Learn About Pelvic Organ Prolapse

Your pelvic muscles and tissues wrap around and support your pelvic organs to keep them in place. Pelvic organ prolapse occurs when the uterus, rectum, bladder, urethra, small bowel, or vagina fall out of their normal positions and into or out of the vaginal canal. Approximately 3% of U.S. women suffer from pelvic organ prolapse.1

Pelvic organ prolapse is usually caused by damage to the tissues (muscles, ligaments, and connective tissue) that support the pelvic organs. Damage, weakening, or stretching of these tissues allow the organs to move out of their normal positions. This causes them to press against (and sometimes move) the inside walls of the vagina.2 The type of pelvic organ prolapse a woman experiences depends on the pelvic organ affected.

The greatest risk factors for pelvic organ prolapse are:1

  • Pregnancy and vaginal delivery
  • Increased intra-abdominal pressure (from a chronic cough, habitual straining, heavy lifting, or constipation)
  • Obesity
  • Advancing age
  • Genetics

In some cases, pelvic organ prolapse also happens after a hysterectomy.1

Symptoms of pelvic organ prolapse can differ depending on which pelvic organ is affected. Sometimes, multiple pelvic organs can prolapse, causing an exacerbation or combination of symptoms.3

The primary and most noticeable symptom of prolapse is a bulge in the vagina that can be seen or felt, caused from pressure from the prolapse. As result, women with pelvic organ prolapse may also feel uncomfortable pressure during physical activity or sex.1

Other symptoms of pelvic organ prolapse include:1

  • Seeing or feeling a bulge or "something coming out" of the vagina
  • A feeling of pressure, discomfort, aching, or fullness in the pelvis
  • Pelvic pressure that gets worse with standing or coughing or as the day goes on
  • Leaking urine (incontinence) or problems having a bowel movement
  • Problems inserting tampons

For some women, symptoms are worse at certain times of the day, during physical activity, or after standing for a long time.1 If you’re experiencing any of the above symptoms, make an appointment to talk to your doctor so you can determine what may be causing your symptoms.

Pelvic Organ Prolapse Treatment Options

Your treatment program for pelvic organ prolapse will depend on the severity of your symptoms and their impact on your quality of life.  If your doctor suspects you are suffering from prolapse, they will conduct a pelvic exam and imaging tests to confirm before selecting a treatment option. They may also evaluate your bladder function.3

There are steps you and your doctor can take to treat pelvic organ prolapse, so it is important that you speak openly with your doctor about your symptoms and lifestyle so you can determine the right approach for you. 

Lifestyle has a tremendous impact on pelvic health, and certain changes, when combined with exercises, can help you manage your pelvic organ prolapse. Things like eating fiber-rich foods can aid in relieving constipation that puts a continuous strain on your pelvic organs. Additionally, as obesity is a risk factor for pelvic organ prolapse, it is recommended that those who suffer maintain a healthy weight or lose weight to help manage their symptoms.

And if you’re a smoker – here is another reason to quit. Smoking can cause chronic coughing, which puts more pressure on your pelvic muscles.  

Exercises

Your doctor may be able to give you exercises to help manage your prolapse depending on your unique situation. These can range from at-home Kegel exercises to pelvic floor physical therapy that is offered by specially trained physical therapists to strengthen the pelvic floor muscles.

Some physical therapy will involve the use of biofeedback, which involves monitoring devices with sensors to show you whether you’re using the right muscles and measure the strength of your contractions (or squeezes). The devices are placed in your vagina, rectum or on your skin, and are intended to help patients learn to do the pelvic exercises properly.

It’s important to understand that long-term strengthening of pelvic floor muscles is the most important factor in reducing your prolapse symptoms.

Estrogen: In certain cases, estrogen may be an option for menopausal women with pelvic organ prolapse. Lowered estrogen levels brought on by menopause can weaken pelvic floor muscles, so taking supplemental estrogen may help reduce the weakening of these muscles. Supplemental estrogen isn’t for everyone, so discuss the risks and benefits with your doctor.

Pessary: Pessaries are the only currently available, non-surgical intervention for women with pelvic organ prolapse. These silicone devices are inserted into the vagina to provide support to pelvic organs and to relieve pressure on the bladder and bowel. Pessaries are a great option for women with a mild case of pelvic organ prolapse who are hoping to delay or decline surgical intervention, or for women who are ineligible for surgical intervention due to other existing medical conditions.

If you and your doctor decide on surgery to address your pelvic organ prolapse, your surgeon’s strategy will depend on the location of prolapse. It’s important to remember that surgery is mainly intended to repair the tissue bulge – if the bulge doesn’t bother you, surgery is often not needed.

It is important to note that recurrent prolapse after surgery is common, because surgery doesn't repair the underlying weakened tissues that lead to prolapse in the first place. While there are several surgical options that your doctor may discuss with you, listed below are some of the more common procedures:

Posterior prolapse: If you’re suffering from a posterior (rectum) prolapse, also known as a rectocele, your surgeon may remove excess tissue and secure the connective tissue between your vagina and rectum to reduce the size of the bulge.

Anterior prolapse: For an anterior (bladder) prolapse, also called a cystocele, your doctor may suggest removing excess tissue and securing the connective tissue between your bladder and vagina to keep the bladder in its proper position. If you have urinary incontinence, your doctor might also perform a bladder neck suspension or sling to support your urethra.

Uterine prolapse: If you don't plan to have children in the future, your surgeon might recommend surgery to remove the uterus (hysterectomy) to correct uterine prolapse.

Vaginal vault prolapse: A vaginal vault prolapse occurs in women who have had a hysterectomy, or surgical removal of the uterus. This type of prolapse might involve the bladder, rectum, and small bowel, where the bulge is called an enterocele. Your surgeon will either perform corrective surgery through the vagina or a small incision in the abdomen.

  • In a vaginal approach, the ligaments that support the uterus will be manipulated to correct the problem. This procedure is known as a sacrospinous fixation.
  • An abdominal procedure is called sacrocolpopexy, and can be performed laparoscopically, robotically or as an open procedure via an incision. In this procedure, your surgeon attaches the vagina to the tailbone, and small portions of synthetic material are inserted to help support vaginal tissues.

REFERENCES

  1. Office on Women’s Health. Pelvic organ prolapse. https://www.womenshealth.gov/a-z-topics/pelvic-organ-prolapse. Accessed March 2019.
  2. Harvard Health Publications, Harvard Medical School Mayo Clinic. (Data on file)
  3. Pelvic Organ Prolapse. https://www.mayoclinic.org/diseases-conditions/pelvic-organ-prolapse/care-at-mayo-clinic/mac-20360560. Accessed March 2019.
  4. Cleveland Clinic. Pelvic Organ Prolapse: Treatment. https://my.clevelandclinic.org/health/diseases/17344-pelvic-organ-prolapse/treatment. Accessed March 2019.
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