Pelvic Prolapse
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Pelvic Prolapse
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Pelvic Organ Prolapse Quantification System - Wikipedia
Pelvic Organ Prolapse , Animation - YouTube
Pelvic Organ Prolapse - Physiopedia
Pelvic Organ Prolapse (POP) - Women's Health Issues - MSD Manual...
Pelvic Organ Prolapse - American Family Physician
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Original Editor - Laura Ritchie , posting on behalf of Lauren Kalvaitis, MPT Class of 2016 at Western University , project for PT9583
Pelvic floor prolapse is the herniation of the pelvic organs through the perineum. Depending on the pelvic organ involved, pelvic prolapse further categorizes into:
Pelvic prolapse is very common among multiparous women over 50 (affects approximately 50% of women over age 50). Symptoms include fecal or urinary incontinence, uterine prolapse, constipation, or incomplete defecation. Pelvic prolapse can negatively impact the patient's body image and sexuality. Pelvic prolapse treatments range from non-surgical approaches like Kegel exercise and pessary to various surgical procedures. Treatments of pelvic prolapse significantly contribute to the healthcare cost in the United States, estimated at approximately $300 million from 2005 to 2006 [1] .
Please see this page for a detailed overview of pelvic floor anatomy.
Pelvic organ prolapse has a multifactorial etiology. It is likely caused by a combination of physiological, anatomical, reproductive, genetic and lifestyle factors that interact and contribute to dysfunction of the pelvic floor. [4]
A variety of symptoms may be present including:
The factors causing pelvic organ prolapse are different between patients. [4] Risk factors include the following:
Pelvic Organ Prolapse Recurrence (after native tissue repair)
As prolapse treatment options expand to include more conservative choices, greater awareness and education is needed among women and professionals about these as a first line treatment and preventive measure (alongside a multi-professional team approach) [8] .
Women presenting with prolapse symptoms need to be [8]
A qualitative research developed a conceptual model that explores the experience of living with a POP, and the model indicated that: the physical losses of POP are linked to loss of identity; women conceptualized POP as part of womanhood, and a vicious cycle of taboo, silence, and misunderstanding about POP and its treatment. And further, POP is not taken seriously in healthcare [9] .
Treatment for pelvic organ prolapse usually involves either conservative management (for mild prolapse or women who are not good surgical candidates) or surgery. Conservative treatments include pelvic floor muscle training and the use of devices (pessaries). [5]
Physical therapists play a major role in the nonsurgical management of POP. Along with pessary support, pelvic-floor muscle training (PFMT) is cited in highly credible reviews as a main nonsurgical option for women with POP. [10]
For all the information re retraining these muscles see the physiotherapy section of Pelvic Floor Dysfunction and Kegel's Exercises
In a study by Panman et al in 2016, examining the two-year effects of pelvic floor muscle retraining, it was demonstrated that in women aged 55 and greater with symptomatic mild pelvic organ prolapse, pelvic floor muscle retraining results in a significant decrease in pelvic floor symptoms when compared to watchful waiting (note: statistically significant but below the minimal clinically important difference). Additionally, it was found that pelvic floor muscle retraining was more effective in women who experienced increased pelvic floor symptom distress at baseline. Conversely, the same study found no difference in sexual functioning, quality of life, function of the pelvic floor muscles or degree of prolapse.
A randomised control trial [11] compared the effect of intravaginal vibratory stimulation (IVVS) with intravaginal electrical stimulation (IVES) in women with pelvic floor dysfunctions, unable to voluntarily contract the pelvic floor muscles. The results showed improvement with both techniques, with IVVS superior to IVES in improving pelvic floor muscle strength.
Pelvic floor muscle retraining included: (Kegel exercises diagram in illustration)
This presentation was created by Carolyn Vandyken, a physiotherapist who specializes in the treatment of male and female pelvic dysfunction. She also provides education and mentorship to physiotherapists who are similarly interested in treating these dysfunctions. In the presentation, Carolyn reviews pelvic anatomy, the history of Kegel exercises and what the evidence tells us about when Kegels are and aren't appropriate for our patients.
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