Urogynecology & Pelvic Organ Prolapse 1
The field of Urogynecology is a subspecialty within Obstetrics and Gynecology and is dedicated to the study and treatment of pelvic floor disorders in women, in all the various ways that it can present itself. Urogynecology involves the diagnosis and treatment of urinary incontinence and female pelvic floor disorders.
Incontinence and pelvic floor problems are remarkably common but many women are reluctant to receive help because of the stigma associated with these conditions.
Pelvic floor conditions are more common than hypertension, depression, or diabetes. One in three adult women have hypertension; one in twenty adult women have depression; one in ten adult women have diabetes; and more than one in two adult women suffer from pelvic floor dysfunction.
Pelvic Relaxation or Pelvic Organ Prolapse occurs when the female pelvic organs fall from their normal position, into or through the vagina. Occurring in women of all ages, it is more common as women age, particularly in those who have delivered large babies or had exceedingly long pushing phases of labor. Smoking, obesity, connective tissue disorders, upper respiratory disorders‚ and repetitive strain injuries can all increase prolapse risk.
- Minor prolapse can be treated with exercises to strengthen the pelvic floor muscles; more serious prolapse, e.g., complete procidentia, requires pessary use or reconstructive surgical treatment. Reconstructive pelvic prolapse surgery may be done without resorting to complete hysterectomy by hysteropexy, the resuspension of the prolapsed uterus.
- Traditional gynecologic practice favors removal of the uterus or ovaries (or both) at the time of prolapse surgery, and one estimate states that of the 600,000 hysterectomies performed in the United States every year, 13 percent are for prolapse. However, there is concern that many of these hysterectomies may be unnecessary and that hysteropexy would suffice as a treatment instead.
- The rectum or urinary bladder may also prolapse as a result of changes in the integrity of connective tissue in the posterior or anterior vaginal walls, respectively. Symptoms may include a feeling of pressure in the pelvis, or the visible protrusion of organs from the vagina. This is known as severe pelvic organ prolapse POP-Q grade 3-4.
- Most of the patients do not receive treatment because the symptoms are not noticeable or not severe. Anyway, there are some people who do not go through a treatment course because of their shyness or because they do not know that pelvic organ prolapse can be treated. Although some studies found that there are a large number of people having pelvic organ prolapse in the world, not many people actually seek for their medical treatment. The reason of this situation can possibly be the thought that pelvic organ prolapse is just only a natural cause and cultural customs which are different in each country.
The cause of pelvic organ prolapse is pelvic area muscle degeneration. Its factors are:
- Age, especially when reaching menopausal age which estrogen is not produced sufficiently.
- Pregnancy and vaginal delivery, especially in difficult birth and instrumental vaginal delivery
- Circumstances where there are increase of abdominal pressure such as coughing, chronic sneezing, constipation, lifting heavy objects and obesity
Pelvic organ prolapse can be categorized as:
- Uterine prolapse
- Anterior vaginal wall prolapse
- Posterior vaginal wall prolapse
- Occurrence of all mentioned above at a time
The symptoms of pelvic organ prolapse are divided into 3 groups:
1) General symptoms directly associated with pelvic organ prolapse:
- A woman complains she feels ‘full’ or ‘heavier’ than normal.
- Difficulty in walking or running associated with severe uterine prolapse.
- Enlarged, wide, and gaping vaginal opening, this is a common symptom of a vaginal vault prolapse.
- Protrusion of tissue at the back wall of the vagina, this is a common symptom of a rectocele.
- Protrusion of tissue at the front wall of the vagina, this is a common symptom of a cystocele or urethrocele.
- Pain that increases during long periods of standing, this may be indicative of an enterocele, vaginal vault prolapse, or prolapsed uterus.
2) Symptoms of Pelvic Organ Prolapse associated with sexual intercourse:
- No gratification or orgasm
- Infrequent sexual intercourse
- Urinary incontinence while having the sexual intercourse