Dr Aruna Tantia

Pelvic Organ Prolapse

Dr. Aruna Tantia, Director and Consultant Surgeon (Gynaecology & Obstetrics) ILS Hospitals

Pelvic Floor Disorder:

Every woman is born with a womb which is supported by a hammock made up of fan-shaped muscles called Levator Ani. These muscles are very strong and are covered with a sheath called fascia. This fascia or thin layer of tissue condense to form ropes like structures called ligaments which attach laterally to pelvic wall and supports uterus or womb like hammock strings. They together form pelvic floor and prevents sagging of the womb, bladder and rectum in a women through the opening in this floor. Any weakness of this system due to loss of strength of muscles or connective tissue is called Pelvic Floor Disorder.

Pelvic Organ Prolapse: (POP)

Pelvic organs are uterus, bladder and rectum. Bladder lies anterior to uterus and rectum lies behind the uterus. Whenever there is a weakness of pelvic floor muscles like levator Ani it can lead to sagging of the uterus along with bladder and rectum collectively or in combination. The mouth of uterus can be felt at mouth of vaginal opening on straining or squatting or at times much below the vaginal opening. If the uterus keeps lying outside then it may develop into a mass with swelling and refuse to be pushed back inside by hand. This condition is called Pelvic Organ Prolapse.
Sometimes it can be seen in young girls who haven’t borne child. This is due to defect in connective tissue leading to muscle weakness and nulliparous prolapse.

At times a ball like structure is seen extruding from vaginal area even after a woman has removed her uterus earlier. This is another entity called Vault prolapse where the supports of vault are absent and it herniates out.

So pelvic organ prolapse are nothing but hernia of woman’s reproductive organ womb and the severity depends upon degree of prolapse.

Causes of Pelvic Organ Prolapse:

There are many causes responsible for pelvic organ prolapse like
a) Repeated Childbirth
b) Instrument delivery like Forceps or Ventouse
c) Difficult and prolonged labor
d) Connective tissue Disorder
e) Chronic constipation or Cough
f) Improper hysterectomy technique

Symptoms of Pelvic Organ Prolapse:

Most symptoms are attributed to degree of prolapse and organ involved.
To enumerate a few
1. Difficulty in passing urine / incomplete emptying.
2. Constipation or incomplete evacuation
3. Dragging pain in back
4. Increased frequency of urination
5. Leakage of urine on coughing
6. Lump like mass coming out of vagina
7. Bloody discharge per vagina
8. Watery discharge per vagina
9. Difficulty in walking.

Diagnosis of Pelvic Organ Prolapse:

Detailed History with any of the above symptoms:

Clinical examination by doctor both in sleeping position and squatting position, Blood counts, Sugar fasting and Post meal, Urine test, Urodynamic study, USG pelvis by TVS and TAS, MRI Pelvis
Treatment of Pelvic Organ Prolapse:
Treatment is according to severity of symptoms.

For grade 1:

Prolapse with little cystocoele One can be treated with pelvic floor exercise to tighten up your loose muscles. One is advised to alternatively contract and relax one’s Perineal muscles or anal sphincter just as one would do to hold urine.

Grade 2:

Prolapse with uterus sagging down a little with cystocoele or bladder Hernia . We can correct it vaginally by correction of cystocoele and correcting uteovaginal prolapse by Cervicopexy / pectopexy. This can be done by combined vaginal and laparoscopic / abdominal method. A mesh is put around the cervix and it is anchored to the sacral bone. If uterus preservation is not desired one can opt for vaginal hysterectomy with cystocoele repair .

Grade 3:

Pelvic organ prolapse: Here the uterus is totally displaced outside vagina. Here both bladder and rectal herniation can be present. Treatment is vaginal removal of uterus and repair of bladder and rectal hernia. Hospital stay is generally for 6-7 days. Alternatively uterus can be lifted up with help of mesh and both Hernia can be corrected. This is done by laparoscopy is advanced laparoscopic unit. Hospital stay is 2-3 days. Success rate is high.

Vault prolapse:

Here the vagina gets everted after removal of uterus surgery earlier. This can be treated by Laparoscopic Sacrocolpopexy where one lifts the apex of vagina with a mesh and attaches it to spinal bone. This is a very gratifying operation and results are immediately seen. Hospital stay 1 day.

Stress Incontinence:

When there is a urine leak on coughing or straining we offer women Laparoscopic Burch procedure whereby she is relieved of her symptom. Hospital stay 1 day only. Same procedure can be done abdominally also where by stay is 6-7 days. With advent of latest diagnostics and equipment’s the treatment of POP has undergone massive change and can safely be done at centers equipped and manned by specialist to deal with it. So no more shunning public life for fear of leaking or organ coming out . Get your problems solved and enjoy life.

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