14 July 2016 July 2016 15 Expert guide: Obstetrics & Gynaecology 2016 What is pelvic organ prolapse?Any organ in the female body like the bowel, bladder, and womb can drop out of place. These result in a condition called pelvic organ pro-lapse (POP). If these organs are no longer in their normal positions and if this condition is not taken care of, quickly enough, these organs can fall farther into the vagina. POP is a very common condition which affects up to 1 in 3 women especially if they have had children.The various types of POP which include cys-tocoele (prolapse of the bladder), hysterocoele (prolapse of the uterus), rectocoele (prolapse of the rectum), enterocoele (prolapse of small in-testine), and vault prolapse (prolapse of the top of the vagina in women who have had a hyster-ectomy). Often more than one type of prolapse may occur at the same time. What are the causes of POP?The weakening of the vaginal support system results in this condition. There are several causes linked to POP. These include:1. A lack of oestrogen (female hormone) following the menopause weakens the pelvic support structure that relies on this hormone for their strength. 2. Pregnancy places a high degree of stress During the initial evaluation, the specialist will take a detailed medical history, looking for fac-tors that may have contributed to this condition and perform a thorough pelvic examination. Your doctor is likely to measure the position of your uterus to determine how severely it has dropped or “prolapsed”. In addition, part of the exam may sometime be performed while you are standing to gauge the severity of the condi-tion. The doctor may ask you to bear down like you were having bowel movement or cough. These actions make the pelvic injury more ob-vious. on the various tissues, ligaments and muscles of the pelvic floor which can also tear during childbirth thus resulting in this condition. 3. Hysterectomy which is surgery that in-volves the removal of the uterus that is a very important part of the support net-work complex in the pelvis can cause a drooping of the upper part of the vagina leading to a vault prolapse. 4. Other causes include ageing, chronic constipation, obesity and certain con-nective tissue disorders.Symptoms and signs to look out for in POP This will depend on the kind of prolapse that you are suffering from however; the most com-mon symptom is the experience a dragging sen-sation or sensation of something that has come down in the vagina. Other symptoms may in-clude pelvic discomfort or a lack of sensation during intercourse, difficulty having a bowel movement or bladder weakness leading to in-continence. How is this condition diagnosed?If you believe you are experiencing symptoms associated with POP, you should seek a consul-tation with a specialist in pelvic floor problems. Diagnostic tests, such as urodynamic studies to evaluate bladder function or special imaging studies to visualise the bladder or rectum may subsequently be arranged. What can be done for POP? Not all women with POP have symptoms that require treatment. The treatment that is best for you will depend on many things – your symp-toms and their effect on your life, your age and your plans for pregnancy, and your expecta-tions for treatment. Intensive and regular pelvic floor exercises help by both strengthening and relaxing the Preetkiron Bhal www.infinitihealthcare.com info@infinitihealthcare.com +44 (0)333 800 8082 Pelvic organ prolapse (POP) – Embarrassingly common? – Help is out there By Preetkiron Bhal uk