women s health issues
Pelvic Organ Prolapse (POP)
Introduction
Pelvic organ prolapse involves relaxation or weakening of the ligaments, connective tissue, and muscles of the pelvis, causing the bladder, urethra, small intestine, rectum, or uterus to bulge into the vagina. Women may feel pressure that feels as if something is bulging out of their vagina or they are sitting on a ball, or they may have a sense of fullness in their pelvis or problems with urination or bowel movements. A pelvic examination is done while a woman bears down to make abnormalities more obvious. Pelvic muscle exercises and pessaries may help, but surgery may be needed. Pelvic organ prolapse occurs only in women and become more common as women age. During their lifetime, about 1 of 11 women has surgery for pelvic organ prolapse. The pelvic floor is a network of muscles, ligaments, and tissues that act like a hammock to support the organs of the pelvis: the uterus, vagina, bladder, urethra, and rectum. If the muscles become weak or the ligaments or tissues are stretched or damaged, the pelvic organs or small intestine may drop down and protrude (prolapse) into the vagina. If the disorder is severe, the organs may protrude all the way through the opening of the vagina and outside the body. Pelvic organ prolapse usually results from a combination of factors. The following factors commonly contribute to development of pelvic organ prolapse: Having a baby, particularly if the baby is delivered vaginally Having obesity Having an injury, as may occur during hysterectomy (removal of the uterus) or another surgical procedure Aging Frequently doing things that increase pressure in the abdomen, such as straining during bowel movements or lifting heavy objects Being pregnant and having a vaginal delivery may weaken or stretch some of the supporting structures in the pelvis. Pelvic organ prolapse is more common among women who have had several vaginal deliveries, and the risk increases with each delivery. The pregnancy or the delivery may damage nerves, leading to muscle weakness. The risk of developing pelvic organ prolapse may be less with a cesarean delivery than with a vaginal delivery. As women age, the supporting structures in the pelvis may weaken, even if a woman has never been pregnant. As a result, pelvic organ prolapse is more likely to develop. Having a hysterectomy may also weaken the structures in the pelvis, increasing the risk of pelvic organ prolapse. Increased pressure on the pelvic floor for a long time, usually many years, may also contribute to pelvic organ prolapse. Frequently straining the pelvic area (for example, because of constipation), having a chronic cough, or frequently lifting heavy object can increase this pressure. Less common factors that may contribute to pelvic organ prolapse include disorders that increase pressure in the abdomen and thus on pelvic organs, such as accumulation of fluid within the abdomen (ascites) and tumors in the abdomen. Disorders of nerves to the pelvic floor and disorders of connective tissue may also contribute. (Connective tissue is the tough, often fibrous tissue that is present in almost every organ, including muscles, and that provides support and elasticity.) Rarely, women have birth defects that affect this area or are born with weak pelvic tissues. 