Do you feel like your pelvic organs have dropped? Let's talk about Pelvic Organ Prolapse (POP)!

Do you sometimes feel a heaviness, pressure, or a feeling like something is coming out of your vagina? Or do you notice a difference when you urinate or defecate? These are not things you can just ignore. Today we are going to talk about a condition that affects many women, but sometimes they hide it because they are embarrassed. This is called Pelvic Organ Prolapse (POP) .

What is Pelvic Organ Prolapse (POP)? Let's understand it simply!

Okay, let's see what this is. Pelvic Organ Prolapse is, simply put, the organs in your pelvic cavity, that is, the (Vagina) , (Uterus) , (Bladder) , (Rectum) (organs like the anus) are lowered from their normal positions. Imagine, these organs in your lower abdomen are held up like a net. This net is what we call the Pelvic Floor . It is made up of muscles, ligaments, and tissues. This Pelvic Floor is like a cradle that holds these organs up from below.

Now, if for some reason the muscles in the pelvic floor become weak, it's like the mesh has become loose, and the organs that are holding them up can't stay in place. That's when these organs start to drop, or the vagina starts to hang down to the side. This condition can occur for reasons like after childbirth or as you get older.

In mild cases of POP, the organ may only be slightly prolapsed. But in more severe cases, the organ may protrude completely from the vagina, like a tumor. People with this condition often describe a feeling of fullness, pressure, or something coming out of the vagina. The exact symptoms you experience and the severity of the condition will determine what type of POP you have.

The best thing is, there are treatments for this. There are non-surgical treatments as well as surgical treatments. Your doctor will assess your condition and discuss with you which treatment options are best for you.

What are the different types of POPs?

The type of POP you have depends on where in your pelvic floor there is weakness, and which organs are affected by that weakness. Let's look at some of the main types:

• Anterior vaginal wall prolapse (Dropped Bladder / Cystocele): This is when the pelvic floor muscles above your vagina weaken, causing your bladder to drop down and protrude into your vagina. This is called a cystocele . This is the most common type of POP that most people see.
• Urethrocele: This is a condition where the urethra ( urinary tube) descends due to weakness of the pelvic floor muscles. Often, when the bladder descends, the urethra can also descend along with it.
• Posterior vaginal wall prolapse (Rectocele): Here, the rectum protrudes towards the back wall of the vagina due to weakness of the pelvic floor muscles between the vagina and rectum .
• Enterocele: When the muscles in the pelvic cavity weaken, your small intestine can protrude into the back wall or upper part of the vagina.
• Uterine prolapse (Dropped Uterus): When the pelvic floor weakens, the uterus can drop down into the vagina.
• Vaginal vault prolapse: This is especially common in women who have had a hysterectomy. When the pelvic floor muscles weaken, the upper part of the vagina (called the vaginal vault) can fall into the vagina.

How common is this situation? Is this something to be ashamed of?

In fact, statistics suggest that between 3% and 11% of women will experience this condition. About 37% of women with pelvic floor disorders (including POP) are between the ages of 60 and 79. More than half are over 80. (Note: "more than half" in this sentence is a Tamil word. It should be "majority" or "more than half". I will correct that.) ... more than half are over 80.

But it's hard to say exactly how many people are affected, because many people don't seek treatment for this. Many people don't seek treatment because they are embarrassed or embarrassed to talk about their genital problems. But the most important thing you need to know is that you are not alone. Many people experience these types of POPs.

What are the symptoms of POP?

The most common symptom is a feeling of something coming out of the vagina, like a ball, or something stuck in it. In addition, there may be other symptoms such as:

• A feeling of fullness, heaviness, or pressure inside the vagina.
• Feeling of fullness, pressure, or pain in the lower abdomen or pelvic area.
• Feeling pain or discomfort during sexual intercourse (Dyspareunia) .
• Changes in the way you urinate and defecate.

The symptoms you experience will depend on where the prolapse has occurred. If you can clearly describe these symptoms to your doctor, they will be able to better identify where your pelvic floor is weak.

Many people only tell their doctor about their symptoms when they have difficulty urinating or defecating, or when sex becomes painful. These side effects are common with POPs. These symptoms include:

• Stress incontinence is the unintentional leakage of urine when you cough, laugh, or exercise.
• A frequent feeling of needing to urinate, or a feeling that the bladder is full.
• Constipation, or the inability to control bowel movements.

Why does POP occur? What are the causes?

There are many reasons why your pelvic floor may be weak. Most often, this happens when the muscles, ligaments, and tissues in your pelvic floor are overstretched. It can also happen because the muscles are not working properly due to lack of use.

Any of the following factors may increase your risk of developing POP:

• Vaginal delivery: This is the main cause of POP. Multiple vaginal deliveries, twins or triplets, large babies (Fetal Macrosomia) , and deliveries using instruments such as forceps or vacuum are all factors that can weaken the pelvic floor muscles. Imagine how much pressure is put on that area during childbirth.
• Aging: As we age, our muscles lose strength. One reason is a decrease in the hormone estrogen . During menopause, your body produces less estrogen . This can weaken the connective tissue that supports the pelvic floor .
• Overweight/Obesity: Studies have shown that people who are overweight, that is, obese, are more likely to develop POP than those in a healthy weight range.
• Prolonged pressure on the abdominal cavity: Continuous pressure on the pelvic floor muscles can weaken them. Things like prolonged constipation , prolonged coughing , and frequent heavy lifting increase the risk of developing POP.
• Family history: Research is still ongoing into whether POP has a genetic influence, but it's possible that you may have inherited a weak pelvic floor .
• Connective tissue diseases: People with conditions such as Ehlers-Danlos syndrome , Marfan syndrome , or Joint Hypermobility Syndrome are at risk of developing POP.

What are the possible complications of POP?

Pelvic Organ Prolapse is an uncomfortable condition that can affect your quality of life. In addition to losing control of your bladder and bowels, here are some other complications that can occur due to POP:

• Infections: If you can't urinate properly due to prolapse, your urine can back up into your urethra or kidneys. This can cause Urinary Tract Infections (UTIs) or kidney infections.
• Kidney Damage: In severe cases, prolonged infection and obstruction of urine flow can cause kidney damage.
• Emotional Distress: POP can disrupt your daily life and affect your mental well-being. You may feel embarrassed to talk about it, which can cause further stress.

How does a doctor diagnose POP?

When you see a doctor, they will first ask about your symptoms and then do a pelvic exam . During this exam, the doctor may ask you to cough, and they may check how much prolapse you have when you are relaxed and when you are straining. They may also examine you while you are lying down or standing up. In most cases, a pelvic exam can help determine if you have POP.

In addition, the following tests can be performed:

• Pelvic floor function tests: These tests allow your doctor to see how strong the muscles and ligaments in your pelvic floor are. This may involve doing certain movements, tightening and relaxing the muscles, etc.
• Bladder function tests: These tests can help check for urinary problems that are common with POP. This may include a test called a cystoscopy , in which the doctor looks inside your bladder and urethra. They may also do a urodynamics test to see how well your bladder and urethra hold and release urine.
• Imaging procedures: These tests can look inside your pelvic cavity. Your doctor may order a pelvic floor ultrasound or MRI to determine the exact extent of your prolapse. However, these imaging tests are usually only used in more complicated cases.

Are there stages of POP?

Yes, there is a way to classify POP. It's called the Pelvic Organ Prolapse Quantification (POP-Q) system . It stages your pelvic organs based on how far they have descended relative to your hymen (the membrane that lines the opening of your vagina).

This scale goes from zero to four:

• Stage Zero: This means that your organs have not moved in any way.
• Stage One: The prolapse is mild. The penis is at least 1 centimeter above your hymen .
• Stage Two: In this stage, the prolapse is moderate. The organ is less than 1 cm from the hymen (that is, from 1 cm above to 1 cm below the hymen ).
• Stage Three: In this stage, the prolapse is severe. The organ is more than 1 centimeter below the hymen , but the prolapse has not completely exited the vagina.
• Stage Four: This means you have a complete prolapse. A complete prolapse is the most severe type. In this case, the prolapsed organ has completely protruded from the vagina.

Think about it, you might have different stages of POP in different organs at the same time. For example, you might have a stage three bladder prolapse and a stage one uterine prolapse.

What are the treatments for POP?

The treatment plan you receive will depend on how severe the prolapse is, where it is located, and how much your symptoms are affecting you. There are both nonsurgical and surgical treatments. For example, if the prolapse is mild and doesn’t bother you too much, you may not need treatment. Your doctor will discuss all of these treatment options with you and help you decide which one is best for you.

Nonsurgical Treatments

Non-surgical treatments focus primarily on helping you control your symptoms and improve your quality of life. Depending on the severity of your condition, the results of these treatments may not be permanent. However, many people prefer non-surgical options or decide that this method is best for them.

Non-surgical treatments for POP include:

• Vaginal Pessary: ​​This is a removable device made of silicone. A doctor can insert it into your vagina and hold it in place where a lowered organ is. It's like a small support for that organ.
• Pelvic floor exercises (Kegel exercises): These are exercises that strengthen your pelvic floor . Your doctor may refer you to a pelvic floor specialist ( Urogynecologist ), who can individually test your muscle strength and prescribe specific exercises to strengthen those muscles. It is very important to do these (Kegel exercises) correctly.

Surgical Treatments

If your symptoms don't improve with standard treatments, or if your doctor thinks that surgery will improve your quality of life, then surgery may be an option. However , it's important to discuss the risks and benefits of surgery with your doctor.

There are several different methods a surgeon can choose to correct a POP condition. There are two main types of surgery: Obliterative surgery and Reconstructive surgery.

Obliterative surgery involves narrowing the opening of your vagina. This will stop the penis from protruding. However, this may result in the loss of the ability to have sex through the vagina.

• Colpocleisis is an obliterative surgery. It shortens the vagina. It prevents any organs from protruding from the body. This is a good option if you are not physically strong enough to undergo reconstructive surgery, and if you no longer want to have sex through the vagina.

Reconstructive surgery involves repairing weakened areas of your pelvic floor and returning the organs to their normal positions.

• Sacrocolpopexy is a surgical procedure used to treat uterine prolapse and vaginal vault prolapse . It involves using a mesh (a type of mesh) to connect your vagina to a ligament in your lower back. This is often done laparoscopically (keyhole surgery) through a few small incisions in your abdomen.
• A procedure called a sacrohysteropexy is also used to treat uterine prolapse. Your doctor will attach a surgical mesh to your cervix and vagina, and then attach it to your lower back. This will bring the uterus up to where it is.
• Colporrhaphy is a surgical procedure to treat anterior and/or posterior vaginal wall prolapse. This procedure is performed through your vagina. The doctor will strengthen your vaginal walls with dissolvable stitches, which will provide better support for your bladder and rectum.
• Uterosacral or sacrospinous ligament fixation is a procedure that uses your own tissue to treat a prolapsed uterus or vaginal vault . This procedure is also done through the vagina (similar to a colporrhaphy ). In this procedure, the doctor attaches the upper part of your vagina to a ligament or muscle in your pelvic cavity with dissolvable sutures. This type of surgery is sometimes called a native tissue repair .

When is surgery necessary?

There is no specific stage at which surgery is required to treat POP. It depends on factors such as how your symptoms are affecting your life and whether you are planning to have more children. However, in general, if you have a stage three or four prolapse, surgery is more likely to be needed.

The most important thing is to talk to your doctor about all treatment options. Get a good idea of ​​whether he or she will recommend surgery or whether you should try non-surgical options first.

Does POP treatment completely heal? Can what has been lowered be put back up?

Yes, this condition can be reversed with treatment. In mild cases of POP, you can strengthen your muscles so that they can hold your organs in their correct positions. Reconstructive surgery strengthens the weaknesses in your pelvic walls so that your organs return to their original positions.

In more severe cases, you may need to push the protruding organ back in, especially when you have a bowel movement or urinate. However, this is only a temporary solution. If your pelvic organ prolapse is this severe, you should definitely see a doctor for treatment.

What can we do to prevent POP from forming?

There are many factors that can contribute to the development of POP that we cannot control. However, you can reduce this risk by adopting certain health habits.

• Do daily pelvic floor exercises (Kegel exercises): Having muscle control in your pelvic floor provides strong support for your organs.
• Maintain a healthy weight: Talk to your doctor about what a healthy weight is for you.
• Prevent constipation: Prolonged constipation can put unnecessary strain on your pelvic floor muscles. Eating a high-fiber diet and drinking plenty of water can help prevent constipation.
• Don't smoke: Smoking can cause a chronic cough. This can put unnecessary pressure on your abdominal cavity and can also put strain on your pelvic floor muscles.
• Protect your pelvic floor when lifting: Ask for help when lifting heavy objects. When lifting alone, squat with your hips and knees bent and your back as straight as possible. Do not twist your torso when lifting. Proper body positioning can help prevent injury to your lower back and protect your pelvic floor .

What to expect when living with a POP condition?

Your outlook depends on several things. These include where the tumor is, how severe it is, what your symptoms are, and what treatment options you have. Think carefully about what you expect from treatment. Talk to your doctor about the pros and cons of each treatment option. Discuss how treatment can help you live a more comfortable life.

The only thing to remember is that Pelvic Organ Prolapse is treatable, and you don't have to live with this discomfort. Ask your doctor for help and let them talk to you about your options. Most people with Pelvic Organ Prolapse find relief from their symptoms with treatment.

What time should I see a doctor?

See a doctor if you have symptoms of pelvic floor prolapse . Symptoms may include:

• If you feel pressure or fullness in your pelvic area.
• If you feel uncomfortable during sex.
• If it feels like something is coming out of the vagina.
• If you cannot control your bowel movements or are constipated.
• If you are leaking urine (unconsciously), or if you feel like you need to urinate frequently.

Pelvic organ prolapse is not life-threatening, but it is not something you should accept as a part of life. It can cause symptoms that can prevent you from living your best life and doing the things you love. Know that you are not alone, and pelvic floor dysfunction is very common among women. If you suspect you have a weak pelvic floor, don’t be shy about talking to your doctor. They can recommend treatments, medical devices, and even lifestyle changes that can repair the prolapse and improve your quality of life.

Finally, I have to tell you (Take-Home Message)

So, while Pelvic Organ Prolapse (POP) is a condition that can affect women and can be a bit uncomfortable, you should definitely remember that there are effective treatments for it.

• Don't be shy: If you have these symptoms, don't be shy or afraid to talk to a doctor about them. This is something that happens to many people.
• Know the causes: It is important to be aware of the factors that contribute to the occurrence of POP (such as childbirth, aging, weight gain).
• Prevention is important: Doing Kegel exercises , maintaining a healthy weight, and avoiding constipation can reduce the risk of this condition.
• There are treatment options: There are various treatment options, ranging from non-surgical treatments (pessary, exercises) to surgery, depending on your condition.
• Seek medical advice: To find out what treatment is best for you, be sure to see a doctor and seek advice.

Take care of your body. If you feel any changes or discomfort, it is wise to seek medical advice without ignoring it.

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