What is pelvic organ prolapse?
The pelvic floor is a group of muscles that form a hammock across the pelvic opening. Normally, these muscles and the connective tissues surrounding them keep the pelvic organs in place.
Pelvic organ prolapse (POP) occurs when the bladder, urethra, rectum, small intestine, uterus, or vagina fall from their regular positions. In mild cases, a slight bulge can be detected inside the vaginal canal. In severe cases, the affected organ may push a lump of tissue past the vaginal opening.
Types of prolapse
Conditions associated with pelvic floor disorders include:
- Vaginal prolapse following a hysterectomy
- Dropped bladder (also known as cystocele) – affects the front (anterior) wall of the vagina and may cause urinary incontinence
- Rectocele – occurs when the rectum bulges into the vaginal wall, caused by a weakened pelvic floor
- Enterocele (also known as small bowel prolapse) – occurs when the small intestine (small bowel) descends into the lower pelvic cavity and pushes at the top part of the vagina, creating a bulge
Although not life-threatening, POP can be life-altering and may result in significant quality of life changes in women suffering from the condition.
Symptoms of pelvic organ prolapse
While some patients with prolapse may not appear to have any symptoms, common symptoms of pelvic organ prolapse include:
- 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) causing urinary tract infections
- Constipation
- Problems inserting tampons
In more severe prolapse cases, an organ bulges onto another organ or outside your body. Women with pelvic organ prolapse may feel uncomfortable pressure during physical activity or sex.
Cause of pelvic organ prolapse
Pelvic organ prolapse happens when the muscles or connective tissues of the pelvis do not work as they should. The most common risk factors are:
- Vaginal delivery, which can stretch and strain the pelvic floor. Multiple vaginal childbirths raise your risk for pelvic organ prolapse later in life. But you can get prolapse even if you have never had children or if you had a cesarean or C-section delivery.
- Long-term pressure on your abdomen, including pressure from obesity, chronic coughing, or often straining during bowel movements.
- Giving birth to a baby weighing more than 8½ pounds.
- Aging. Pelvic floor disorders are more common in older women. About 37% of women with pelvic floor disorders are 60 to 79 years of age, and about half are 80 or older.
- Hormonal changes during menopause. Loss of the female hormone estrogen during and after menopause can raise your risk for pelvic organ prolapse. Researchers are not sure exactly why this happens.
- Family history. Researchers are studying how genetics can play a role in pelvic organ prolapse.
Some women indicated that their symptoms are worse at certain times of the day, during physical activity, or after standing for a long time. Talk to your healthcare doctor or nurse about your symptoms to confirm your medical condition.
How is pelvic organ prolapse diagnosed?
Your healthcare provider will assess your symptoms during your appointment and conduct a pelvic examination. They may ask you to cough to evaluate the extent of your prolapse under strain and at rest. The examination may be performed while you’re lying down and standing up. In many cases, a pelvic exam is sufficient to diagnose a prolapse. Additional tests may include bladder function tests and imaging.
Organ prolapse treatment
If your condition is mild and doesn’t cause any symptoms, it may not require treatment. If you’re experiencing only slight discomfort, your doctor may recommend a conservative, non-surgical treatment plan.
Vaginal pessary
A vaginal pessary is a small, doughnut-shaped device made out of plastic or rubber that can be inserted into the vagina to lend extra support to the pelvic organs. Your gynecologist can insert the pessary for you the first time and show you how to remove, clean, and re-insert the device on your own.
Kegel exercises
These are exercises designed to strengthen the pelvic floor muscles. They are easy to do and can be done anywhere, on your own time. Squeeze the muscles you would use to stop the flow of urine, hold for 3 seconds, then release. Perform 20 repetitions of this exercise 3-5 times per day. Your doctor may show you how to do pelvic floor exercises or refer you to a physical therapist.
Maintain a healthy weight
Overweight or obese women can relieve some of the pressure on their pelvic organs by losing some weight. Your doctor can talk to you about healthy ways to lose weight, such as diet and exercise.
Do not smoke
Smoking can lead to chronic coughing, which puts stress on the pelvic floor muscles. If your prolapse is more severe, you may want to discuss surgical treatment options with your doctor. Your age, medical history, and particular risk factors will influence the type and timing of your surgery. For example, if you plan on becoming pregnant in the future, you may wish to postpone surgery until after the pregnancy.
Surgery for pelvic organ prolapse
Surgery may be an option if your symptoms haven’t improved with conservative treatments and if you no longer wish to have children. Childbirth following surgery may increase the risk of your prolapse returning.
Obliterative surgery (colpocleisis)
This procedure involves supporting the pelvic tissue by surgically closing off the vagina. After this procedure, you are no longer able to have penetrative vaginal sex.
Reconstructive surgery
In this approach, the goal is to place the pelvic organs in their original position and reconstruct the pelvic floor to provide more support to the organs. In most cases, sexual intercourse is still possible after you’ve made a full recovery.
Types of reconstructive surgical options
There are several types of reconstructive surgery, which can be performed through an incision in the vagina, in the abdomen, or through laparoscopy.
Uterosacral ligament suspension and sacrospinous fixation
In this procedure, your pelvic organ(s) will be fixated or suspended using the surrounding tissues. It’s typically performed through the vagina, which can cut down on recovery time.
Colporrhaphy, anterior or posterior
This surgery involves strengthening either the front or back walls of the vagina with stitches, restoring support to the bladder or rectum. It is also commonly performed vaginally.
Sacrocolpopexy and sacrohysteropexy
Performed through incisions in the abdomen, these procedures involve suspending the prolapsed cervix or vaginal vault (in the case of hysterectomy) to a bone at the base of the spine. Although recovery time may be longer, there is less risk of lingering pain during vaginal intercourse.
Vaginally-placed mesh
In this procedure, the vaginal walls are supported by the placement of surgical mesh. This type of treatment carries a risk of pain, infection, and erosion of the mesh over time. It’s generally only used when other procedures have failed to fix the problem, when abdominal surgery is too risky, or when the woman’s tissues have sustained significant damage.
Recovery from reconstructive surgery
Because the different surgical interventions are individualized to your case, full recovery times will vary. Generally speaking, you may need to take 3-5 weeks off work to rest and recover. During this time, you should avoid heavy lifting, strenuous exercise, and vaginal intercourse.
Worried about pelvic organ prolapse? Talk to Dr. Aliabadi
As one of the nation’s leading OB/GYNs, Dr. Thaïs Aliabadi offers the very best in women’s health and well-being. Together with her warm, professional team, Dr. Aliabadi provides compassionate care for women through all phases of life. She fosters a special one-on-one relationship between patient and doctor.
Highly trained and honored by the medical community, Dr. Thais Aliabadi is board-certified and a Diplomat of the American College of Obstetrics and Gynecology. She implements the most advanced, state-of-the-art technology and treatment options. Dr. Aliabadi specializes in up-to-date, minimally invasive surgical techniques, promising her patients shorter recovery times, reduced pain, and the least interruption to their daily lives.
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Sources
Surgery for pelvic organ prolapse. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/surgery-for-pelvic-organ-prolapse. Accessed Jan. 2, 2024.
Hall AF, Theofrastous JP, Cundiff GW, Harris RL, Hamilton LF, Swift SE, Bump RC. Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system. Am J Obstet Gynecol. 1996 Dec;175(6):1467-70; discussion 1470-1. [PubMed]
Karjalainen PK, Mattsson NK, Nieminen K, Tolppanen AM, Jalkanen JT. The relationship of defecation symptoms and posterior vaginal wall prolapse in women undergoing pelvic organ prolapse surgery. Am J Obstet Gynecol. 2019 Nov;221(5):480.e1-480.e10. [PubMed]
Supported by her warm professional team, Dr. Aliabadi treats women through all phases of life and cherishes the special one-on-one relationship between patient and doctor.