Preventing Pelvic Organ Prolapse

Pelvic organ prolapse is a distressing health condition in women related to the descent of the uterus or neighboring organs from their original location in the pelvis through the pelvic floor. This is due to a loss of pelvic support, and can decrease the quality of life by producing symptoms related to the urethra, bladder, and vagina. It can also produce psychological and emotional distress.

It is more common in women who have had more than one delivery, difficult births, or large babies. Other factors which push down the pelvic organs against the pelvic supports are also operative in many cases. The failure of the levator ani muscles, which make up the primary component of the pelvic diaphragm, is key to mediating the effect of these factors on pelvic organ support.

The prevalence of pelvic organ prolapse is between 30% and 40%.

Prevention of Pelvic Organ Prolapse

Many studies have focused on identifying the risk factors and mechanism of pelvic organ prolapse. Without finding these factors, prevention is difficult.

Giving birth vaginally is the most important predisposing factor in pelvic organ prolapse, but can obviously not be avoided in all women. However, women with a high risk of prolapse may be offered an elective Caesarean section. This risk may be measured in terms of risk factors such as:

• Fetal weight over 4 kg
• Maternal height less than 160 cm
• Urinary incontinence predating pregnancy
• Racial origin
• Younger age at first vaginal delivery
• Body mass index
• Family history of pelvic floor dysfunction

Reducing Pressure on the Pelvic Floor

There are several methods that can help to reduce pressure on the pelvic floor and thus decrease the risk of pelvic organ prolapse.

For example, regular pelvic floor exercises (Kegel’s exercises, with or without biofeedback) have been supposed to prevent prolapse by strengthening the muscular supports of the pelvis. However, objective evidence is lacking on the long-term success of this approach.

Other recommendation to reduce the pressure of the pelvic floor include:

• Losing weight if required, or keeping to a healthy weight
• Preventing straining at stools by including adequate fiber in your diet, through plenty of fresh fruits and vegetables, as well as whole grains.
• Using the right lifting techniques to avoid putting strain on your pelvic muscles while lifting heavy things
• Quitting smoking which weakens the muscles, and induces chronic cough

Preventing Recurrence Following Surgery

Another important factor contributing to pelvic organ prolapse is a history of certain types of surgery on the reproductive tract.

A vaginal hysterectomy with a McCall culdoplasty to buttress the vault of the vagina is one procedure which can reduce the incidence of this condition. Using a vaginal vault support procedure when repairing a prolapse vaginally could prevent its recurrence to some extent.

A total or subtotal abdominal hysterectomy is not found to prevent pelvic organ prolapse.

Preventing Recurrence with Estrogens

The role of estrogens has been tested in preventing pelvic floor weakening as a result of urogenital atrophy following the onset of peri- and post-menopausal hormonal reductions.

Topical estrogen treatment may be more useful than systemic administration, because of the reduction in side effects and the lower dosage necessary. Estrogen improves the strength of the muscular, ligamentous, and mucosal components of the pelvic supports.

References

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166938/
• http://www.voicesforpfd.org/p/cm/ld/fid=25
• https://medlineplus.gov/pelvicsupportproblems.html#cat93
• http://www.nhs.uk/conditions/Prolapse-of-the-uterus/Pages/Introduction.aspx