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.


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  • 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