How do i know if I’ve got pelvic organ prolapse?
WHAT IS A PROLAPSE?
Pelvic organ prolapse is a term used for when the bladder, uterus or rectum has shifted to a lower anatomical position. These three organs are usually kept in place by supporting and suspending structures such as connective tissues and ligaments, as well as by the pelvic floor muscles which support the pelvic organs from below. If these tissues become damaged, overdistended or weak they may no longer be able to keep the pelvic organs in their original anatomic position. The bladder, uterus (cervix) or rectum may then start to push down into the vagina and toward the vaginal opening.
DIFFERENT TYPES OF PELVIC ORGAN PROLAPSE
If it’s the front vaginal wall which is pushing into the vagina or down toward the vaginal opening, it may be due to the bladder having shifted from its original place. A prolapse of the bladder is called a cystocele. A cystocele may cause symptoms, such as pressure or heaviness in your pelvis or vagina, especially after having been on your feet for a while. You may leak urine or feel that you’re not voiding your bladder completely when peeing. A cystocele increases the risk of frequent urinary tract infections. A cystocele can also be asymptomatic, meaning you have no symptoms. Visibly, a bulge shaped like an egg may protrude from the vaginal opening, especially while bearing down, and may be felt while standing.
Uterine prolapse typically causes a feeling of something protruding out of the vaginal opening. The sensation of heaviness or protrusion is often exacerbated by standing and walking. Physical activity such as heavy lifting often causes a worsening of symptoms, at least temporarily. Uterine prolapse can cause difficulty voiding as well as difficulty passing stool.
If it’s the back vaginal wall which is pushing into the vagina or down toward the vaginal opening, it may be due to a rectocele. A rectocele is when the rectum pushes onto the back vaginal wall so that the vaginal wall falls into the vagina. This is caused by lack of support from the connective tissues and muscles which are located in the space between the posterior vaginal wall and rectum. A rectocele may cause symptoms such as a feeling of something protruding, difficulty passing stool and the need to press i.e. with your thumb or fingers on your perineum or back vaginal wall in order to have a bowel movement. Bowel movement may be incomplete and stool may be trapped in the rectocele. A slight rectocele may be asymptomatic.
HOW DO I KNOW IF I HAVE A PELVIC ORGAN PROLAPSE?
If you have read the text above, you may understand why it can be difficult to determine on your own what type of prolapse you may have, since the different types of prolapse often give rise to very similar symptoms. In conclusion, pelvic organ prolapse can cause any of the following:
- A sensation of something filling the vagina or protruding out of it
- Dragging and a feeling of fatigue it your pelvic floor
- Sensation as if a tampon is stuck or falling out.
- Being able to palpate or see something pushing down or out of the vagina
- Difficulty voiding your bladder when peeing or frequent urination
- Difficulty passing stool or emptying your bowel completely
- Symptoms may worsen during the day and improve when you lie down. If your prolapse is protruding out of your vaginal opening this can also cause chafing.
HOW COMMON IS PROLAPSE?
This question is difficult to answer. It’s not always easy to diagnose a prolapse. Many have a so-called asymptomatic anatomical prolapse where there is a visible anatomical change but no symptoms whatsoever. An asymptomatic prolapse is not necessarily a sign of something bad or wrong, which is why a diagnosis is not always warranted. Others may have a symptomatic prolapse that is hardly visible. A symptomatic prolapse means having symptoms due to your prolapse. A small prolapse may not be diagnosed properly, even if it is highly symptomatic.
Internationally, one in five women undergo surgery due to prolapse. This may however be just the tip of the iceberg, since many don’t seek help for their symptoms.
WHAT CAUSES PROLAPSE?
Vaginal birth is the by far largest risk factor for developing pelvic organ prolapse. While descending down through the birth canal, the baby stretches the surrounding connective tissues and muscles. Due to this stretching, the tissues often sustain some degree of damage.
Other things which put frequent or long term pressure on the pelvic floor may also contribute to the development of prolapse, such as chronic cough and chronic constipation. Age, overweight and heavy daily lifting i.e. due to a physically demanding vocation may also be contributing risk factors.
Genetics and heredity play a large role regarding the risk of developing pelvic organ prolapse.
HOW IS PROLAPSE TREATED?
Treatment of prolapse is based on what, if any, symptoms you have.
Pelvic floor exercises and lifestyle changes may be enough to cause a reduction or complete removal of symptoms, especially if your prolapse is of a smaller grade. Lifestyle changes may include avoiding constipation, adjusting your way of exercising as well as losing weight if needed. Some may benefit greatly from using a supporting device such as a pessary.
Pelvic organ prolapse may need surgical treatment. The specific type of surgery and method used is determined by what type of prolapse you have and what symptoms your prolapse is causing you.
I THINK I HAVE A PROLAPSE BUT MY GYNECOLOGIST SAYS IT LOOKS NORMAL!
Lower grades of prolapse can be hard to diagnose, especially if you are not told to bear down during the examination. This is due to the fact that the prolapsed tissues slide back into the vagina when you are lying down. It is also important to know that just as some may not have any symptoms despite their prolapse being clearly visible, others have a lot of symptoms despite their prolapse being very small.
I’M GOING TO VISIT MY GYNECOLOGIST, WHAT SHOULD I ASK ABOUT?
|What questions should I ask?|
|1||What is causing my issues? Can you please show me and explain which anatomic structures are involved?|
|2||What do you consider to be a suitable first-choice treatment for my issues?|
|3||How long will it take before I can assess the result of the treatment?|
|4||What other options of treatment are there? Is there a risk I may need surgery?|
|5||Do I need a referral to another healthcare provider or specialist to receive further examinations, treatment or in order to have all my questions properly answered?|
|6||Who will provide follow ups for my issues?|
Who do I contact if I have further questions?
|7||Where do I turn to receive psychotherapy if needed?|
|8||Is there anything I need to know prior to a subsequent pregnancy?|
HOW DO I KNOW IF I HAVE A PROLAPSE?
If you have a symptomatic prolapse you will notice something doesn’t feel right. In such a case, you should visit a gynecologist for an examination.
An asymptomatic prolapse is not a cause for concern.
Translate websites with google translate:
This website is mainly in swedish. If you want to read more about pelvic floor issues and pelvic organ prolapse, you can use Google translate to read the swedish posts.
On your computer, go to Google Translate.
In the text box, enter a URL.
To choose the language you want to translate to, at the top right, click the Down arrow .
On the right, click the URL that appears. The URL will open a new tab and the website will be translated.
Is it always possible to diagnose prolapse with the help of 3D-ultrasound, even if the person is lying down?
If the person makes a valsalva maneuver it is considered correct to diagnose prolapse, even if the person is lying down. The pressure given by valsalva corresponds to or exceeds the pressure from gravity. This means that you can see as much in lying down as standing, if the instruction to bear down is properly instructed.