“Doctor, I feel like there’s something…falling out, down there,” my patient admitted reluctantly. She’s not the first woman to feel embarrassed about having this problem. Pelvic organ prolapse (where the pelvic organs slip from their usual position) is a discomfiting condition that many women find difficult to talk about.
Pelvic organ prolapse isn’t that uncommon. Many women will find that their pelvic organs change as they get older, particularly if they have had children. They may begin to suffer from pelvic support problems, which causes them to feel as if “something is falling out” of their vaginas. In this article, I will talk about what causes the prolapse, what are the symptoms, and what can be done to fix the problem.
What are the pelvic organs?
The pelvic organs that require support are the urethra, bladder, small intestines, rectum, uterus and vagina. These pelvic organs stay in place because they are supported by layers of connecting tissue called endopelvic fascia, and thickened parts of the fascia called ligaments. They are also supported by a group of muscles around the openings of the urethra, vagina and rectum. When these supportive tissues and muscles become over-stretched, they can’t support the organs, which then drop down and bulge against the wall of the vagina.
Doctors believe that pregnancy and childbirth, especially multiple vaginal births, are among the main factors contributing to pelvic organ prolapse. However, this problem can also occur in women who have never had children, as there are other factors like age, obesity and certain chronic illnesses, which also play a role in pelvic support problems.
Falling down…
When the organs drop down, the feeling may be one of pressure, heaviness or something “falling out”. But that’s not all you will experience – you may also experience some discomfort, or problems with the functions of the organs. Depending on which organs are involved, you may also feel a pulling or aching sensation in the lower abdomen or pelvis. You may have chronic lower backache. You may also experience leakage of urine or problems having bowel movements.
If the prolapse is very severe, your pelvic organs may even bulge into the vagina and stick out of the vagina opening. There are four main types of pelvic support problems that can cause bulging:
- Cystocele (anterior vaginal wall prolapse)
A cystocele is when the bladder slips from its normal position into the vagina. Small cystoceles often do not cause any problems. If it is more serious, it may cause you to leak urine when you cough, sneeze, walk or lift objects.
- Vaginal vault prolapse
This condition is when the top of the vagina loses its support and drops into the vagina. This sometimes happens in women who have had a hysterectomy (surgery to remove the uterus). The top of the vagina may drop only partly into the vagina, or all the way through to the vaginal opening.
- Rectocele (posterior vaginal wall prolapse)
A rectocele is when the rectum bulges into the vagina, or through the vaginal opening. In some cases, if the rectocele is large, it may be difficult to have bowel movements.
- Uterine prolapse
Sometimes, the uterus can also drop down into the vagina, causing uterine prolapse. As alarming as it may sound, mild cases of uterine prolapse are actually quite common. In such cases, they may not cause any discomfort and do not require surgery.
If it is more severe, you may feel some pressure in your pelvis, or a pulling feeling in your vagina or lower back. You may even find that your cervix sticks out from your vagina. Needless to say, this can cause some discomfort (and cause problems with sexual intercourse), so you should seek help if it occurs. If you suffer from any of the symptoms described above, you should go to your gynaecologist or family physician for advice. The doctor will do a pelvic examination to look for signs of prolapse. He or she may also perform other tests, such as an ultrasound of your pelvis, to have a better look at the prolapse.
You need not be overly alarmed if you have any form of pelvic organ prolapse. There are ways to treat the condition, both surgical and non-surgical, so that you can have better quality of life again. In my next article, I will talk about these various treatment options.
The Star Newspaper, April, 2008
By Dr Nor Ashikin Mokhtar
