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What is Pelvic Organ Prolapse?

Pelvic prolapse is the third most common pelvic floor disorder. Prolapse occurs when the pelvic muscles and other supporting tissues becomes weak, which causes the organs within the pelvis to fall out of their normal anatomical positions.

Prolapse can be caused by childbirth or certain types of surgery. Women who have given birth are more likely to experience a prolapse. In addition, it’s possible to have more than one organ prolapse at the same time.

Common Types of Pelvic Organ Prolapse

Bladder Prolapse

Bladder Prolapse (Cystocele) occurs when the upper wall of the vagina loses support and the bladder drops out of position and into the vagina.

Typical symptoms associated with bladder prolapse:

  • Feeling pressure from pelvic organs pressing against the vaginal wall
  • Feeling very full in your lower belly
  • Feeling as if something is falling out of your vagina
  • Feeling a pull or stretch in your groin area or pain in your lower back
  • Releasing urine without meaning to (incontinence), or needing to urinate a lot
  • Vaginal pain during sex
  • Having problems with your bowels, such as constipation

Vaginal Prolapse and Prolapsed Uterus

Vaginal Prolapse (Vaginal Vault Prolapse) and Prolapsed Uterus (Uterine Prolapse) occurs when the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or extends outside of the vagina. The main cause of vaginal prolapse is weakness in the vaginal and pelvic muscles. Conditions that contribute to developing vaginal prolapse are:

  • Childbirth
  • Menopause
  • Hysterectomy

Typical symptoms associated with vaginal prolapse:

  • A feeling of heaviness in the pelvic area
  • Backache
  • A mass bulging into the vaginal canal or out of the vagina that may make standing and walking difficult
  • Involuntary release of urine (incontinence)
  • Vaginal bleeding

Rectal/Anal Prolapse

Rectal/Anal Prolapse (Rectocele) occurs when part or all of the rectum wall slides out of place, sometimes sticking out of the anus. The main causes for rectal or anal prolapse are:

  • Straining during bowel movements due to constipation
  • Damage to pelvic floor tissues due to childbirth or surgery
  • Weakening of the pelvic floor muscles associated with aging

Typical symptoms associated with rectal prolapse are:

  • A feeling of having full bowels and an urgent need to have a bowel movement
  • Passage of many very small stools
  • The feeling of not being able to empty the bowels completely
  • Anal pain, itching, irritation, and bleeding
  • Bright red tissue that sticks out of the anus

Small Bowel Prolapse

Small Bowel Prolapse (Enterocele) occurs when the small bowel presses against and moves the upper wall of the vagina. Small bowel prolapse is more likely to develop if the pelvic muscles become damaged due to childbirth, surgery (hysterectomy) or are weakened as part of the normal aging process.

With small bowel prolapse, it’s possible to not experience any symptoms until it becomes so large that it intrudes on the vaginal canal. If the prolapse is more severe, symptoms will include:

  • A pulling sensation in the pelvis
  • A feeling of pelvic fullness, pressure or pain
  • Low back pain
  • A soft bulge of tissue in the vagina
  • Vaginal discomfort and painful intercourse

When should I seek medical attention?

If you are currently experiencing any of the following symptoms, you should seek appropriate medical treatment:

  • Feeling pressure from pelvic organs pressing against the vaginal wall
  • Feeling very full in your lower belly
  • Feeling as if something is falling out of your vagina
  • Feeling a pull or stretch in your groin area or pain in your lower back
  • Releasing urine without meaning to (incontinence), or needing to urinate a lot
  • Vaginal pain during sex
  • Having problems with your bowels, such as constipation
  • A feeling of heaviness in the pelvic area
  • A mass bulging into the vaginal canal or out of the vagina that may make standing and walking difficult
  • Involuntary release of urine (incontinence)
  • Vaginal bleeding
  • A feeling of having full bowels and an urgent need to have a bowel movement
  • Passage of many very small stools
  • The feeling of not being able to empty the bowels completely
  • Anal pain, itching, irritation, and bleeding
  • Bright red tissue that sticks out of the anus
  • A pulling sensation in the pelvis

Are There Certain Tests My Doctor Will Use to Determine if I Have Pelvic Organ Prolapse?

For a diagnosis of prolapse, your doctor will typically perform a physical examination along with a pelvic exam and a full medical history. In addition, there are several routine tests that your doctor can perform in order to determine the extent of the prolapse. These are:

  • Cytoscopy – allows your doctor to view the lining of the bladder and urethra
  • Intravenous pyelogram (IVP) – this is an X-ray which details the size, shape and position of the kidneys, bladder, and urethra
  • CT scan – provides a picture of the entire pelvic area via X-ray
  • Post-void residual (PVR) – this test measures the amount of urine remaining in the bladder after urination
  • Urinalysis – analysis of the appearance, concentration and content of urine

All of these tests are fairly standard and relatively easy for patients to undergo. There is also a classification system which is used to determine the correct “stage” for any case of prolapse:

  • Stage 0: There is no evidence of prolapse
  • Stage 1: The prolapse extends more than one centimeter above the level of the hymen
  • Stage 2: The prolapse is one centimeter or less from the hymen
  • Stage 3: The prolapse extends more than one centimeter below the hymen but no more than two centimeters less than the total length of the vagina
  • Stage 4: The prolapse extends completely outside of the vagina

What Are My Treatment Options for Prolapse?

If pelvic organ prolapse symptoms are mild, there are a few less-invasive treatments that can help:

  • Kegel exercises – these help to strengthen the pelvic floor muscles by contracting and releasing them regularly
  • Pessary – this device is similar to a diaphragm as it fits into the cervical cavity to help support the pelvic area.
  • Medications – such as estrogen or other hormone therapy are usually prescribed during menopause but may also help strengthen the pelvic tissue
  • Physical Therapy – after fully assessing the pelvic floor muscles, a physical therapist will develop a customized treatment plan to improve the functioning of the pelvic floor muscles

In addition to the above options, certain lifestyle changes may help with alleviating mild prolapse symptoms:

  • Losing weight
  • Smoking cessation
  • Avoiding the lifting of heavy objects
  • Eating a diet rich in high fiber, including plenty of fruits and vegetables
  • Drinking enough fluids every day

For more severe cases of prolapse, particularly if the prolapse symptoms are causing a lot of discomfort and inconvenience, surgery can be the best option for successful treatment.

Available surgical treatments for prolapse:

  • Pelvic Organ Prolapse Surgery – this is performed to restore the natural anatomy in the pelvic floor area prior to the prolapse
  • Obliterative Surgery – narrows or closes off the vagina in order to provide more support to the prolapsed organs. One consideration with obliterative surgery is that vaginal intercourse is no longer possible
  • Reconstructive Surgery – essentially rebuilds the pelvic floor in order to restore the pelvic organs back to their natural anatomical position prior to the prolapse

What Are the Success Rates for Prolapse Surgery?

According to Medscape, approximately 300,000 women undergo some form of prolapse surgery in the U.S. each year. Success rates for any type of surgery will vary and are dependent on several factors.

Most importantly, the type of surgery selected to address the prolapse condition. Also, many patients who opt for prolapse surgery may decide to include an additional surgical procedure (urinary incontinence) while also addressing the prolapse.

For reconstructive surgery, success rates are between 78 percent and 100 percent* depending upon the type of surgical method used: vaginal vs. abdominal.

For obliterative surgery, patient satisfaction is higher with shorter operative time and lower rates of complications* during surgery.