Pelvic organ prolapse (POP)

POP develops when tissues, pelvic floor muscles and ligaments that support the pelvic organs (bladder, uterus and bowel) become damaged, usually in childbirth, causing organs to shift or ‘drop’ into or outside the vagina. POP is essentially a hernia through which organs protrude because supporting tissue is weak. This can lead to debilitating symptoms, including poor bladder or bowel control and pain during sex.

The condition can be exacerbated by age, ethnicity, multiple births, obesity and family genetics. One in five women require surgery – and often multiple surgeries.

Causes of pelvic organ prolapse

Risk factors include

• Childbirth
• Age – muscles and connective tissue become weaker with age
• Weight – vaginal or uterine prolapse is more common in women who are very overweight
• Women who have genetically weak tissue.

Pelvic organ prolapse types

• Bladder prolapse (cystocele) is the most common type of pelvic organ prolapse. The bladder pushes down against the vaginal wall.
• Bowel prolapse the small intestine (enterocele) or the last part of bowel (rectocele) bulge into the vagina.
• Uterine prolapse the womb (uterus) drops down into the vagina.

In addition, because the one or more supports for these organs have weakened, several or all organs will often drop down together.

Mild cases of pelvic organ prolapse often don’t cause any symptoms until the woman is older. But if the organs drop down further, the most common symptoms can be debilitating and include pain, and a feeling of heaviness, fullness or pressure in the vaginal area,  and that the uterus, bladder or rectum is bulging or dropping out.

Other common symptoms include difficulty emptying the bladder or bowel and pain during sex.

Pelvic organ prolapse diagnosis

A medical examination by a doctor or urogynecologist is used to diagnose a prolapse and determine the severity.

There are four general prolapse stages, defined by how far the bladder, womb or bowel have dropped down.

• First-stage prolapse | The organs have only slipped down a little.
• Second-stage prolapse | The organs have slipped down to the level of the vaginal opening.
• Third-stage prolapse | The vagina or womb has dropped down so much that up to one centimetre of it is bulging out of the vaginal opening.
• Fourth stage prolapse | The vagina or womb is completely outside the vagina.

While milder cases of POP may be treated with pelvic floor exercises or pessaries (a removable device that fits in the vagina to support the pelvic organs and vaginal wall), one in five women will need vaginal surgery, which has up to a 30 percent failure rate.

Until recently, transvaginal meshes have been used for treating pelvic organ prolapse, but they are now banned from clinical use in many countries. Transvaginal meshes were banned in Australia in 2017, mainly due to the excessive stiffness resulting in penetration through the vagina into other organs, and undesirable foreign body response to synthetic non-degradable meshes which led to serious complications in some women.

There is an urgent need for safe, effective POP treatments.