هبوط أعضاء الحوض

What’s Pelvic Organ Prolapse?

Pelvic Organ Prolapse (POP) is a condition in which one or more of the pelvic organs—such as the bladder, uterus, rectum, or small intestine—descend from their normal positions and bulge into or out of the vaginal canal due to weakened or damaged pelvic floor muscles and connective tissues.

Causes:

The pelvic floor muscles and ligaments support the pelvic organs. When these structures become stretched, weakened, or injured, they can no longer hold the organs in place. Common causes include:

• Childbirth (especially vaginal delivery)

• Aging and menopause (decreased estrogen levels)

• Chronic constipation or straining during bowel movements

• Heavy lifting or chronic coughing

• Obesity

• Previous pelvic surgery, including hysterectomy

Types of Pelvic Organ Prolapse:

1. Cystocele (Anterior Prolapse): Bladder drops into the front wall of the vagina.

2. Rectocele (Posterior Prolapse): Rectum bulges into the back wall of the vagina.

3. Uterine Prolapse: Uterus descends into the vaginal canal.

4. Enterocele: Small intestine pushes into the upper part of the vagina.

5. Vaginal Vault Prolapse: Occurs after hysterectomy, when the top of the vagina descends.

Symptoms:

• A feeling of pressure, fullness, or heaviness in the pelvic area

• A visible or palpable bulge in the vagina

• Discomfort or pain during intercourse

• Urinary problems (incontinence, urgency, incomplete emptying)

• Difficulty with bowel movements

• Lower back pain

• Sensation of something “falling out” of the vagina

Symptoms may worsen after standing, lifting, or at the end of the day.

Diagnosis:

POP is typically diagnosed through a pelvic examination by a healthcare provider, who may also use imaging studies like ultrasound or MRI for detailed assessment. A grading system (e.g., POP-Q) is often used to determine severity.

Treatment Options:

Conservative Management:

• Pelvic floor physical therapy

• Kegel exercises to strengthen the pelvic muscles

• Pessary (a removable device inserted into the vagina to support organs)

• Lifestyle changes (weight loss, avoiding heavy lifting, treating constipation)

Surgical Options:

• Vaginal or abdominal repair surgeries

• Uterine suspension or hysterectomy (in severe cases)

• Mesh augmentation (use of synthetic mesh, although controversial and regulated)

Prevention:

• Maintain a healthy weight

• Do pelvic floor exercises regularly

• Avoid chronic straining and manage constipation

• Treat chronic cough or respiratory conditions

• Use proper techniques when lifting heavy objects