O Pelvic organ prolapse is a problem that affects many women, especially during menopause. Since it is a benign condition, it is often ignored, despite the problems and discomfort it can cause.
“The prevalence of pelvic organ prolapse is difficult to estimate and is underestimated, as many women do not seek medical help”, he reveals to Lifestyle to the Minute Catarina Neves, gynecology/obstetrics intern at Centro Hospitalar Universitário do Algarve, in Portimão, in another section The Doctor Explains.
The diagnosis of the pathology, which can most affect women between the ages of 50 and 79, is made through a gynecological examination. There are several types of prolapse and also different forms of treatment, with surgery being one of the most effective.
What is pelvic organ prolapse?
The pelvic organs (uterus, bladder, rectum and intestine) are normally supported by muscles and ligaments that are inserted into the bones of the pelvis and make up the pelvic floor. When these supporting tissues weaken, become flaccid and stretch, these organs may protrude and bulge into the walls of the vagina, which is called prolapse. Pelvic organ prolapse is mainly a problem after menopause. It is a pathology that affects a woman’s quality of life, being a fundamental point in the assessment of women’s health.
Studies indicate that around 40% of women between the ages of 50 and 79 may have some type of prolapse
Are there different types of prolapse?
Yes, depending on the organ affected and the region of the vaginal wall affected. Cystocele consists of prolapse of the anterior wall of the vagina, associated with bladder descent. Hysterocele refers to the prolapse of the upper part of the vagina, with descent of the cervix and the body of the uterus. The rectocele refers to the prolapse of the posterior wall of the vagina, being associated with the descent of the rectum. Then there is the prolapse of the vaginal vault, which occurs most frequently after a hysterectomy. [cirurgia de remoção do útero]. Different types of prolapse can coexist in the same woman, since the pelvic organs and their supports are related.
Is it something very common in Portugal?
The prevalence of pelvic organ prolapse is difficult to estimate and is underestimated, as many women do not seek medical help. Studies indicate that around 40% of women between the ages of 50 and 79 may have some type of prolapse.
What are the main symptoms?
Pelvic organ prolapse can be mild, not causing any type of symptoms and is only diagnosed during a routine gynecological examination.
Symptoms can significantly interfere with quality of life in daily activities, physical activity or compromising sexual activity.
The main symptoms are a feeling of pressure, discomfort or pelvic pain that improves with lying down, the perception of a ‘ball’ or mass inside or at the entrance to the vagina, urinary symptoms such as difficulty urinating or completely emptying the bladder, urinary infections, leakage involuntary urination or urgency to urinate, and difficulty in having a bowel movement or discomfort during sexual intercourse.
Are there any risk factors, such as age, for example?
The main risk factors for pelvic organ prolapse are the normal aging process and menopause, pregnancy, especially in situations of multiple births, instrumented births and large-for-gestational-age newborns, obesity, situations that increase blood pressure abdominal pain, such as chronic cough, constipation and weight-bearing work, surgery to remove the uterus [histerectomia] previous, hereditary risk of prolapse or some connective tissue diseases, for example Marfan syndrome or Ehlers-Danlos syndrome.
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When should a woman be most worried?
Women must maintain gynecological surveillance appropriate to their age and specific characteristics. They should consult their attending physician or gynecologist if symptoms or signs suggestive of the disease appear.
How is the diagnosis made?
The diagnosis is most often made in a gynecology consultation using a complete clinical history and careful gynecological examination. Sometimes additional tests may be needed to help clarify the full nature of the problem, such as gynecological ultrasound, magnetic resonance imaging, urodynamic studies, which evaluate the bladder’s ability to store and empty urine, or urethrocystoscopy, which allows visualization of the urethra and bladder.
It is estimated that the prolapse cure rate using surgical treatment is approximately between 75% and 90%.Is it possible to live with prolapse? What can happen if left untreated?
Pelvic organ prolapse is a benign condition that is not life-threatening and, therefore, the patient can choose not to undergo any treatment. However, if left untreated, as the woman ages, the degree of prolapse may worsen, causing more symptoms and discomfort.
What types of treatment are there and how are they carried out?
Asymptomatic or mildly symptomatic women with no impact on their quality of life may not require any treatment. However, they must adopt habits that reduce the risk of worsening the prolapse, namely, a balanced diet that promotes good intestinal functioning, avoiding constipation, drinking adequate amounts of water, stopping smoking, controlling chronic coughs; maintaining a body weight within healthy limits and avoiding repeated loads and efforts. In symptomatic women whose quality of life is affected, there are surgical or non-surgical treatments available. Medical treatment (non-surgical) is preferred when the aim is to preserve a woman’s reproductive capacity and allows the postponement of definitive surgical treatment and includes exercises to strengthen and rehabilitate the pelvic floor or vaginal pessaries, which are silicone devices placed in the vagina and that support prolapsed organs, relieving symptoms. With regard to surgical treatment, there are different approaches, vaginal, laparoscopic or abdominal, with or without the use of prostheses. All are decided individually between the doctor and the patient.
Which is the most effective?
The choice of treatment depends on several factors such as the type and intensity of the symptoms, the woman’s age, the existence of concomitant diseases, expectations regarding sexual activity and reproductive planning and the presence of risk factors for recurrence. Therefore, treatment should be a shared decision between the doctor and the patient. It is estimated that the prolapse cure rate using surgical treatment is approximately between 75% and 90%. Most of the time, prolapse recurrence is due to the maintenance of risk factors.
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