A Lump or Mass That Can Be Felt, Indicating Uterine Prolapse

     Sagging or laxity, whether in the upper or lower body, can cause issues. This chapter focuses on pelvic organ prolapse (POP), characterized by a protrusion or lump felt in the vaginal area. Pelvic organ prolapse occurs when pelvic organs—such as the uterus, bladder, or bowel (and in cases of a prior hysterectomy, the vaginal vault)—descend from their normal position.

Symptoms of Pelvic Organ or Uterine Prolapse

     Symptoms can affect various systems, including the urinary system (difficulty urinating, frequent urination, inability to urinate, or urinary tract infections) and the digestive system (difficulty passing stool, incomplete evacuation, or fecal incontinence). Other symptoms include pelvic pain, back pain, a heavy sensation in the vagina, difficulty walking or sitting due to the protrusion, pressure sores, bleeding, or infected wounds.

Risk Factors for Pelvic Organ Prolapse

• Vaginal delivery: Having one vaginal birth doubles the risk of developing pelvic organ prolapse.
• History of difficult labor, such as delivering a large baby.
• Age: The risk doubles every 10 years between the ages of 20 and 59.
• Ethnicity.
• Obesity.
• History of prior pelvic surgery.
• Chronic conditions that increase intra-abdominal pressure, such as constipation, chronic cough, or heavy lifting.
• History of connective tissue disorders.

Severity Levels of Pelvic Organ Prolapse (POP-Q System)

• Stage 0: No prolapse is identified.
• Stage I: The organ has descended but remains more than 1 cm above the hymen.
• Stage II: The organ has descended to within 1 cm above or below the hymen.
• Stage III: The organ has descended more than 1 cm below the hymen but not entirely.
• Stage IV: Complete eversion; the organ has descended entirely past the hymen.

Measuring Pelvic Organ Prolapse using the POP-Q System

Treatment for Pelvic Organ Prolapse Includes:

1.  Nonsurgical Methods

     Pelvic floor muscle exercises (Kegels) can improve strength and provide better prevention. Reducing risk factors, such as weight loss, treating chronic cough, and avoiding heavy lifting, is also recommended.

2.  Pessary Treatment

     Recommended for patients with underlying medical conditions that make surgery risky, or for those who prefer not to undergo surgery.

3.  Surgical Methods

     Surgical treatments can be performed via vaginal, abdominal, or laparoscopic (minimally invasive) approaches to repair the prolapse.