Pelvic organ prolapse — or the intrusion of nearby organs into the vaginal canal — is a condition that occurs most often as a side effect of natural childbirth.
But can pelvic organ prolapse ever be a sign of cancer? We checked in with O. Lenaine Westney, M.D., a reconstructive urologist who occasionally treats this condition. She specializes in managing urinary incontinence and structural genitourinary problems that occur during or after treatment for pelvic cancers. Here’s what she shared with us.
What is a prolapse?
A prolapse is a type of herniation, in which an organ bulges out of an opening that it normally wouldn’t — in this case, the vagina. Hernias are normally associated with the intestines, but prolapse is specific to the vagina. This means it could involve any of the structures that border it, including:
the bladder: known as a “cystocele”
the rectum: known as a “rectocele”
the small intestine: known as an “enterocele”
the uterus: also called a “descensus” or “procidentia”
The term “prolapse” itself is very nonspecific, though, because it doesn’t tell you which organ is involved. And that depends on what’s on the other side of the weakened tissues. Still, a prolapse is only possible if you have a vaginal canal — because, by definition, whichever organ is involved will be pushing its way into that cavity.
What’s the most common cause of pelvic organ prolapse?
It’s not a very common occurrence, but it happens most often in women who have given birth vaginally. It can also be a side effect of a hysterectomy, or the surgical removal of the uterus.
Once the cervix is removed, the uppermost part of the vagina has to be reconnected to the ligaments and other structures that normally hold it in place. Otherwise, it becomes unstable inside the abdominal cavity and can kind of collapse on itself so that the top part of the vagina protrudes and becomes visible outside the body.
Is pelvic organ prolapse a symptom of cancer?
No. Pelvic organ prolapse is not related to the development of any particular type of cancer.
However, it can occur because a large mass in the abdomen is creating abdominal pressure, or because a significant amount of fluid has accumulated in the pelvis. It may also occur after surgery for some cancers because it’s related to the removal of other structures.
Whenever a bladder is removed, for instance, some of the supporting tissue that lends thickness and muscularity to the vaginal wall gets removed, too. The same thing happens when surgery is performed on the rectum or cervix. Any time changes are made to the structures that normally support the vagina, they can weaken or destabilize its walls. And that, in turn, can lead to a secondary prolapse.
Can pelvic organ prolapse be treated?
Yes. But how it’s treated depends entirely on the severity of someone’s condition. Pelvic organ prolapse is graded on a scale of 1 to 4, with 1 being very mild and 4 being where the entire vagina is turned inside out.
One of the simplest and least invasive methods of treating mild pelvic organ prolapse is physical therapy. Patients are given various exercises to perform to increase the strength of their pelvic floor. They may also be prescribed stool softeners or other medications to reduce constipation and be given weight-lifting restrictions to reduce abdominal strain or pressure.
Another relatively non-invasive treatment is a pessary, in which a silicone or plastic object is placed in the vagina to keep the prolapse from bulging outside of it. Pessaries come in many shapes, depending on the type of prolapse, but the most common one is shaped like a doughnut.
Surgery is usually recommended for more advanced cases of pelvic organ prolapse. Doctors use a biological mesh to reinforce weakened areas and hold everything in place. They might also perform a sacral colpopexy. That’s where the top of the vaginal canal is connected to the sacrum, or tailbone, and mesh is used as a bridge to stabilize it.
Are there any other factors that make someone more likely to develop pelvic organ prolapse?
Again, it’s not a very common occurrence, but your risk does increase slightly with each additional vaginal delivery. Advanced age is also a risk factor, as ligaments and other support structures naturally weaken over time.
There are some exceptionally rare vascular disorders that can also prevent the development of good connective tissues and lead to prolapse, but those are highly unusual.
When should you see a doctor if you think you might have pelvic organ prolapse?
Call your doctor immediately if you see or feel something unusual protruding from your vagina when you bear down to urinate or defecate. But symptoms are not always so dramatic, so see a doctor, too, if you have difficulty emptying your bladder or having a bowel movement, especially if it doesn’t seem to improve on its own after a week or two.