Management of Prolapse || obstetrics & gynecology

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Pelvic organ prolapse (POP or female genital prolapse) is the protrusion of bladder, rectum, intestines, uterus, cervix, or vaginal apex into the vaginal vault due to decreased pelvic floor support. It is commonly seen in women of advanced age. Other risk factors include multiparity (particularly vaginal births), prior pelvic surgery, connective tissue disorders, and increased intra-abdominal pressure secondary to obesity or chronic constipation. Patients present with a sensation of vaginal pressure, discomfort, and/or pain. The protruded pelvic organ is visualized and assessed during inspection. Low-grade prolapse can be managed conservatively with pelvic floor (Kegel) exercises or a vaginal pessary to support the pelvic floor. Pelvic floor repair surgery is indicated for women with symptomatic prolapse who do not respond to or decline conservative management. Complications include urinary or fecal retention or incontinence, abdominal/pelvic pain, and avoidance of sexual activity because of embarrassment or discomfort.

Treatment/Management or pelvic organ prolapse

As prolapse treatment options expand to include more conservative choices, greater awareness and education is needed among women and professionals about these as a first line treatment and preventive measure (alongside a multi-professional team approach).

Women presenting with prolapse symptoms need to be

listened to by the health care team,
offered information about treatment choices
supported to make a decision that is right for them.
A qualitative research developed a conceptual model that explores the experience of living with a POP, and the model indicated that: the physical losses of POP are linked to loss of identity; women conceptualized POP as part of womanhood, and a vicious cycle of taboo, silence, and misunderstanding about POP and its treatment. And further, POP is not taken seriously in healthcare.

Treatment for pelvic organ prolapse usually involves either conservative management (for mild prolapse or women who are not good surgical candidates) or surgery. Conservative treatments include pelvic floor muscle training and the use of devices (pessaries).

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