About Pelvic Organ Prolapse

Women in rural areas of Ethiopia are responsible for activities like caring for children, housework, carrying heavy items, carrying containers of water for a long distance, and helping husbands with farming.

Women have no right to their own income, no right to decide how many children they should have, and in addition they don’t have timely medical care if they experience POP.

Pelvic organ prolapse (POP) is a bulge or protrusion of the pelvic organs and their associated vaginal segments into or through the vagina. It is a common and difficult affliction for older women. Vaginal childbirth and menopause are the two leading causes of pelvic organ prolapse.

Women with POP typically have multiple risk factors, but even one damaging childbirth experience can be sufficient to cause problems that evolve into pelvic organ prolapse. Women in every age demographic experience POP.

Pelvic organ prolapse can occur when the pelvic floor muscles weaken and one or more organs shift out of their normal positions into the vaginal canal. In advanced cases of POP, tissues push through the vaginal canal and bulge outside of the body. The worst case scenario is that a woman’s uterus can be completely outside of the vagina.

There are five types of POP: organs that can prolapse are the bladder (cystocele), the intestines (enterocele), the rectum (rectocele), the uterus (uterine), and the vagina (vaginal vault). There are four levels of severity: grade 1 is the mildest, grade 4 the most severe.

Researchers agree that POP originates from multiple causes and develops gradually over a span of years. Some of the risk factors are pregnancy, vaginal childbirth, multiparty, menopause, ageing,  hypoestrogenism, chronically increased intra-abdominal pressure, chronic obstructive pulmonary disease (COPD), constipation, obesity, pelvic floor trauma, genetic factors (connective tissue disorders),  race,  hysterectomy and spina bifida.

There are multiple causes of POP: factors vary with age and it is likely that most women have more than one significant cause and additional contributing factors that add to the individual dynamic. The most common causes of POP are:

  • Vaginal childbirth – complications from large birth-weight babies, a long second-stage labour, nerve damage, forceps or suction deliveries, multiple childbirths or improperly repaired episiotomies. The impact of childbirth may present itself immediately after a difficult delivery or it may not show up until twenty years later;
  • Menopause – age-related pelvic floor muscle tissue integrity impacts, due to a drop in estrogen level – this impacts the strength, elasticity, and density of muscle tissue;
  • Chronic constipation – irritable bowel syndrome, poor diet or lack of exercise may impact regularity; repetitive downward pushing to have a bowel movement pushes pelvic tissues down repeatedly;
  • Chronic coughing – allergies, bronchitis and emphysema can create chronic coughing, jerking tissues down;
  • Heavy lifting – lifting children, repetitive heavy lifting at work and while doing housework and carrying water and wood;
  • Genetics – a family member with POP means you may be predisposed to POP;
  • Neuromuscular diseases – MS, diabetic neuropathy.

Pelvic organ prolapse is a health concern affecting millions of women worldwide. It is an extremely common female condition that has been on medical record for over 4,000 years; unfortunately it receives little attention. Women in every country experience symptoms of POP yet they have little idea what is occurring in their bodies because they are embarrassed to discuss it with anyone.

It is now time to shift this lack of recognition and establish a public dialogue. It has been estimated that over the next 30 years, the demand for treatment of POP will increase by 45%, commensurate with an increase in the population of women older than 50 years of age.

POP is common in both developed and developing countries – there are 600,000 women in Nepal with uterine prolapse and 3.3 million in USA. A World Health Organization (WHO) study indicated that half of the women in Lebanon had at least one type of prolapse. Guesstimates indicate that there are 34 million women worldwide with POP and studies frequently estimate that up to 50% of the female population has POP. The reality is that we truly don’t know what the real figures are – there have been no accurate statistical captures to date.

Statistical capture for the prevalence of pelvic organ prolapse in most countries is sorely lacking and difficult to estimate because there is little screening in place and many women are too embarrassed to mention symptoms to their physicians.

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