Pelvic Organ Prolapse

What is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the pelvic floor muscles and tissue weaken or tear. This leads to the inability to no longer support the pelvic organs (uterus, vagina, bowel and bladder), resulting in the bulge (prolapse) of the organs into the vagina. As many as one in three women will develop prolapse in their lifetime, and approximately 15 percent will require surgery.

What are the Types of Pelvic Organ Prolapse?

There are four types of pelvic organ prolapse, depending on the location of the pelvic floor defect. It is likely, that a woman develops more than one type:

Anterior Vaginal Wall Prolapse (Cystocele):
The front vaginal wall bulges downward, which allows the bladder to drop from its normal position and bulge into the vagina. This usually leads to bothersome urinary symptoms as well.

Posterior Vaginal Wall Prolapse (Rectocele):
The back vaginal wall bulges upward, which allows the rectum to bulge into the vagina. This can be associated with difficulty in having bowel movements.

Uterine Prolapse (Enterocele):
Weakened support of the uterus, cervix, and upper vagina allows for the uterus to slip downward into the vaginal canal.

Vaginal Vault Prolapse: 
In women who have previously undergone a hysterectomy (removal of the uterus), weakening of the upper vagina and vault allows for the descent of the “roof” of the vagina into the vaginal canal.

What are Symptoms Associated with Pelvic Organ Prolapse?

  • A bulging sensation, or protrusion of tissue, from the vaginal opening
  • Pelvic pressure and discomfort
  • Urinary Symptoms: slow urinary stream, incomplete bladder emptying, needing to push up on the vaginal bulge to empty the bladder
  • Bowel Symptoms: difficulty moving the bowels, a feeling of stool being trapped in the rectum, needing to push down on the vaginal bulge to empty bowels

What are the Causes of Pelvic Organ Prolapse?

There are several factors that may cause injury to the pelvic floor musculature and tissue, including:

Pregnancy and Childbirth:
Pregnancy and delivery can damage the pelvic muscles, tissues, and nerves, allowing for prolapse to develop. This occurs more commonly in women who have delivered multiple babies, delivered large babies, or have required forceps for delivery. Prolapse symptoms may develop shortly after pregnancy but often take many years to develop

Aging:
Pelvic organ prolapse becomes more common with increasing age, as aging leads to loss of estrogen in tissue and weakening of pelvic floor support.

Health conditions:
Certain health conditions that encompass chronic straining, such as chronic coughing, constipation, and obesity, can weaken the pelvic floor support over time.

How is Pelvic Organ Prolapse Diagnosed?

The diagnosis of Pelvic Organ Prolapse is primarily made with a thorough medical history and physical examination by your urogynecologist. Supplementary tests may include a 3D pelvic ultrasound and Urodynamics (bladder function test).

How is Pelvic Organ Prolapse Treated?

There are a variety of therapies, both surgical and non-surgical, that can treat pelvic organ prolapse and bothersome symptoms:

Pelvic Floor Physical Therapy:
Pelvic floor physical therapy focuses on optimizing your pelvic floor function. Your physician will evaluate your pelvic floor muscles at your initial consultation and provide a referral if necessary

Vaginal Pessary:
A vaginal pessary is a soft, silicone, removable device that is inserted into your vagina to support the prolapsed pelvic organs. Pessaries are a safe, long-term treatment for pelvic organ prolapse in patients who want to avoid surgery

Surgery for Pelvic Organ Prolapse:
Different minimally-invasive surgical options are available for surgical repair of pelvic organ prolapse. A woman may benefit from one type of surgery more than another based on her treatment goals, overall health, prior surgical history, and severity of prolapse. Your physician will help you determine which surgery is best for you.