Prolapse of the reproductive organ

Genital prolapse (Genital Descensus) is a change in the position of the uterus and vagina due to muscle stretching, but it's not limited to that! It also involves the lowering of the urinary tract, small intestine, and rectum, as well as sexual dysfunction. Not all of these changes always occur simultaneously; sometimes you may not even notice them or suspect other conditions. Therefore, it's worth learning more about it, seeking specialist advice, and getting help, as not every change of this type requires plastic surgery.

Natalia Stopa-Harasiuk, M.A. , a urogynecological therapist accredited by the Polish Urogynecological Society, about the problem of pelvic organ prolapse

Causes of prolapse of the reproductive organ

Many factors contribute to impaired pelvic floor statics. The most common causes of these anatomical abnormalities include damage to the myofascial-neural structures within the pelvic floor . This damage can result from mechanical trauma, such as childbirth, but also from pelvic floor surgery . Aging can also cause pelvic floor prolapse, caused by hormone deficiencies (estrogens, androgens), which leads to impaired structure and function of proteins responsible for the mechanical strength of pelvic floor tissues.

You may simply be predisposed to pelvic organ prolapse. This can be facilitated by specific anatomy, congenital collagen synthesis disorders, and contributing factors such as chronic cough, obesity, and current or past heavy physical labor. According to available epidemiological data, 50% of multiparous women experience pelvic organ prolapse, yet only 10% require surgical intervention.

Symptoms of pelvic floor static disorders

One of the most bothersome symptoms of pelvic organ prolapse is discomfort during urination: frequent urination, urgency, feeling of incomplete emptying of the bladder, difficulty in starting urination .

Equally troublesome are defecation disorders: constipation, feeling of incomplete defecation, discomfort during defecation, feeling of urge to defecate.

Other symptoms reported by patients include: a feeling of heaviness, pain in the lower abdomen, perineum, or sacral spine, abdominal discomfort, and a palpable spherical foreign body in the vagina . These can also be consequences of pelvic organ prolapse, which you may not even associate with this problem.

What are the types of pelvic organ prolapse?

Depending on the degree of reduction, we distinguish:

I degree – the prolapsed part of the uterus or vagina does not exceed the vestibule of the vagina
II degree – the prolapsed part of the uterus or vagina reaches the vestibule of the vagina
III degree – the prolapsed part of the uterus exceeds the vestibule of the vagina and is visible externally (partial or complete prolapse of the reproductive organ)

Depending on the type of defect, we distinguish:

• urethrocele – damage to the ligamentous structures supporting the urethra
• cystocele – damage to the vesico-vaginal fascia
• enterocele – damage to the uterosacral ligaments
• rectocele – a lesion of the rectovaginal fascia
• in addition to the above, defects also include prolapse of the uterus and vagina

Reproductive organ dysfunction requires specialized diagnostics and an appropriate therapeutic approach. Health awareness and the desire to maintain a healthy quality of life are increasing among women, so more and more women struggling with this problem are seeking specialist help. In this case, making a proper diagnosis requires understanding the exact cause of the dysfunction, which is why examination and treatment are performed by a specialist in urogynecological physiotherapy .

This field is primarily concerned with restoring proper tension, particularly in the pelvic area. The entire process should be based on the premise that the female pelvis is composed of interconnected structures and that there is a close connection between its structure and function.

Prolapse of the reproductive organ – treatment

The most important step is to properly diagnose the type and severity of the disease . The patient's age is a secondary consideration. For first- and second-degree (IIa) uterine prolapses, conservative treatment is recommended, consisting of pessary therapy and therapy with a urogynecological physiotherapist. Pelvic floor exercises and education on how to change daily habits are key to treatment.

Local estrogen therapy is used in postmenopausal patients. If urinary urgency occurs, bladder conditioning and pelvic floor exercises are recommended.

When conservative treatment is not possible, depending on the severity of the pelvic organ, bladder, or rectum prolapse, appropriately selected surgical methods are used. Surgeries are performed via vaginal, laparoscopic, or abdominal approaches.

After surgery, it's recommended to seek postoperative physiotherapy consultation . The foundation of proper recovery is educating the patient on how to avoid engaging the abdominal wall, how to perform daily activities without straining the pelvic floor muscles, and how to learn how to activate these muscles.

Source:

1. Interdisciplinary guidelines of the Polish Urogynecological Society regarding the diagnosis and treatment of pelvic organ prolapse; https://ptug.pl/
2. Interdisciplinary guidelines of the Polish Urogynecological Society regarding physiotherapeutic treatment of functional disorders of the pelvic organs; https://ptug.pl/
3. Etiology and risk factors of female reproductive organ prolapse and urinary incontinence Curr Gynecol Oncol 2019, 17(2), p. 69–77
4. Risk factors for pelvic floor defects in women scheduled for reconstructive surgery – a Polish multicenter study; Ginekol. Pol. 2010, 81, 821-827