Insights from Health Talk FM.102's Happy&Healthy Program: Understanding Pelvic Organ Prolapse

Insights from Health Talk FM.102's Happy&Healthy Program: Understanding Pelvic Organ Prolapse

Prolapsed pelvic organs

The pelvic floor is a cup-shaped area in the body, surrounded by robust pelvic bones, muscles, and connective tissue. It houses the pelvic organs, including the urinary bladder, uterus, vagina, and rectum in women. These organs can become displaced or "slack" due to the deterioration or injury of the connective tissues that support them. Factors like age, heredity, pregnancy, childbirth (especially multiple or assisted deliveries), obesity, and conditions that increase abdominal pressure (such as coughing, sneezing, and chronic constipation) can contribute to the weakening of these tissues.

Pelvic organ prolapse most commonly affects the female reproductive organs, namely the uterus and vagina, due to structural differences between men and women. Pelvic prolapse refers to the protrusion of pelvic organs into the vagina, such as the descent of the uterus or the anterior/posterior vaginal wall. The severity of this condition can be classified using the POP-Q system, which distinguishes between four grades. Grades 1-2 indicate mild prolapse, where the organs are still mostly contained within the vagina and may not cause noticeable symptoms. In more severe cases (grades 3-4), a visible lump may protrude from the vaginal opening, potentially accompanied by symptoms like abnormal vaginal bleeding, urinary retention, kidney issues, and abnormal bowel movements. In addition to the female reproductive organs, pelvic organ prolapse can also affect the rectum (the last part of the colon) in both men and women, although it is less commonly discussed. Treatment for rectal prolapse requires the expertise of a colorectal surgeon and differs from the management of prolapse involving the female reproductive organs.

The treatment approach for pelvic organ prolapse in women depends on the severity of the condition and the presence of symptoms. Here are several treatment options:

1. Risk factor management: It is crucial to avoid or address risk factors that contribute to pelvic organ prolapse, such as weight loss in overweight individuals, avoiding heavy lifting, managing chronic coughing and sneezing, and addressing constipation. These measures help reduce abdominal pressure, an important factor in the effectiveness of treatment.

2. Pelvic floor muscle training: For patients in the early stages of prolapse, pelvic floor muscle training is the primary treatment. This approach aims to strengthen the muscles supporting the pelvic organs, potentially reducing vulvar size. Similar to training other muscles, regular and disciplined practice is essential. It is recommended to practice at least 3-4 days a week, with approximately 30-40 repetitions per day. However, for patients with advanced pelvic organ prolapse, pelvic floor muscle training alone may not provide significant benefits or resolve all symptoms.

3. Pessary use: A pessary is a device inserted into the vagina to support specific parts and prevent their movement, alleviating symptoms. It is a convenient, non-surgical option that can be fitted to each patient's individual needs. Pessaries offer immediate symptom relief without the need for hospital visits or surgical wounds. However, it is important to note that wearing a pessary does not correct the underlying anatomical issue. Continuous use is necessary to prevent symptoms.

4. Corrective surgery: Surgical intervention may be considered for pelvic organ prolapse. Procedures aim to restore the vaginal area close to its original position or close the vagina entirely. It is a misconception that both the uterus and vagina can be completely removed in most cases of advanced pelvic organ prolapse. Only the uterus can be removed, as the vagina remains essential for its connections to the bladder and rectum. It also acts as a protective barrier between internal organs and external elements like air.

The main cause of prolapsed pelvic organs is the deterioration of the connective tissue structure. Therefore, the primary method of prevention is to minimize risk factors. This includes maintaining a healthy weight, addressing chronic cough and chronic constipation. Pelvic floor muscle training can be initiated from a normal age of maturity. Additionally, for women who do not experience symptoms, it is advised to undergo annual health check-ups that include internal examinations, cervical cancer screenings, and ultrasounds. If any symptoms arise, such as changes in urinary patterns or stool, it is important to seek immediate medical attention for proper treatment or further investigation into the underlying cause.

Dr. Parit Vajasitthisilp, Obstetrician and Gynecologist, Specialist in Medicine