Pelvic Organ Prolapse

Pelvic organ prolapse is a disorder of the pelvic floor—the group of muscles and tissues that create a “hammock” across the pelvic opening.  It’s this structure that keeps the pelvic organs—including the uterus, bladder, vagina, small bowel and rectum—in their normal position. Nearly one-third of all women, however, experience a prolapse or dropping of the pelvic floor as a result of weakened muscles due to childbirth, aging or other conditions. When the bladder prolapses, it can push against the walls of the vagina.

The symptoms of pelvic organ prolapse may include:

  • Pain or pressure in the pelvic area
  • Urinary flow changes or difficulties, including incontinence and recurrent urinary tract infections
  • Pain with intercourse
  • Bulging in the vaginal area
  • Constipation
  • Difficulty with bowel movements

Pelvic prolapses are further classified by the specific organ that has shifted, the symptoms resulting and the treatment required.

Classifications of pelvic organ prolapse include:

  • Cystocele: When the bladder pushes into the vaginal canal
  • Rectocele: When the rectum bulges into the lower part of the vagina
  • Prolapsed uterus: When loss of ligament support causes the uterus to drop into the vaginal canal
  • Apical prolapse: After hysterectomy, there is a “cuff” at the top of the vagina. This term refers to the protrusion of that cuff as the result of prolapse.
  • Enterocele: When the small intestine protruding around the “cuff.”

How is pelvic organ prolapse treated?

Depending upon the type of prolapse and the severity of symptoms, a urologist may recommend one or a combination of treatments, including:

  • Medications
  • Physical therapy to strengthen the pelvic floor muscles
  • Medical devices, such as pessaries, which are placed inside the vagina to support weakened areas causing the prolapse
  • Surgery to restore the vagina to its normal shape and function. One of the procedures most commonly used for this intervention is sacrocolpopexy. It may be
    performed through a traditional abdominal incision or with a minimally invasive laparoscopic technique. With either, a specialized hernia mesh is sewn in to support the pelvic organs.
  • Along with intervention—or to keep tissues from weakening further—these lifestyle changes will likely be recommended:
    • Smoking cessation
    • Treatment of conditions that strain the pelvic floor, including constipation
    • Weight loss, if necessary
    • Exercises to strength one’s core and pelvic floor