Pelvic organ prolapse is an unwelcome condition affecting many menopausal women. Approximately 35 to 65% of American women will experience some form of organ prolapse and as the University of Maryland Medical Center notes, around 200,000 medical procedure take place each year. This article explains the various stages of pelvic organ prolapse and looks at some of the most common treatment options available.

Information in this article is strictly for general information and is meant as a starting point for conducting further research for discussion with a healthcare provider.

Pelvic organ prolapse occurs when damaged muscles and connective tissues are unable to support the internal organs. Without proper support, an organ will prolapse or ‘drop’ out of its normal position and put pressure on surrounding organs or the abdominal wall.

Damage may be due to childbirth, hysterectomy (where lack of a uterus may affect other organs), and during menopause when low estrogen and collagen levels make connective tissues less supple and strong.

Stages of pelvic organ prolapse:
Doctors use a system called the POP-Q or Pelvic Organ Prolapse Quantifiable classification to determine the severity of a pelvic organ prolapse. After a physical examination and diagnosis, patients may fall into one of the following categories:

*Stage 0 – No prolapse or one so minor that there is no cause for concern
*Stage 1 - The part of the pelvic organ affected that is furthest from its original position (the lower most part of the organ) is measured to be about 1cm above the vulva opening; nothing is outside of the body at this point
*Stage 2 – The organ is measured within 1cm of the vulvar opening and may or may not be outside of the body
*Stage 3 – The organ prolapse is now at least 1cm beyond the vulvar opening and outside of the body
*Stage 4 – The organ is now a complete protrusion or fully outside of the body

Pelvic organ prolapse treatment
Depending on the severity of the prolapse, there are several treatment options available.

Mild pelvic organ prolapse is usually treated with a combination of lifestyle improvement habits including:
*Kegel exercises and ‘the Knack’ to help strengthen the pelvic muscles
*Losing excessive weight especially around the midsection and maintaining that weight
*Quitting smoking
*Decreasing caffeine consumption; caffeine acts as a diuretic that stimulates the urinary urges
*Avoiding heavy lifting to prevent muscle strain
*Increasing fiber consumption to prevent constipation and bowel strain

Moderate pelvic organ prolapse sufferers also benefit from the above recommendations but may also need additional pelvic muscle support. A pessary, a device that holds the pelvic muscles in place, is inserted. Pessaries are removable, require simple maintenance and cleaning, and help to improve a patient’s quality of life.

More severe cases of pelvic organ prolapse often require surgery. Even if the protrusion is not complete, patients may have considerable abdominal pain, bladder and bowel troubles, and very painful intercourse and surgery will help to alleviate the discomfort.

Women who plan to have/continue having children should talk to their doctor about delaying the surgery if possible as having children after surgery may trigger the prolapse again.

Surgery alone is not a guarantee that the prolapse will not return and doctors will usually help patients follow new health habits such as those described earlier, especially the Kegel exercise and ‘the Knack’ to strengthen the pelvic floor muscles.

Pelvic organ prolapse is uncomfortable and sometimes embarrassing to discuss but seeking a proper diagnosis from a healthcare provider means putting an end to the pain and discomfort and getting back to life.

Some very helpful information is available at www.healthlinkbc.ca.


Menopause, Your Doctor, and You