March 25, 2019
Pelvic Organ Prolapse: The Lowdown

Pelvic Organ Prolapse: The Lowdown

by Wellness Letter

Anyone who watches late-night television has probably seen commercials enumerating all the adverse effects associated with transvaginal mesh implants and the class-action lawsuits against the manufacturers who make them. These synthetic grafts, inserted through the vagina, are used to reinforce weak tissues as a treatment for pelvic organ prolapse.

Here’s a look at the risk factors, symptoms, and treatments for this condition—and how to avoid becoming one of the statistics noted in these TV ads.

Background on pelvic organ prolapse

Pelvic organ prolapse (POP) develops when pelvic floor muscles and connective tissues within the pelvis that support the pelvic organs gradually weaken, allowing the organs to descend from their normal positions. The organs include the uterus, vagina, bowel, and bladder. Basically, it’s a type of hernia.

POP can be asymptomatic (despite the organs having descended to varying degrees) or symptomatic (the organs have descended to such an extent that there is discomfort in the pelvic area, or a feeling like something is falling out of the vagina or rectum). Sometimes the cervix or vagina may be seen or felt bulging from the entrance to the vagina.

Symptoms may also include painful intercourse, low back pain, difficulty urinating, or urinary frequency, urgency, or leakage, as well as constipation or difficulty defecating completely. Some symptoms may worsen when jumping, standing, or lifting objects. POP can have a significant negative impacton a woman’s quality of life, affecting her ability to have sexual intercourse, exercise, or go about daily activities.

It’s not known exactly how many women have POP—for a number of reasons, including differences in classifying POP and studies varying in terms of whether they report on symptomatic versus asymptomatic POP. Also, many women with the condition don’t seek medical care. By some reports, anywhere from 100,000 to 200,000 surgical procedures for POP are performed each year in the U.S.

Who’s at risk?

Genetic factors play a role, as women with a family history of POP are at increased risk for developing it. Several gene variants that cause altered collagen structure and metabolism have been found, but it’s unclear whether these are the only types of genetic influences in POP. What is certain is that factors that increase pressure on the pelvic tissues—notably childbirth—also play a major role in its development.

Obesity, repetitive heavy lifting, chronic coughing, and straining from constipation may contribute, as may prior pelvic surgery. Menopause is a risk factor because changing hormone levels are associated with a drop in the body’s level of collagen, a key protein giving structure to the body’s connective tissue.

SOS for POP

If you have bothersome symptoms, a pessary—a silicone device that’s placed in the vagina—may be recommended to help provide support to the internal organs. Pelvic floor exercises, such as Kegel exercises, can also improve symptoms. Some doctors prescribe a low-dose estrogen cream, which isapplied vaginally to strengthen connective tissue, though evidence of benefit is lacking. Women with POP should avoid such activities as heavy lifting, take measures to prevent constipation and chronic coughing, and lose weight if overweight.

If your symptoms are severe and such conservative measures do not help enough, surgery may be an option. The original surgical procedure that has long been used to repair POP is colporrhaphy, which involves using the patient’s own tissues, along with sutures, to reinforce the weak muscles andconnective tissue and provide pelvic floor support. The defect is repaired by going through the vagina or through a tiny abdominal incision, where a laparoscope is inserted.

Transvaginal Mesh Problems: From Lawsuits to Government Action

If you watch late-night television, you've probably seen commercials enumerating all the adverse effects associated with transvaginal mesh implants used to treat pelvic organ prolapse. Here's a look at this mesh mess.

Beginning in the early 2000s, however, surgeons started using synthetic mesh, typically made of polypropylene plastic, to augment the weakened pelvic tissues (similar to how surgeons use mesh to shore up certain other hernias), because of the relatively high failure rate of colporrhaphy, which has been reported to be 20 to 30 percent. But because of all the complications with the mesh, it is rarelyused today, and doctors have been going back to colporrhaphy, which is minimally invasive and still fixes the problem most of the time.

This article first appeared in the UC Berkeley Wellness Letter.

Also see What Are Pelvic Floor Spasms?