Pelvic organ prolapse refers to the anatomical disorder that occurs when a pelvic organ (bladder, rectum, uterus, or vaginal cuff in women who have undergone hysterectomy) descends through the vaginal wall.

This condition results from the weakening of the muscles and supporting structures of the pelvic floor, primarily caused by pregnancy and vaginal delivery. Age and menopause also play significant roles.

Prolapse affects many women, especially after menopause and particularly those with a history of vaginal births. In many cases, the condition may remain unnoticed for a long time, as symptoms can be absent. However, symptoms can range from mild discomfort to severe and potentially dangerous issues, making specialized medical diagnosis and treatment essential.

CAUSES

The organs of the female pelvis are held in place by a muscular and ligamentous system, which also ensures continence of both urination and defecation. Over time, and especially after menopause, natural weakening of these tissues can occur, particularly if one or more pregnancies and deliveries have taken place.

Risk factors for the development of prolapse include smoking, chronic cough, chronic obstructive pulmonary disease (COPD), constipation, obesity, heavy lifting, and pelvic surgeries. Similarly, pregnancy—especially when accompanied by excessive weight gain—and vaginal delivery, particularly prolonged labor, are significant contributing factors that promote the onset of prolapse. Finally, heredity may also play a role.

Prolapse may affect the anterior vaginal wall (cystocele/urethrocele), the middle compartment (uterine prolapse or vaginal cuff prolapse following hysterectomy), or the posterior vaginal wall (rectocele/enterocele). In some cases, prolapse of two or more organs may occur simultaneously.

SYMPTOMS

Symptoms vary depending on the severity of the prolapse and the specific organ involved:

  • A feeling of heaviness in the vagina and lower back
  • A sensation of fullness in the vagina (like a “ball” filling the vagina or protruding outside)
  • Difficulty or pain during sexual intercourse
  • Urinary symptoms such as difficulty urinating, frequent urination, urgency, urge urinary incontinence, or stress urinary incontinence
  • Bowel symptoms such as constipation

DIAGNOSIS

The diagnosis of the type and severity of pelvic organ prolapse is made through a detailed medical history and clinical examination by a specialized urogynecologist. For greater diagnostic accuracy, urodynamic testing and 2D-3D pelvic floor ultrasound are considered valuable tools.

Treatment options

The treatment of uterine and vaginal prolapse is personalized and depends on several factors, including the woman’s age (reproductive age, perimenopause, or postmenopause), the severity of symptoms, and the degree of the prolapse. There are both conservative treatments aimed at avoiding surgery and preserving fertility, and surgical options, which typically require hospitalization and a longer recovery period.

As a general principle, conservative treatment using pelvic floor exercises, under the guidance of specialized physiotherapists, may be the first line of management—particularly when symptoms are mild and the prolapse is at an early stage.Conservative management may also include the use of a vaginal pessary, a device designed to support the prolapsed organ and help relieve bothersome symptoms by keeping the organ in its proper anatomical position.

INDICATIONS

The insertion of a vaginal pessary is considered a conservative treatment option in cases of mild uterine prolapse.

It is recommended for women who do not wish to undergo surgery, or for elderly patients with serious chronic conditions for whom surgical intervention is not appropriate.

VAGINAL PESSARY

A vaginal pessary is a specialized device, usually made of medical-grade silicone, that is inserted into the vagina and helps support the vaginal walls.

ΤΟΠΟΘΕΤΗΣΗ

The insertion of a vaginal pessary is a simple and relatively painless procedure. The patient is placed in the gynecological position, and the physician, after performing the appropriate tests and measurements, inserts the properly sized pessary into the vagina. After placement, the patient will be asked to walk, bend over, and urinate in order to ensure that the pessary is correctly positioned and does not cause any discomfort.

If the patient, upon returning to her daily routine, experiences pain or difficulty during urination, or notices mild constipation and/or slight discomfort in the lower abdomen, she should inform her doctor.
It is recommended that the pessary be replaced every six months.

Until recently, the vaginal pessaries available on the market were used to manage mild (first-degree) prolapse. Today, it is possible to treat second- and even third-degree prolapse (including cases where the organ protrudes outside the vagina).

POPY™ Vaginal Pessary for Uterine Prolapse by MEDIPLUS UK

This is a clinically recognized product, supported by scientific studies.
  • Improves quality of life
  • Easy-to-use and user friendly
  • Made of high-quality, soft medical-grade silicone, ensuring optimal comfort and anatomical adaptability for every woman
  • Clinically co-designed with physicians for maximum effectiveness and comfort
  • No risk of urethral obstruction
  • Low-cost alternative compared to surgical interventions
  • 5 year lifespan (or 20 washes)
  • Reusable after sterilization every 6 months

See the clinical studies of POPY here.

    Buy here