Pelvic Organ Prolapse
What is Pelvic Organ Prolapse?
As the name suggests, pelvic organ prolapse (POP) involves the prolapse (“protrusion”) of the organs in the pelvic cavity – bladder, urethra, uterus, small intestine, rectum and vaginal apex.
This pathology is defined by the dropping of the position of the organs, which occurs due to flaccidity and weakness of the ligaments, muscles, tendons, fascias and other pelvic structures.
POP is very frequent in women of all ages, though it increases with age, and is most common after menopause. Some studies identify mild and moderate prolapse rates of around 48% in women, with more serious cases affecting around 2% of women.
Pregnancy or various births
Classification of Pelvic Organ Prolapse
The Baden-Walker system has been used to describe POP and assess its severity for many years.
The lowest position of the pelvic organs when making abdominal exertions or in orthostasis (standing) was used for classification:
- Stage 0 – Normal;
- Stage 1 – Prolapse half way down the vagina;
- Stage 2 – Prolapse at the level of the hymen;
- Stage 3 – Prolapse below the level of the hymen;
- Stage 4 – Total prolapse.
Though very popular and easy to use, this classification is gradually being replaced by the POP-Q (Q for “quantification”) system. This is more complex, precise and detailed in describing prolapses.
Some symptoms are identified in the diagnosis and worsen over time. The main ones are:
- Vaginal mass palpation;
- Symptoms related to the volume occupied by the prolapse (with the sensation of pressure or weight on the pelvic or vaginal region);
- Urinary symptoms;
- Intestinal symptoms;
- Sexual dysfunction (dyspareunia – pain during sex, less lubrication);
● Complaints about pain (vaginal, vesical, rectal or lower back).
Diagnosis of Pelvic Organ Prolapse
POP involves multiple anatomical and functional systems and is associated with genitourinary, gastrointestinal and muscular-skeletal symptoms.
Initial assessment must necessarily include symptoms characterisation and the consequent change in daily habits that affects it.
A careful gynaecological examination must be performed.
Various test can be done to understand the nature of the pathology:
Do you have any of these POP symptoms?
Treatment of POP
In women who are asymptomatic or have few symptoms, a conservative treatment may be suitable.
When the prolapse is significant or the symptoms are very uncomfortable, some type of therapy, whether surgery or not, must be used.
The choice of treatment depends on:
- The type and intensity of symptoms;
- Expectations with regard to sex;
- Presence of risk factors for recurrence.
Preventive Measures during Treatment
Measures advised for patients are:
- Healthy diet
- Weight control
- Avoidance of smoking
- Reduction in vigorous exertion
- Low trauma childbirth
- Prevention of constipation
- Use of hormone therapy after pelvic surgery
Types of treatment for POP
Treatment may or may not involve surgery.
The main non-surgical treatments are:
- Pessaries (medical devices that provide structural support to the pelvic structures and organs);
- Exercises to strengthen the pelvic floor (Kegel exercises);
- Pelvic rehabilitation (through electrostimulation and biofeedback techniques).
The main surgical treatments are:
- Obliterative (involving the closing of the vagina);
- Reconstructive (to try and re-establish the pelvic anatomy) – obviously the most common.
Surgery may involve the different vaginal “compartments”:
- Anterior compartment (when it involves the anterior vaginal wall, usually due to prolapse of the bladder);
- Middle compartment (when a prolapse of the uterus or vaginal apex occurs, in this case with intestinal herniation;
- Posterior compartment (associated with a prolapse of the rectum).
During corrective surgery, the uterus may be removed (hysterectomy) and prostheses applied to avoid recurrence.
POP is a health problem that has a huge impact on patients’ quality of life.
Greater knowledge of the risk factors and evolution, such as events related to pregnancy or birth, will help to increase the chances and efficacy of preventing POP in the future.
Effective treatment must tackle the symptoms and their correlation with the anatomical changes presented.
Dr. José Santos Dias
Clinical Director of the Instituto da Próstata
- Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
- Specialist in Urology
- Fellow of the European Board of Urology
- Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"
FAQs about POP
What is pelvic organ prolapse (POP)?
What causes POP?
What are the main symptoms?
What types of treatment exist?
- DIAS, José Santos. Urologia Fundamental: na prática clínica. Lisboa: Lidel - Edições Técnicas, Lda, 2010.
- Prolapso dos Órgãos Pélvicos - http://apnug.pt/docs/docs/prolapso_dos_orgaos_pelvicos.pdf
- Pelvic organ prolapse - https://www.womenshealth.gov/a-z-topics/pelvic-organ-prolapse
- Pelvic Organ Prolapse - https://www.webmd.com/urinary-incontinence-oab/pelvic-organ-prolapse
- Pelvic organ prolapse - https://www.nhs.uk/conditions/pelvic-organ-prolapse/