Menopause and Pelvic Organ Prolapse

As we continue to make progress in addressing women’s health in the post-reproductive years, it is important to confront the most difficult and uncomfortable of topics in search of assistance and information for the female population. One of these topics – pelvic organ prolapse – is a source of incredible discomfort for a huge number of women, both on a physical and emotional level.

What is Pelvic Organ Prolapse?

The word “prolapse” means a slipping forward or down of a part or organ of the body. Pelvic organ prolapse occurs when one or more of the female pelvic organs bulge or drop down through the vagina. The pelvic organs involved include the uterus, bladder, bowel and vagina itself.

What Causes It?

Pelvic organ prolapse does not seem to occur for any one particular reason, though there are a number of factors which make a person more prone to the condition:

  1. Childbirth – Women who have given birth to a number of children, or who have experienced a particularly difficult labour are more prone to a prolapse condition. Pelvic organ prolapse is said to affect approximately 50% of women who have given birth.
  2. Menopause – The hormonal changes which women undergo during menopause can give rise to pelvic organ sagging. Menopause is also associated with general weakening in the tissues that support the pelvic organs. The ageing process is a natural contributor to this process also.
  3. Pelvic Pressure – Growths in the uterus such as fibroids or cysts can put pressure on pelvic muscles. Issues with weight and obesity can also affect the strength of the pelvic area.

What are the types of Pelvic Organ Prolapse?

A prolapse can affect the top, back or front of the vagina.

There are five main types of prolapse:

  1. Cystocele – where the bladder bulges into the front wall of the vagina. This can cause stress incontinence especially on sneezing and coughing.
  2. Enterocele – this occurs when the back and front vaginal walls separate, allowing the small bowel to press against the vagina. This is more common after women have undergone a hysterectomy.
  3. Rectocele – this occurs when the back of the vagina weakens and the rectum prolapses into the vagina. This condition may cause a bulge which is very noticeable and uncomfortable for the sufferer.
  4. Uterine Prolapse – This occurs when the ligaments supporting the top of the vagina weaken, in turn causing other ligaments elsewhere to weaken, allowing the uterus (womb) to prolapse. This can have differing degrees of severity in terms of how low the uterus drops into the vagina.
  5. Vaginal Vault Prolapse – This occurs when the upper portion of the vagina loses its normal shape and drops down. This again can occur after the performance of a hysterectomy and can often occur in combination with one of the other types of prolapse listed above.

Uncomfortable Symptoms

As you would imagine, from the conditions listed above, pelvic organ prolapse is an incredibly difficult condition for women to cope with.

Common symptoms (which can be experienced frequently or constantly) include:

  • A feeling of heaviness in the pelvic area
  • A bulging sensation in the vaginal area
  • Backache
  • Incontinence
  • \Discomfort during sex

These symptoms can be embarrassing and worrying for women as they carry on their daily lives. Women can struggle with incontinence and discomfort in social situations, and their intimate relationships can also suffer given the bodily changes they are experiencing. This can be a very upsetting time, and women can be shy to address these issues with their GPs or seek assistance and information from other health professionals.

What can be done to help?

As with any health condition arising during the menopause or otherwise, women should be made to feel comfortable talking about the changes happening to their body. Pelvic organ prolapse is a very common condition and women should never feel embarrassed in discussing in detail the symptoms they are going through. All women should feel completely comfortable and entitled to seek appropriate advice in helping them deal with the issue as best they can.

In mild cases, simple steps can be taken in terms of pelvic floor exercises and weight to alleviate symptoms. Women may be referred for specialist physiotherapy and they should investigate this option with their GP surgery. Women should also seek counselling and emotional support if they feel they are suffering on a psychological level with the effects the condition can involve.

Other options for more severe symptoms include the insertion of a ring pessary into the vagina which can help hold the prolapsed organ in place. This can be fitted in an outpatient clinic, no surgery is needed. Ring pessaries do carry associated risks of vaginal irritation, discharge and infection however, and women should be made aware of these risks.

Surgical Options

Women should be advised that surgery may be an option for treating pelvic organ prolapse, but only if it is truly warranted in the circumstances and it is felt that the benefits outweigh the risks. All patients should be aware of the differing surgical options and the risks associated with each.

  1. Surgical repair can occur in the stitching of prolapse organs back into place to support the existing tissues. This is not necessarily always successful however, and the prolapse can return.
  2. Vaginal Mesh is also used to support the vaginal wall and internal organs. These meshes have been associated with a number of complications however, and there have been many reports of persistent pain, sexual problems, and injury to other organs involving their use. Women should be very careful in considering the insertion of a vaginal mesh as a result.
  3. If the uterus is prolapsed, a hysterectomy can be performed. This involves the removal of the uterus, allowing the vagina to maintain better support. A hysterectomy is a very major operation, and women should be advised of the procedure involved, as well as any possible complications and side effects. Careful consideration of this as an option should take place in advance of any final decision.

Time to Talk

As a clinical negligence solicitor, with a number of female clients, I am all too aware of the traumatic times women can experience in dealing with pelvic organ prolapse and all the symptoms it can include. Women should rest assured that there is medical assistance available in terms of their struggle, and there are many sympathetic and understanding ears out there, ready to listen. As we all become more aware of the daily struggles that women endure, so can the medical world react to the improvements needed.

Women should be aware of all their options in terms of treatment for pelvic organ prolapse, as well as the risks and side effects associated with them. As always, menopause is a time to ask questions, as we all work to ease the physical and emotional discomfort women suffer too bravely and all too quietly.