When one or more pelvic organs slip out of place, pelvic organ prolapse may occur. It causes the bladder, uterus, small bowel and rectum to bulge into or emerge from the vagina. There are several different types of pelvic organ prolapse, including uterine prolapse, vaginal vault prolapse, cystocele (bladder prolapse, rectocele (rectal prolapse), urethrocele (urethral prolapse) and enterocele (small bowel prolapse).

What Are Signs and Symptoms of Prolapse?

While many women with pelvic organ prolapse have no symptoms, some may experience the following:

• Discomfort, similar to pressure or fullness
• Pelvic heaviness
• Difficult bowel movements
• Vaginal bleeding from the exposed vaginal lining that rubs on pads or underwear
• Increased discharge
• Sexual intercourse difficulties
• Bulge near the opening of the vagina

As pelvic organ prolapse worsens, you may notice some of the following:

• Sensation like you’re sitting on a ball
• Urinary problems, including:
  • Difficulty starting to urinate
  • Weak or spraying stream of urine
  • Frequent urge to urinate or the feeling that you’re not able to fully empty your bladder
• Lower back pain
• The need to push in the vaginal bulge (splinting) to urinate or have a bowel movement start urination

While this can all be uncomfortable and may lead to embarrassment, help is available. There are several surgical options to reconstruct the pelvic floor.

What Can Cause Pelvic Organ Prolapse?

A prolapse can occur when something happens to weaken or damage the normal pelvic floor support. Some of the ways this can happen include:

• Long-term pressure on your abdomen such as frequent straining during bowel movements.
• Pregnancy and vaginal childbirth strains the pelvic floor and can lead to incontinence and pelvic organ prolapse. This can occur even if you have had a cesarean or C-section delivery.
• Hormonal changes during menopause. Loss of the female hormone estrogen during and after menopause can raise your risk for pelvic organ prolapse.
• Aging
• Family history or genetics may also play a role in the tendency to develop pelvic organ prolapse.

Pelvic Organ Prolapse Treatment Options

Pessary

These are silicone inserts that are placed into the vaginal to push the pelvic organs back into place. They may be used as a permanent treatment or as a trial prior to pelvic surgery.

Surgical Options

The goal of surgery is to reinforce the pelvic floor to keep the pelvic organs in place. Prolapse repairs can be done in several ways:

Abdominal Surgery

This procedure is called a sacrocolpopexy. Traditionally this was performed using an open abdominal technique but now is routinely performed using a robotic technique which aides in increased visibility, decreases blood loss and decreases post-operative pain compared to open abdominal surgery. This surgery involves making several small incisions on the abdomen and using mesh that helps retract the vaginal canal back into its normal location within the pelvis.

Transvaginal Surgery

Multiple transvaginal surgery options for pelvic reconstruction exist, including anterior and posterior colporrhaphy. These involve vaginal incisions and using a patient’s native tissues to repair the prolapse. Your healthcare provider will talk with you about which procedure is the best fit for your condition.

What Is Right for You?

Determining the right procedure for you depends on your specific issues and goals. Let us help you go over your options and map out a treatment plan that works best for your situation.