Factors Increasing Pelvic Organ Prolapse
Pelvic organ prolapse is a medical condition that may be caused by several reasons. Some of the factors contributing to an increase in pelvic organ prolapse chances are “The damage of the supporting fascial-ligamentous structures of the pelvis predispose to POP,4 and the risk factors include pregnancy, childbirth and birth weight, parity, previous pelvic surgery and menopause. Conditions such as a chronic cough, asthma, constipation, carrying heavy loads, or obesity predispose and worsen prolapse” (Tseng, 2015, p. 40).
Symptoms of Pelvic Organ Prolapse
The symptoms leading to detecting pelvic organ prolapse may be both asymptomatic and symptomatic. The signs usually become gradually worse unless detected and treated in time. Some of the most significant symptoms include directly seeing or being able to feel the prolapse itself, vaginal heaviness, suprapubic or pelvic discomfort, dyspareunia, pain or other troubling sensations when having sexual intercourse, aches in the lumbar spine area, and vaginal discharges or bleeding.
At least one of the symptoms (vaginal heaviness or, as reported by the patient “fullness”) is present. Although most of the most significant symptoms (including the direct visual affirmation of a prolapse) are absent, pelvic organ prolapse may be considered one of the most probable diagnoses.
Types of Pelvic Organ Prolapse
There are five known types of pelvic organ prolapse: cystocele, enterocele, rectocele, uterine prolapse, and vaginal vault prolapse. Cystocele refers to bladder prolapse. Enterocele is a small bowel prolapse; rectocele prolapse is a rectum prolapse. Finally, uterine prolapse is the prolapse of the uterus.
Since the patient’s first complaint was a vaginal heaviness, both uterine prolapse and vaginal vault prolapse are possible. It is impossible to determine which type of prolapse the patient is experiencing (if any) without having a thorough examination. However, vaginal vault prolapse is often coupled with a small bowel prolapse, which further supports the need for an examination.
Vaginal Estrogen Role
Vaginal estrogen is used to treat pelvic organ prolapse. The application of estrogen before surgical treatment increases the chances of quicker recovery. As stated by Rahn et al. (2015), “vaginal estrogen application before pelvic organ prolapse surgery improved the vaginal maturation index and increased vaginal epithelial thickness” (p. 3). Therefore, it is possible to suggest that vaginal estrogen must be applied if surgical treatment is required.
Indications of Surgery
The most significant sign that would allow suggesting that surgery is necessary would be the most prominent symptom of pelvic organ prolapse – seeing the prolapse directly. However, as stated before, the patient did not report this symptom. This lack of evidence supporting the need for a surgical intervention implies that nonsurgical treatment would probably be the most recommended course of action. Nevertheless, as stated before, unless an examination is carried out, there is no certainty in saying that surgery must be avoided.
Although there are certainly signs of pelvic organ prolapse in the patient, a full examination may demonstrate that the treatment is not necessary. After all, there are cases of prolapse that do not require immediate intervention, if any at all. However, the patient reported that the symptoms were lasting. Therefore, other options must be considered. These options include lifestyle and behavior adjustments, pelvic floor physical therapy, and the implementation of specialized vaginal devices.
Rahn, D. D., Ward, R. M., Sanses, T. V., Carberry, C., Mamik, M. M., Meriwether, K. V., … Murphy, M. (2015). Vaginal estrogen use in postmenopausal women with pelvic floor disorders: systematic review and practice guidelines. International Urogynecology Journal, 26(1), 3-13.
Tseng, A. (2015). Pelvic organ prolapse. Current management approaches to a common problem. Web.