What is Prolapse?
Have you recently received a diagnosis of pelvic organ prolapse from your healthcare provider? Perhaps you stumbled upon this term while researching your symptoms online, but you're unsure about its exact meaning. Let's chat about what prolapse is and help that is available!
What is Pelvic Organ Prolapse?
Pelvic Organ Prolapse refers to the condition where one or more pelvic organs, such as the bladder, uterus, or rectum, lose their normal support from surrounding muscles, ligaments, and fascia. This results in the organs descending lower within the pelvis than their usual position. While childbirth is a common trigger for prolapse, other causes include chronic constipation, surgical procedures, and conditions linked to increased intra-abdominal pressure, like obesity or COPD.
The Different Kinds of Prolapse
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Cystocele: A cystocele is where the bladder is falling backward into the vaginal wall. Sometime is accompanied by a urethral prolapse where the urethra has also lost support and falls inward. You might experience difficulty peeing, leaking issues, or notice pressure or a bulge in the front of your vagina.
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Rectocele: A rectocele is where the rectum begins to sag forward into the vaginal wall. You might experience difficulty passing stool, feeling like you can't completely empty or notice a bulge/pressure in your vagina.
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Uterine Prolapse: A uterine prolapse is where the ligaments holding up the uterus are lax enough to let it fall downward toward the opening of the vagina. This can cause pain during intercourse, feeling something in the way, a lump/bulge or pressure in the vagina, or pain in your low back
There are a few other types of prolapse, but these are the most common.
How bad is my Prolapse?
Did your doctor mention a stage of your prolapse? Or perhaps maybe you're just wondering how bad is your prolapse? Staging a prolapse is just a way for doctor's to describe how far has the organ fallen. Beginning in 1996, the POP-Q system of staging prolapses became the gold standard. Doctors use these 4 stages to describe the furthest down your prolapse descends.
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Stage 0: Very Mild or No movement- There is possibly a small amount of movement when bearing down, but the patient is not experiencing any symptoms
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Stage 1: Defined as there is movement present but it is well within the vagina and stays above the entrance.
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Stage 2: Prolapse is present and sits at the entrance to the vagina (Within +/- 1 cm of the vaginal opening). This is easily seen using a hand mirror. Stage 2a would be just inside the vagina and stage 2b would be just outside the opening.
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Stage 3: Prolapse is present and there is descension more than 1 cm outside of the vagina
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Stage 4: Complete eversion of the entire vaginal vault (can be up to 9 cm)
Well crap... I have a prolapse. Now what?
What we want you to hear more than anything else is:
There is hope!
Surgery is not your only option!
We get it, seeing something "down there" can be very scary. But there are options to dealing with your prolapse beyond just having surgery.
Pelvic Floor Physical or Occupational Therapy
​Pelvic floor therapy is an essential part of healing your prolapse, no matter what option you choose. Physical or occupational therapy helps you improve the environment that is contributing to your prolapse. Improving the circumstances around the prolapse - pressure management during activity, constipation, or other issues - will only benefit you in the long term, whether it be improving your prolapse overall, decreasing your symptoms, or improving your outcomes during surgery is ESSENTIAL to returning to a normal life.
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Pessaries
A pessary is a internal medical device that supports the organs that sits inside the vaginal canal much like a menstrual cup. This tool won't heal your prolapse, but it will improve the environment in which your prolapse exists and allows you to work on improving the strength and mechanics of how your body moves. This can increase the likelihood that your prolapse can improve. Pessaries aren't always necessary, but an option to discuss with your provider.
Surgery
Surgery is always an option for a prolapse, however, it is not always the easy option that it is presented as. Can it "fix" a prolapse? Usually. Does it fix it forever? That's less likely. Unfortunately, a significant number of surgeries fail in the first 5 years. This can be improved upon by adding pelvic floor therapy into your care regimen. The surgeon will strengthen the area around where the prolapse is happening and help to anchor the organs higher into the pelvis. A lot of times though, once you've had surgery, other non-surgical options - like pessaries - are off the table. So, while this can be an effective option, it's important to weight the pros and cons of your particular case.
We understand prolapses.
Your Next Step:
We know the potential of having a prolapse is scary. We also know that knowledge is power and understanding what is going on and the options in front of you are the first step. Rest assured that when you come in for your evaluation, you will be greeted by experts in the field who see this day in and day out. They are compassionate and knowledgeable and will leaving you feeling confident in the decisions you make.
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It's time to book your evaluation. Reach out today!