Pelvic organ prolapse (POP) occurs when the muscles and connective tissues of the pelvic floor weaken, causing one or more pelvic organs, such as the bladder, uterus, or rectum, to descend or bulge into the vagina. This anatomical descent is often described as a feeling of heaviness or a bulge. A common concern is whether this condition is directly responsible for an unpleasant odor. This article clarifies the relationship between pelvic organ prolapse and the potential for an associated smell.
The Prolapse Condition and Odor
The anatomical displacement of pelvic organs itself does not produce a smell. Pelvic organ prolapse is a structural issue involving the weakening of supportive tissues, which is not inherently odoriferous. Any odor noticed is a secondary symptom, arising from complications or coexisting conditions exacerbated by the organ descent. The presence of an odor indicates a change in the vaginal or surrounding environment, suggesting a microbial imbalance or the presence of excretory materials.
Secondary Factors Causing Associated Odor
Impaired Discharge Drainage
One of the most frequent causes of odor is impaired drainage of normal vaginal discharge. When a pelvic organ bulges into the vaginal canal, it can create pockets where discharge pools and stagnates. This trapped discharge provides an ideal environment for the overgrowth of anaerobic bacteria. This can lead to conditions like bacterial vaginosis (BV), which is known for producing a distinct, fishy odor.
Tissue Ulceration
Tissue ulceration is a more concerning cause, developing in cases of severe prolapse where the tissue protrudes beyond the vaginal opening. When the prolapsed tissue rubs continuously against clothing or is exposed to air, it can become dry and irritated. This irritation can lead to open sores called decubitus ulcers. These ulcers are prone to infection and tissue breakdown, resulting in a foul, sometimes necrotic, odor.
Urinary and Fecal Leakage
The mechanical effects of prolapse frequently impair the function of the urinary and bowel systems. Pelvic floor weakness often leads to stress urinary incontinence, where small amounts of urine leak out during activities like coughing. Similarly, a rectocele (prolapse of the rectum) can make complete evacuation difficult, leading to residual fecal material. The residue from either urinary or fecal leakage, even in trace amounts, can cause a persistent and noticeable odor.
Practical Hygiene and Symptom Management
Hygiene Practices
To manage odors caused by discharge or minor incontinence, gentle and consistent hygiene is recommended. Regular washing with warm water is usually sufficient, as the vagina is a self-cleaning organ. Avoid douching or using harsh, scented soaps, which can disrupt the natural, slightly acidic pH balance and potentially worsen bacterial overgrowth.
Moisture Management
Managing moisture in the genital area is important for reducing odor-causing bacteria. Wearing loose-fitting, breathable cotton underwear helps promote air circulation and minimizes a damp environment. For those with minor leakage, utilizing thin, absorbent incontinence pads and changing them frequently is recommended. Standard panty liners are not designed to manage urine effectively.
Bowel and Pessary Care
Addressing the underlying issue of constipation can alleviate odor associated with rectoceles. Increasing dietary fiber and fluid intake helps ensure softer stools and more complete bowel movements, reducing the likelihood of residual fecal matter. Regular removal and cleaning of a pessary, if one is used, is critical, as a poorly maintained pessary can cause discharge and odor.
When Professional Medical Attention is Needed
Diagnosis and Treatment
Any persistent or strong odor, especially one accompanied by changes in discharge color, severe itching, or pelvic pain, warrants an immediate medical evaluation. A healthcare provider, such as a gynecologist or urogynecologist, can perform a pelvic exam and specialized testing to determine the precise cause. Testing may include microscopic analysis of vaginal discharge, checking the pH level, or performing a culture to identify a specific infection.
Medical Interventions
Treatment depends entirely on the diagnosed cause. If a bacterial infection like BV is identified, prescription antibiotics are used to restore the microbial balance. For odors resulting from tissue irritation, a doctor may prescribe a topical estrogen cream to strengthen the vaginal wall tissue and promote healing.
Structural Solutions
If the prolapse is severe and contributing to ulceration, a pessary may be fitted to physically support the organs. In cases where conservative measures fail, surgical repair can be considered to correct the anatomical defect. Correcting the structural issues will resolve the odor’s root cause, which is part of comprehensive prolapse management.