The word “prolapse” comes from a Latin word meaning “to fall out of place,” which is an apt description of what happens with pelvic organ prolapse, or POP. POP occurs when an organ in the pelvic region (typically the bladder, uterus, or part of the vagina) “falls” and shifts position, sometimes protruding outside of the vagina. Urinary incontinence is the most common symptom of POP.
As of 2009, approximately 3.3 million women in the US alone were estimated to be affected by POP. Based on census data and an aging population, the incidence of women with POP is expected to increase dramatically. By the year 2050, the number of women undergoing surgery for POP is projected to increase by nearly 50%. This data forewarns us that approximately 1 out of every 5 women in the US will undergo some sort of surgery for pelvic organ prolapse in her lifetime. That’s a lot of POP—and a lot of surgery!
So why have so few women heard of pelvic organ prolapse? That’s one of the questions Sherrie Palm asked when she was faced with it herself. This newsletter started out as a review of her book, Pelvic Organ Prolapse: The Silent Epidemic, in which she shares her personal history (including a hysterectomy and subsequent POP), her quest for information, her decision to have surgery to correct POP, and the aftermath of that surgery. Her book will undoubtedly prove to be a valuable resource to many women experiencing POP or considering a hysterectomy.
In reading through Sherrie’s book, as well as others on the topic, we found ourselves also asking: Why?
- Why do so many women experience prolapse?
- Who do so few women (even medical professionals) talk about prolapse?
- Why do so many women have surgery?
- Why do so many women regret having that surgery, even though it may have “fixed” their symptoms?
We think the answers to these questions are important to explore, with the hope that it might mean that fewer women will experience pelvic organ prolapse and that fewer women will have to face a difficult decision regarding pelvic surgery.
First, we will review definitions and provide a little background on pelvic organ prolapse (POP).
Types of Pelvic Organ Prolapse
There are different types of prolapse (see figures) and all can occur in varying degrees. Some women experience no symptoms, while the symptoms for others can be debilitating and life-altering.
Bladder prolapse (cystocele) is the most common form and is frequently accompanied by urinary incontinence. If the muscles and connective tissue that hold the bladder in place become weak, stretched, or injured, the bladder can fall away from its natural spot and press against the vaginal wall, causing discomfort and potentially forming a bulge in the vagina. The urethra can also collapse (urethrocele) if not properly supported by the muscle tissue around it.
Uterine prolapse can occur if the muscles and ligaments of the pelvic floor and surrounding tissue are weak. Without enough support, the uterus may fall from its normal position into the cervix, creating a bulge in the vagina.
Vaginal prolapse (also called vaginal vault prolapse) is quite common after a hysterectomy (surgery to remove the uterus), but not everyone who has a hysterectomy experiences POP. Without the uterine attachments to hold it up, the top of the vagina can drop into the vaginal canal.
Other forms of prolapse (not shown) involve the small bowel (enterocele) and rectum (rectocele). If the tissues and muscles surrounding these areas become weak or damaged, they also can fall against the wall of the vagina, causing pressure or a bulge.
The precise cause of pelvic organ prolapse may be hard to determine, as there are often multiple factors at work, including genetics, vaginal childbirth, hysterectomy or other pelvic surgery, obesity, heavy lifting, chronic cough, chronic constipation, and age-related hormone loss or other hormone imbalances.
The majority of women with POP most likely have given birth to one or more children. The stress on connective tissue as the baby grows, the pressure of the uterus and increasing weight on the pelvic floor, the abdominal strain during labor, and general trauma to the overall pelvic region during vaginal delivery all enhance the risk of POP.
Surgical repair after childbirth is common, but not always effective. The repair itself can lead to other discomfort or health problems, and subsequent surgery, especially if the mesh fails or the patient has an allergic reaction to the mesh.