Pelvic Organ Prolapse

Pelvic organ prolapse is a condition in which the muscles and tissues that support the pelvic organs become stretched, damaged or weakened, causing the organs they support to drop downward or sag. The pelvic organs include the vagina, cervix, uterus, bladder, urethra, small intestines, and rectum. Many women who have had a baby have some degree of pelvic organ prolapse, but it can also occur in women who have never given birth. Most women with pelvic organ prolapse have minor symptoms, if any at all.

There are several types of pelvic organ prolapse, including:

• Uterine prolapse. Uterus drops down into the vagina
• Vaginal vault prolapse. Top of the vagina (vaginal vault) drops down
• Cystocele. Bladder drops down into the front (anterior wall) of the vagina; also called dropped bladder
• Urethrocele. Urethra drops down and bulges into the vagina
• Enterocele. Small intestine drops and pushes into the wall of the vagina
• Rectocele. Rectum drops down and bulges into the vagina (also known as posterior wall prolapse)

The main cause of pelvic organ prolapse is injury to the muscles or supporting tissue of the pelvic floor caused by childbirth, particularly vaginal delivery. Other causes of pelvic support problems include:

• Aging
• Hysterectomy or prior pelvic surgery
• Menopause
• Intense physical activity
• Obesity
• Family history
• Chronic straining due to constipation
• Chronic coughing

Many women have no symptoms at all. Pelvic organ prolapse may only be detected during their pelvic exam. For those who do have symptoms, they may include:

• Heaviness or fullness in the pelvic area
• Bulge in the vagina or organs bulging out of the vagina
• Pulling or aching feeling in the lower abdomen or pelvis
• Lower back pain
• Leakage of urine (urinary incontinence) or other voiding issues
• Problems having a bowel movement
• Pain during intercourse
• Problems inserting tampons
• Pelvic pressure that worsens with standing, lifting, coughing or as the day passes

Diagnosing the exact cause of pelvic organ prolapse is critical to successful treatment. Proper diagnosis starts with a detailed medical history and a thorough physical exam, including both pelvic and rectal exam. Pelvic organ prolapse can usually be diagnosed by observation of the vaginal walls and cervix. You may be asked to strain or cough during the exam. Bladder function may also be tested.

Treatment will depend on the type and degree of prolapse, your age, and other factors. Treatment options include:

Observation. Through regular exams, for those women with no symptoms or problems.

Lifestyle changes. Such as dietary changes to address constipation or obesity.

Kegel exercises. To strengthen pelvic floor muscles for better support.

Pessaries. Devices inserted into the vagina to support the pelvic organs.

Surgery. To restore the normal structure and function of the female pelvic organs. Surgery to correct pelvic support problems can be performed either through the vagina, through the abdomen, or through laparoscopy, depending on the support problem.