Prolapse Particulars, Part I

A few more words about Pelvic Organ Prolapse, from Riva Preil.

June is Pelvic Organ Prolapse Awareness Month. Pelvic organ prolapse (POP), descent of any of the pelvic floor organs, is one of the most common indications for gynecological surgery.  Usually, the organs in the pelvic floor (bladder, uterus, and rectum) are held in their proper position by a series of ligaments.  In addition, the pelvic floor muscles serve as a “backup support” the ligaments and support the organs from below.  As women age, the ligaments and muscles have a harder time holding the organs in their upright proper position against gravity, and each previous pregnancy and delivery further contributes to increased likelihood of developing weakened structures over time. In fact, the physical weight of the developing fetus along with the physical trauma of labor and delivery add further stress to the pelvic floor muscles and ligaments, and some of these damaged structures may never fully return to their previous strength and level of structural support.  In addition, certain birthing related complications (ex. prolonged labor, large birthweight of the baby, and vaginal delivery which requires forceps extraction) increases a woman’s risk of developing prolapse. It is unclear whether or not an episiotomy affects POP development.  In women above age 50, it is reported as the most common reason for hysterectomy (removal of the uterus).  It is estimated that in the United States, almost double the amount of surgeries are performed to treat prolapse compared to treating urinary incontinence.  The reason for this is that it is often not diagnosed until later stages of the dysfunction at which point conservative, non-surgical interventions would not suffice in treating the POP.

Naturally occurring age-related changes, mainly due to decreased estrogen levels in the bloodstream, increase the likelihood of developing prolapse. Furthermore, women who are overweight are more likely to develop POP due to increased abdominal and pelvic floor pressure.  Furthermore, chronic coughing (due to bronchitis, asthma, or smoking) as well as chronic constipation and straining predispose an individual to developing POP due to prolonged history of added stress and pressure to the pelvic floor structures. Furthermore, women who have worked for many years at a job that involves heavy lifting (ex. flight attendants) are at greater risk of developing POP for the same reason. The pelvic floor structures contain collagen, a connective tissue that provides support and elasticity. Therefore, any systemic disease such as Marfans or Ehlers-Danlos, which are associated with impaired collagen production, predisposes an individual to developing POP.  Research has shown that prolapse is most prevalent amongst white and Hispanic women.

To be continued…

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