weight

  • Avoid constipation

  • Don't smoke - smoking can harm tissues and cause chronic coughing. This increases the risk of developing problems.

  • Don't use your back or abs when lifting; use your legs instead.

Treatment for pelvic organ prolapse

If you are not having any symptoms, or the prolapse is delicate and not bothering you, you will not want medical treatment.

But creating some life-style changes can in all probability still facilitate.

These include:

  • losing weight if you're overweight

  • avoiding heavy lifting

  • preventing or treating constipation

If the prolapse is additional severe or your symptoms are moving your everyday life, there are many additional treatment choices to contemplate.

These include:

  • pelvic floor exercises

  • hormone treatment

  • vaginal pessaries

  • surgery

The suggested treatment can depend upon the sort and severity of the prolapse, your symptoms and your overall health.

You and your doctor can decide along what is the best choice for you.

There are several treatment options available for pelvic organ prolapse.

The most suitable for you will depend on:

  • the severity of your symptoms

  • the severity of the prolapse

  • your age and health

  • whether you're planning to have children in the future

You may not want any treatment if the prolapse is gentle to moderate and not inflicting any pain or discomfort.

Treatment choices include:

  • lifestyle changes

  • pelvic floor exercises

  • hormone treatment

  • vaginal pessaries

  • surgery

Your doctor should offer you the full range of treatments and explain the possible benefits and risks of each option. This will help you choose the right one for you.

Lifestyle changes

If you are not having any symptoms or the prolapse is gentle, creating some fashion changes could facilitate and will stop the prolapse from getting worse.

They can conjointly facilitate cut back your risk of obtaining a prolapse within the initial place.

They include:

  • losing weight if you're overweight

  • eating a high-fiber diet to avoid constipation

  • avoiding lifting heavy objects

Pelvic floor exercises

Doing girdle floor exercises can strengthen your girdle floor muscles and should well relieve your symptoms.

A MD or specialist could suggest a programme of supervised girdle floor muscle coaching for a minimum of sixteen weeks before you progress on to alternative treatments or surgery.

You'll be shown a way to do the exercises. If they assist, you'll be asked to continue with them.

Find out additional concerning girdle floor exercises

Hormone (estrogen) treatment

If you've got a gentle prolapse and are through the biological time, your doctor could advocate treatment with estrogen to ease a number of your symptoms, like epithelial duct waterlessness or discomfort throughout sex.

Estrogen is obtainable as:

  • a cream you apply to your vagina

  • a tablet you insert into your vagina

  • an estrogen-releasing vaginal ring

Vaginal pessaries

A device manufactured from rubber (latex) or polymer is inserted into the channel and left in situ to support the duct walls and girdle organs.

Vaginal pessaries enable you to induce pregnancy within the future. they will be accustomed to ease the symptoms of moderate or severe prolapses and area unit an honest possibility if you can't or would like to not have surgery.

Vaginal pessaries are available in completely different shapes and sizes betting on your wants. The foremost common is termed a hoop contraceptive device.

You may have to be compelled to strive for different types and sizes to search out the one that works best for you.

A medical specialist or a specialist nurse sometimes fits a contraceptive device. It must be removed, clean and replaced often.

Side effects of vaginal pessaries

Vaginal pessaries can occasionally cause:

  • unpleasant smelling vaginal discharge, which could be a sign of a bacterial infection in the vagina (bacterial vaginosis)

  • some irritation and sores inside your vagina, and possibly bleeding

  • stress incontinence, where you pass a small amount of urine when you cough, sneeze or exercise

  • a urinary tract infection

  • interference with sex (but most women can have sex without any problems)

These side effects can usually be treated.

Surgery

If non-surgical choices haven't worked or the prolapse is additional severe, surgery could also be an associate degree choice.

There are many totally different surgical treatments for girdle organ prolapse.

They include:

  • surgical repair

  • vaginal mesh surgery

  • hysterectomy

  • closing the vagina

Your doctor will discuss the benefits and risks of different treatments, and you'll decide together which is best for you.

Surgical repair

There are many different kinds of surgery that involve lifting and supporting the girdle organs.

This could be by handicraft them into place or supporting the prevailing tissues to create them stronger.

Surgical repairs are sometimes done by creating cuts within the wall of the epithelial duct beneath anesthetic.

This means you will be asleep throughout the operation and can not feel any pain.

You may want half a dozen to twelve weeks off work to recover, betting on the sort of surgery you have got.

Vaginal mesh surgery

Information:

At the moment, it isn't doable to possess duct mesh surgery for girdle organ prolapse on the NHS unless there is not any difference and therefore the procedure can't be delayed, and when elaborated discussion between you and a doctor.

Vaginal mesh surgery is wherever a bit of artificial mesh, a plastic product that appears sort of a web, is inserted to carry the girdle organs in situ.

The mesh stays in your body for good.

You'll be asleep throughout the operation and you'll typically ought to keep in hospital for one to three days later on.

A few ladies have had serious complications when mesh surgery. Some, however not all, of those complications can even happen when alternative styles of surgery.

The complications include:

  • long-lasting pain

  • permanent nerve damage

  • incontinence

  • constipation

  • sexual problems

  • mesh exposure through vaginal tissues and occasionally injury to nearby organs, such as the bladder or bowel

If you're concerned about vaginal mesh

If you've got antecedently had duct mesh inserted and suppose you are having complications, speak to a MD or your sawbones.

If you are not having any complications, there isn't any ought to do something.

Many women have had these forms of surgery while not developing any issues later on.

You can report a haul with a medication or medical device on GOV.UK

Find out additional concerning the foundations for the employment of duct mesh on GOV.UK

You can conjointly {read concerning|examine} the Mesh unit discovered by NHS England to deal with safety considerations about the employment of duct mesh

Hysterectomy

For women with a prolapsed uterus UN agency are through the change of life or don't want to own any further youngsters, a doctor could suggest surgery to get rid of the uterus (hysterectomy).

It will facilitate pressure on the walls of the duct and cut back the possibility of a prolapse returning.

You cannot get pregnant when having a ablation, and typically it's going to cause you to travel through the change of life early.

You may like six to twelve weeks off work to recover.

Closing the vagina

Occasionally, an operation that closes part or all of the vagina may be an option.

This treatment is only offered to women who have advanced prolapse, when other treatments have not worked and they're sure they do not want to have sex again in the future.

This operation can be a good option for frail women who would not be able to have more complex surgery.

Side effects of surgery

Our doctor ought to have AN in-depth discussion with you regarding the risks and edges of the four differing kinds of surgery, together with mesh surgery, before you choose whether or not one in every of them can be AN choice.

Doctors should additionally keep elaborate records regarding the sort of surgery they are doing, together with any complications you get once you have had your surgery.

You should learn a duplicate of this record.

Possible aspect effects of all four styles of surgery, together with mesh surgery, include:

  • risks associated with anesthesia

  • bleeding, which may require a blood transfusion

  • damage to the surrounding organs, such as your bladder or bowel

  • an infection – you may be given antibiotics to take during and after surgery to reduce the risk

  • changes to your sex life, such as discomfort during intercourse – but this should improve over time

  • vaginal discharge and bleeding

  • experiencing more prolapse symptoms, which may require further surgery

  • a blood clot (DVT) forming in 1 of your veins, such as in your leg – you may be given medicine to help reduce this risk after surgery

If you have any of the following symptoms after your surgery, let your surgeon or a GP know as soon as possible:

  • a high temperature

  • severe pain low in your tummy

  • heavy vaginal bleeding

  • a stinging or burning sensation when you pee

  • abnormal vaginal discharge – this may be an infection

You should be offered a check-up 6 months after surgery that includes a vaginal examination.

More information to help you choose which type of prolapse surgery

There are several useful guides that you can read to help you decide, together with your doctor, which type of surgery would be right for you:

  • NICE guidance: management of urinary incontinence and pelvic organ prolapse in women – patient decision aids and user guides

  • NHS guide to surgical treatments for pelvic organ prolapse

Recovering from surgery

You'll probably ought to keep in hospital nightlong or for a number of days following prolapse surgery.

You may have a drip in your arm to supply fluids, and a skinny plastic tube (urinary catheter) to empty pee from your bladder.

Some gauze could also be placed within your epithelial duct to act as a bandage for the primary twenty four hours, which can be slightly uncomfortable.

General summary

Pelvic organ prolapse occurs when the muscles ligaments or tissues that hold the pelvic organs in place are damaged allowing them to slip or "drop" into the vagina It is a progressive condition that may worsen over time without treatment Surgery is often recommended for women with mild to moderate prolapse who want to prevent further damage or avoid future complications

How do you get rid of pelvic prolapse?

How do you get rid of pelvic prolapse? While the answer to this question isn't simple the good news is that there are many treatment options available In fact more than one treatment may be necessary for a patient with pelvic prolapse These treatments can include vaginal pessaries reconstructive surgery and surgical repositioning of connective tissues in the pelvis

Can a prolapse be fixed without surgery?

Prolapse refers to a condition in which structures that normally remain inside the body move out of place affecting the organs and tissues around them As women age their pelvic floor weakens which makes it more likely for these internal structures to begin slipping or falling out of place In many cases minor prolapses can be treated without surgery through physical therapy or by using Kegel exercises to strengthen the muscles responsible for holding up these organs Surgery is generally necessary when a person's prolapse has developed so severely that medical treatment isn't enough to correct it

Can pelvic organ prolapse correct itself?

Yes pelvic organ prolapse can correct itself over time The uterus and bladder are actually suspended by ligaments rather than being held in place by muscles so that when those ligaments stretch due to pregnancy or age the organs drop into the vaginal canal Some women's bodies respond to this change by strengthening the supporting ligaments which can ultimately help hold the organs in place For some women however hormone replacement therapy may be necessary to help support pelvic organs and keep them from slipping out of place In general though most women who have had a prolapse go on to experience less severe symptoms over time if they maintain good

Can I push my prolapse back up?

If you want to try pushing your prolapse back up do Kegels Kegel exercises strengthen the muscles that support the uterus bladder and bowel as well as the surrounding ligaments

Can you push a prolapse back into place?

After childbirth it may be necessary to push a prolapse back into place A woman's pelvic floor muscles have weakened and the connective tissue that holds the uterus in place has stretched causing a bulge or her uterus and sometimes other organs like the bladder to come out of place To prevent infection doctors recommend repositioning a prolapsed organ instead of waiting for symptoms to appear

How come when I poop a lump comes out?

In this case the lump may be just a little piece of tough stool The cause of your problem is probably related to diet which means that you need a change in your diet Increase the intake of fresh fruit and vegetables especially prunes and plums

Does walking make the prolapse worse?

You can certainly harm your prolapsed organ by jumping running or doing abdominal exercises Jogging and performing sit-ups dig into neighboring organs so stay away from them But if you walk at a slow pace for about 30 minutes every day it should not be harmful Try to go on foot whenever possible because even walking for five minutes or so twice in a day has proven beneficial in reducing the risk of many diseases You can keep an eye out for any discomfort while walking too If there is any pain during exercise stop immediately

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Pelvic organ prolapse: Causes, Types, Symptoms, Diagnosis and Treatment

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