By Emily Quinn PT

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse (POP) is defined as the descent of one or more of the pelvic organs including the uterus, bladder, rectum and small intestine into the vaginal canal. POP occurs in varying degrees in up to 50% of women. Common symptoms associated with POP include bulging in the vaginal area, heaviness, urinary and/or fecal incontinence and incomplete emptying of the bowel and/or bladder.

What are the Risk Factors of POP?

There are several factors that increase one’s susceptibility to developing POP in their lifetime. Our pelvic organs are largely supported and held in place by a) the muscular pelvic floor system and b) the surrounding connective tissue including a network of fascia and ligaments. Change to the integrity and strength of the pelvic floor and/or connective tissue can thereby reduce the support to our pelvic organs, which can in turn result in a lowering of the organs into the vaginal canal.  Some of the factors that may directly or indirectly promote pelvic organ lowering include:

Age
Due to the changes in muscular and connective tissue that occur with age, the risk of developing POP increases with age. 31% of all women with POP are between the ages of 50-59, while nearly 50% are over the age of 80.

BMI
An increased weight results in an increased pressure on the pelvic floor tissues, thereby making it more challenging for these structures to support our pelvic organs.

Genetic
There is a strong genetic component to POP such that women with a family history of POP are 2.5x more likely to develop POP. This may in part be explained by the strength of our collagen, the main component of connective tissue.

Obstetrical and Gynecological History
The risk of developing POP increases with the number of deliveries that a woman experiences. In addition, the risk is higher for vaginal deliveries compared to cesarean sections. The use of instruments during vaginal deliveries including forceps and suction also increases one’s risk of developing POP. Furthermore, women who undergo gynecological surgeries including a hysterectomy may also be at an increased risk due to possible injury to the various pelvic floor tissues.

Menopause
Estrogen has an important role in maintaining the strength and integrity of our pelvic floor tissues, including the supportive connective tissue. Due to the reduced estrogen levels that occur during menopause, women in this stage of life are also at an increased risk of developing POP.

Lifestyle and Occupation
Lifestyle factors including straining toileting habits, chronic coughing and occupations that require heavy lifting may result in an increased amount of pressure on the pelvic floor tissue. Over time, these factors may also increase one’s susceptibility to developing POP.

What are the Treatment Options available for POP?

Despite the negative impact on quality of life that POP has for several women, there are many options available to help prevent and manage this condition. Pelvic floor physiotherapy is an effective conservative POP management strategy for some women.  Pelvic floor physiotherapists may utilize a combination of active exercise based treatments to help optimize the strength and coordination of the pelvic floor muscular system. In addition, lifestyle and behaviour modification to help prevent and manage symptoms of POP may also be implemented. Alternative treatment interventions including the use of a removable supportive device called a pessary or surgery may be indicated for some women.

References:

1. Hagen S, Stark D. (2011). Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. (12), CD003882.

2. Saunders K. (2017). Recent advances in understanding pelvic- floor tissue of women with and without pelvic organ prolapse: considerations for physical therapists. Phys Ther. 97(4), 455–463.

3. Weintraub A., Glinter H., & Marcus-Braun N. (2020). Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. International Braz J Urol. 46(1), 5–14.