Pelvic Organ Prolapse: What It Is, How to Deal with It, and How It Can Be Prevented

Pelvic organ prolapse is a widespread problem among women: according to some scientific estimates, between 30% and 50% of the female population suffers from it. Probably, however, the numbers are higher – just consider that among the risk factors of pelvic prolapse there is the practice of some sports activities at a competitive level – because many women do not turn to the doctor because of the embarrassing symptoms that characterize the disease, often considered taboo and cause of great discomfort, especially in the relational sphere.

We talk about it with Dr. Valeria Gianfreda, surgeon of the digestive system, colon-proctologist and pelvic organs, with over 15 years of experience in minimally invasive oncological and laparoscopic surgery and in the treatment of colonproctological and female pelvic diseases (hemorrhoids, rectal prolapse, bladder prolapse, uterine and vaginal prolapse, urinary incontinence, fecal incontinence and constipation).

A woman who deals with female diseases. This is especially important for patients.

Considering how delicate and important the issue is in a woman's life, impacting on the quality of social and professional life, I believe it can be an element of help to approach the problem. This is why I always pay particular attention to the consultation phase with patients.

Prolapse is a very common disease: what are the causes?

Yes, it affects many women, and the causes are multifactorial. At the base there is familiarity. Among the other triggers are to consider pregnancies, hormonal imbalances that occur during a woman's life, as well as sudden and considerable changes in body weight, therefore often associated with eating disorders.

Can anything be done to prevent it?

For the prevention of pelvic organ prolapse it is certainly very important to maintain tone and elasticity with pelvic floor gymnastics, especially in postpartum and in the perimenopausal period; as well as care must be taken in following a diet rich in fiber, fruits and vegetables.

How can the condition be recognized?

Symptoms can be varied. As for disorders of the urinary sphere, bladder prolapse, there is a feeling of bladder weight, urinary incontinence or incomplete emptying.

Disorders of the genital sphere, on the other hand, are often accompanied by pain in sexual intercourse, anorgasmia, disorders in the menstrual phases and related to hormonal changes, descent of the uterus, sense of vaginal weight.

Finally, the problems of the rectum can lead to incomplete evacuation, constipation, disorders of hemorrhoids, anus, bleeding.The important thing is to learn to know your body, develop sensitivity and attention to yourself, to be able to recognize the symptoms early.

Why is there talk of "multi-organ" pelvic prolapse?

Because the bladder, uterus and rectum are organs that are extremely connected to each other. For this reason, a comprehensive, tricompartmental, multi-organ approach is essential, which allows them all to be treated at the same time.

What type of specialist should be turned to in order to possibly diagnose and deal with the pathology in this multi-organ vision?

The most suitable specialist is the pelvic surgeon or pelvic surgeon who performs both a gynecological and colonproctological examination. After the visit and a careful anamnesis to investigate causes and symptoms, if necessary, the surgeon will give instructions to perform defecorisonance, the radiological instrumental examination (without contrast medium) considered gold standard to verify the presence and state of the prolapse.

How is it resolved, when is it necessary to intervene?

It is necessary to intervene surgically starting from the diagnosis of prolapse above the second degree. In these cases I propose, when possible, surgery with P.O.P.S. technique: Pelvic Organ Prolapse Suspension – Suspension of the pelvic organs, to which it is always good to prepare with pelviperineal gymnastics, which must be performed both in the pre-operative phase and in the post-operative phase, about 1 month after surgery.

What is the intervention with P.O.P.S. technique?

It is a minimally invasive methodology, applied in laparoscopy. 3 small incisions of 1 cm are made through which a V-shaped polypropylene net, called Mesh, is applied to the abdomen, anchored to the uterus, vagina and organs that must be suspended. The network goes to support the pelvic organs that return to their correct position. The treatment allows to correct at the same time, in a single surgery, the prolapse of the bladder, uterus and rectum and consequently also the disorders in urination and defecation. On average, the intervention lasts 120 minutes and generally requires 3 days of hospitalization, with a rapid resumption of normal life and work activity.

What are the advantages of this intervention?

The intervention with P.O.P.S technique allows to preserve the uterus, naturally when possible in the absence of diseases. I think this is one of the main advantages and psychologically most relevant aspects for a woman. It also allows you to restore the anatomy of the pelvic organs and reconstitute the injured ligaments in a single operation, to return to normal life, regaining its quality, in about a month.