Pelvic Organ Prolapse

What is pelvic organ prolapse?

POP in short, is the protrusion of the uterus (sometimes along with the bladder, rectum) into the vaginal canal.

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Why does prolapse occur?

POP occurs due to the weakening of the muscles of the pelvic floor and the ligamentous fascia surrounding the uterus. Women who had difficult or instrumental delivery (Coupled with genetic factors) are more susceptible to develop a prolapse.

What are the symptoms of pelvic organ prolapse?

Patients feel “something coming out” of the vagina, which is discomforting especially when standing. Other bowel and bladder dysfunctions like urinary incontinence and difficulty in evacuating the bowel can be associated with prolapse.
Due to the protrusion of the cervix to the exterior, it might undergo hyperplasia and start to bleed.

What are management options?

If the prolapse is within grade 2 (i.e. uterus descent is present, but still inside the vagina) then Kaegle’s exercises to strengthen the pelvic floor musculature can be tried. This has shown inconsistent results and works for only a certain category of women.

If the patient is unfit for surgery, then vaginal silicone plugs are used to retain the uterus within the vaginal canal.

Is there a definitive cure for prolapse?

The surgical approach depends on the age and parity of the patient. If the patient wants to have more children, then laparoscopic sacro-hysteropexy is the treatment of choice. In this procedure a mesh is attached to the cervical junction and anchored to the sacral promontory (see picture below). This process requires sufficient skill and we at Indigo Womens Centre are one of the few hospitals around Chennai performing this procedure.

Vaginal hysterectomy is the choice treatment for patients with Pelvic organ prolapse who have completed their family life. During the surgery an evaluation of the bladder and rectal descent is performed and corrected accordingly.

Patients with urinary incontinence (involuntary urinary leak) can undergo a sling procedure in the same sitting.

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