Pelvic Organ Prolapse

For women living with pelvic prolapse, the discomfort and pain can be limiting. An estimated 34 million women worldwide are affected by pelvic organ prolapse, yet many of these women are too embarrassed to discuss it with their doctor. As a result, they suffer in silence. This doesn’t have to be the case for you.

What Is Pelvic Organ Prolapse?

The network of muscles, ligaments, fascia, and skin around a woman’s vagina acts as a complex support structure that holds pelvic organs and tissues in place. Various parts of this support system may eventually weaken or break, causing a common condition called vaginal or pelvic organ prolapse.

Vaginal prolapse is a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse or fall out of their normal positions. Without medical treatment or surgery, these structures may eventually prolapse farther and farther into the vagina or even through the vaginal opening if their support weakens enough. It may be caused by increasing age, previous childbirth, pelvic surgeries, obesity, and so on.

Symptoms of pelvic organ prolapse include:

A bulge or lump in the vagina
Pulling or stretching feeling in the lower groin area
Difficult or painful intercourse
Vaginal pain, pressure, irregular bleeding, or spotting
Frequent need to urinate (overactive bladder)
Difficulty emptying the bladder
Difficulty emptying bowels
A feeling that the bladder is not emptying completely (stress urinary incontinence)
Delayed or slow urine stream

Types of Pelvic Organ Prolapse

Cystocele

This is a prolapse of the front wall of the vagina that often results in the bladder prolapsing into the vagina. Stress urinary incontinence is a common symptom of a cystocele.

Rectocele

This involves a prolapse of the back wall of the vagina. As a result, the rectal wall pushes against the vaginal wall, creating a bulge.

Enterocele

When the front and back walls of the vagina separate, the intestines push against the vaginal skin. An enterocele usually occurs following a hysterectomy.

Prolapsed uterus

The weakening of a group of ligaments at the top of the vagina cause the uterus to prolapse into the vagina

Vaginal vault prolapse

The top of the vagina falls toward the vaginal opening. This type of prolapse may occur following a hysterectomy.

Diagnosing Pelvic Organ Prolapse

Your doctor will begin the diagnostic process by taking a detailed medical history, performing a physical exam and by determining the strength and function of your pelvic floor muscles. Your doctor may also order additional diagnostic testing including, a pelvic ultrasound, bladder function test, and urodynamic testing. These diagnostic tests evaluate the function of the bladder and urethra and include uroflow, cystometrogram, EMG, pressure flow study, or videourodynamics.

Pelvic Organ Prolapse Treatment

Nonsurgical Treatments

Fortunately, first-line therapies that do not include surgery have helped restore quality of life for many women.

You may be a candidate for:

Physical Therapy: The muscles of the pelvic floor are vital to keeping your pelvic organs in place. When women experience pelvic floor muscle weakness, prolapse and urinary incontinence often become an issue. Physical therapists teach you how to perform pelvic floor exercises that will help tighten these important muscles. These exercises are often used to treat mild cases of prolapse or in conjunction with other prolapse treatment modalities.

Your physical therapist may use biofeedback, where monitoring devices with sensors can show on a computer screen whether you are using the correct muscles to perform a pelvic floor muscle exercise. The physical therapist will also be able to see the strength of each muscle contraction as you perform the exercise to ensure you are performing the exercises properly.

Vaginal Pessary: A vaginal pessary is a small device that is placed inside of the vagina to support the vagina and reinforce the pelvic floor muscles and surrounding pelvic organs. The pessary is a safe, minimally-invasive option for women and typically will relieve most, if not all, symptoms of prolapse.
Medical Therapy: For certain women, your doctor may prescribe estrogen replacement therapy using a transvaginal estrogen cream to help strengthen the muscles and tissues in and around the vagina. Women naturally stop producing estrogen after menopause so estrogen replacement may provide relief. Your doctor will discuss the risks and benefits of this treatment and, based on your medical history and health, will determine if this option is right for you.

Surgical Treatments for Pelvic Organ Prolapse

When first-line therapies such as physical therapy do not provide complete relief from pelvic organ prolapse, women have a number of surgical options that can help minimize, if not, alleviate, symptoms of pelvic organ prolapse. Laparoscopic surgery to correct pelvic organ prolapse has provided many women with relief from the discomfort and pain associated with this condition.

Surgical interventions include:

Hysterectomy – Performed minimally invasively, this procedure to remove the uterus is used to treat uterine prolapse and is commonly performed on postmenopausal women or for women who do not want more children.
Vaginal vault suspension – This surgery is performed for women who suffer from vaginal vault prolapse. The vagina is attached to strong tissue in the pelvis or to the sacral bone located at the base of the spine.
Cystocele and rectocele repair – Through an incision in the vaginal wall, prolapsed organs are pushed up into proper place and secured, closing the vaginal wall to keep the organ in its normal position.
Robotic sacrocopopexy – Through small abdominal incisions, mesh is inserted and used to hold the pelvic organs in their correct, natural position. This minimally invasive surgery for total vaginal prolapse is sometimes performed after a hysterectomy to hold the pelvic organs in place and provide support for the vagina.