Pelvic organ prolapse (POP) is a common problem among Asian women although most are hesitant to seek help due to the stigma associated with the condition.
Pelvic floor disorders affect the proper functioning of a woman’s pelvic organs as well as issues related to bladder or bowel control functions, due to the sagging or prolapse of these organs.
Collectively known as urogynelogic disorders, pelvic floor disorders can include:
- Pelvic organ prolapse (POP), often described as a fallen bladder, uterus, vagina or rectum.
- Urinary incontinence, which can be divided into stress incontinence (tiny leaks that occur when a motion like coughing or sneezing stresses the bladder), or urge incontinence (the urge to go to the toilet followed by an involuntary loss of urine).
- Faecal incontinence, which is the involuntary loss of solid or liquid stool
- Fistulas, which can either be vesicovaginal or rectovaginal; the leakage of either urine or faeces caused by an opening between the wall of the vagina and the wall of the bladder or rectum.
What is POP and who is at risk?
Dr Harvard Lin, Consultant Obstetrician, Gynaecologist and Urogynaecologist at the Asian Obstetrics & Gynaecologic Centre (AOGC), explains, “POP refers to a condition where the pelvic floor muscles become weakened and are unable to adequately support organs such as the vagina, uterus, bladder, and rectum. When these muscles are damaged and/or lose their strength/become weak, the organs may descend, and in severe cases, protrude through the vaginal opening, causing a noticeable bulge.”
“Many reasons can contribute to the problem, such as vaginal childbirth, prolonged abdominal pressure and menopause. Oestrogen plays a crucial role in maintaining the strength, health, and lubrication of pelvic tissues. Decreased oestrogen levels can result in thinner, drier, and less elastic vaginal muscles and tissues; making women more susceptible to prolapse as they age,” says Dr Lin.
Individuals who work in occupations that require prolonged standing or heavy lifting, those who often suffer from constipation, as well as people who suffer from chronic coughing that exert continuous pressure on the abdominal muscles have a significantly higher risk of POP.
Types of POP
There are various types of prolapse, depending on the location of weakness within the pelvic region and the affected organs. The more common types include:
- Cystocele: The most prevalent type of POP, affecting approximately 50% of women where the bladder descends into the vagina.
- Uterine prolapse: Occurs when the uterus descends into the vagina.
- Vaginal vault prolapse: When the top of the vagina loses support and sags.
POP can occur either by itself or together with urinary or faecal incontinence.
What are the symptoms of POP?
According to Dr Lin, in its early stages, vaginal prolapse often presents with mild symptoms such as a dragging discomfort within the vagina and an increased need to urinate.
“If no treatment is sought at this stage and the organs are left to descend, the patient may experience more pronounced symptoms including tissues protruding from the vagina, painful sexual intercourse, urinary difficulties, stress urinary incontinence (SUI) while coughing or sneezing, and recurrent urinary tract infections due to urinary retention. If treatment is still not sought, her case may increase in severity, often leading to kidney damage as a result of kidney obstruction.”
What are the available treatments?
Conservative treatments for POP include the use of removable vaginal pessaries. These devices, typically made of latex, plastic, or silicone, are inserted into the vagina to provide support in the area affected by prolapse. The three common types of pessaries used are the ring pessary, which is often the first choice for clinicians due to its ease of insertion and removal; the donut and the Gellhorn pessary.
“Pessaries are suited for those who are not ideal candidates for surgery or those who want to avoid surgery. However, there are some drawbacks. Some patients may find the treatment cumbersome and uncomfortable, as they are expected to return to their healthcare providers every four to five months for follow-ups and maintenance,” says Dr Lin.
He adds pessaries may be unable to effectively address advanced cases of prolapse where kidney damage has set in. In such cases, Dr Lin recommends surgical correction.
“Surgical procedures for POP fall into two main categories, which are the vaginal mesh surgery, which involves the permanent installation of a plastic mesh into the vagina to support and hold the pelvic organs in place; or reconstructive surgery, which offers a safer alternative to mesh surgery. This involves removing the prolapsed organ, for example the uterus, and repairing the vagina by stitching it to a ligament or pelvic muscle. In more severe cases of POP, a more aggressive type of surgery may be performed utilising a surgical mesh attached to the front and back of the vagina, and secured to the tailbone to lift the vagina back into place,” he explains.
While POP surgeries are fairly common, like all surgical procedures they carry risks including bleeding, wound infection, blood collection and the accumulation of pus or infected fluid. However, Dr Lin assures these complications can be effectively managed through fluid drainage and antibiotics.
Many Asian women do not take POP seriously, resulting in a delay in diagnosis which then limits treatment options that can effectively treat the problem.
“More often than not, Asian women tend to dismiss or downplay the symptoms associated with POP as a normal part of ageing and hesitate to seek help. While POP is not life-threatening, women experiencing symptoms such as bulges in their vaginal area, difficulty urinating, incontinence or recurring infections should consider consulting a doctor, especially when these symptoms start to affect their quality of life,” says Dr Lin.
To prevent or delay the weakening of the pelvic floor as women age, he strongly recommends regular Kegel exercises for all women, even if they do not have any symptoms, to strengthen the pelvic floor muscles.
“While the exercises may not correct the prolapse, they can help control symptoms and limit the worsening of prolapse. It’s recommended to performing four sets of 10 reps each day at least, for a total of 40 Kegels a day
Like any form of exercise, Kegels must be done consistently to notice results.”
Featured photo from Shutterstock.
Dr Harvard Lin photo courtesy of Dr Harvard Lin.