Pelvic organ prolapse, symptoms and causes (and the 2 different approaches to treat it)

Pelvic organ prolapse (also called POP) is a medical condition in which one or more of the pelvic organs, such as the bladder, uterus, rectum, or small intestine, descend from their regular position and press against or even protrude into the vaginal canal due to weakening of the pelvic floor muscles and connective tissues.

As I’ll say later, there are many conditions that can cause POP. Diagnosis typically involves a pelvic examination, and treatment options depend on the degree of prolapse and the patient’s lifestyle and preferences. Management strategies can include pelvic floor physical therapy, the use of a pessary (a device inserted into the vagina for support), or surgical repair. Early recognition and intervention can significantly improve quality of life for individuals affected by this condition.

In this article we’ll take a look at what is pelvic organ prolapse, what does it looks like, what are its symptoms and the causes. I’ll describe how the treatment for this condition works, including some information about the relation between POP and the latest technologies in robotic surgery like the Da Vinci System.

Mild pelvic organ prolapse

There’s also a condition called mild pelvic organ prolapse. It is very similar to regular pelvic organ prolapse, but it doesn’t trigger significant symptoms, and usually doesn’t require any kind of treatment or therapy. It is indeed a “softer” form of POP.

Speaking of symptoms, now let’s take a look at what are the signs to check out to know if you have POP.

Symptoms and causes of pelvic organ prolapse

Pelvic organ prolapse is caused by a weakening or damage to the muscles, ligaments, and connective tissues that support the pelvic organs, primarily due to excessive pressure on the pelvic floor over time. 

One of the most common causes is vaginal childbirth, especially multiple or complicated deliveries, which can stretch and strain the pelvic structures. Aging and the natural decline in estrogen levels during menopause also play a significant role in weakening pelvic support tissues. Other contributing factors include obesity, chronic coughing (such as in smokers or individuals with respiratory conditions), frequent heavy lifting, chronic constipation, and even genetic predisposition.

The symptoms of POP can vary depending on the specific organs affected and the severity of the prolapse, but common signs include:

– A feeling of heaviness or pressure in the pelvic area,

– A sensation that something is “falling out” of the vagina, 

• Visible or palpable bulging from the vaginal opening, 
• Urinary symptoms such as incontinence, urgency, or difficulty emptying the bladder, 
• Bowel symptoms like constipation or incomplete evacuation, 
• Pain or discomfort during sexual intercourse. 
• In some cases, women may also experience lower back pain or difficulty walking and standing for long periods. These symptoms often worsen with prolonged standing, physical activity, or at the end of the day, and can significantly impact a woman’s quality of life. Early diagnosis and appropriate treatment are essential for managing symptoms and preventing further progression of the condition.

Treatment for pelvic organ prolapse

People usually ask: “can you fix pelvic organ prolapse?” Or “Does pelvic organ prolapse go away?” Maybe thinking that it could be one of those conditions that goes away by itself after a while. Actually, there are two types of POP treatment: surgical and non-surgical.

The treatment of POP actually depends on the severity of the condition, the patient’s symptoms, organs involved, overall health, and personal preferences. In mild cases, especially when symptoms are minimal, conservative management is often recommended. This may include pelvic floor exercises, such as Kegel exercises, which aim to strengthen the muscles that support the pelvic organs. Physical therapy with a specialized pelvic floor therapist can also be highly effective.

Another non-surgical option is the use of a pessary, a removable device inserted into the vagina to provide structural support and relieve pressure. 

In more advanced or symptomatic cases, surgical intervention may be necessary. The types of procedures can include vaginal, abdominal, or minimally invasive approaches, and may involve using the patient’s own tissues or synthetic mesh to support the prolapsed organs. In some cases, a hysterectomy may be performed if the uterus is significantly involved. The choice of treatment is individual and should be made in consultation with a healthcare provider who specializes in pelvic floor disorders. Regardless of the approach, follow-up care and ongoing pelvic health maintenance are essential to reduce the risk of recurrence.

Treating POP with robotic surgery

Robotic-assisted surgery has become an increasingly popular and effective option for treating pelvic organ prolapse, particularly in moderate to severe cases where surgical repair is necessary. One of the most advanced and widely used systems for this purpose is the Da Vinci Surgical System, which allows surgeons to perform complex procedures with greater precision, flexibility, and control through small incisions. 

During robotic prolapse repair, commonly a sacrocolpopexy or hysteropexy, the surgeon uses robotic arms equipped with tiny instruments and a high-definition 3D camera to reposition and support the prolapsed organs, often using a surgical mesh for reinforcement. The robotic approach offers several potential benefits compared to traditional open or even laparoscopic surgery, including reduced blood loss, shorter hospital stays, less postoperative pain, faster recovery, and smaller scars. 

Additionally, the enhanced visualization and precision provided by the Da Vinci System may improve outcomes and reduce the risk of complications. However, not all patients are candidates for robotic surgery, and the decision depends on factors such as overall health, anatomy, type of prolapse, and surgical history. It’s important for patients to discuss all available options with a urogynecologist or pelvic floor specialist to determine the most appropriate treatment plan.

Pelvic organ prolapse: my conclusions

As we’ve seen in this article, pelvic organ prolapse is a common condition, and it usually occurs with aging, after childbirth or in many other situations, and it is caused by the weakening of pelvic floor support. It can significantly affect quality of life. 

While mild cases may be managed with pelvic floor exercises or a pessary, more severe prolapse may require surgical treatment. Among the surgical options, robotic-assisted procedures using the Da Vinci system offer a minimally invasive, precise approach with faster recovery times. Early diagnosis and individualized care are key to effective management and long-term well-being.