Pelvic Organ Prolapse

Pelvic organ prolapse refers to changes in anatomy where the pelvic organs (bladder, uterus, vagina, rectum) can drop lower in the pelvis. This can lead to symptoms of feeling a bulge in the vagina and other associated symptoms.

Pelvic organ prolapse is fairly common and can develop because of very common life events – namely, carrying a pregnancy and undergoing childbirth. Pregnancy and delivery (especially multiple deliveries) can cause trauma and laxity to the pelvis. As we age, the muscles, ligaments, and tissue of the pelvis develop weakness and can’t support the pelvic organs in the same way. 

Other contributors to developing this condition including anything that causes repetitive strain on the pelvic floor. For example, chronic constipation can be a huge problem. Other risk factors include weight gain, heavy lifting/manual labor, and chronic cough or lung issues (coughing puts a lot of stress on the pelvic floor!). Family history and genetics also play a strong role.

Uterine prolapse is when the ligaments and muscles supporting the uterus have more laxity, and the uterus drops lower into the vagina. In very severe cases, the uterus can protrude out of the vagina completely. Constant friction of the tissue against clothing can cause irritation or even ulcers.

Similarly, bladder prolapse (cystocele) is when the bladder bulges into the vagina. Sometimes women with bladder prolapse will also have issues with urinating.

Rectocele is when the rectum protrudes into the vagina. Sometimes a rectocele is large enough that it becomes difficult to have a bowel movement. Sometimes in order to have a bowel movement, women will place a finger into the vagina and press down (this maneuver is called splinting) to minimize the rectocele.

You may have one or any combination of these types of prolapse at the same time.

Mild pelvic organ prolapse may actually be unnoticeable – in which case there is no need to do anything! When prolapse is more notable, symptoms include:

· Feeling a bulge or constant awareness in the vagina

· Discomfort with sitting

· Pelvic heaviness

· Urinary problems

· Difficulty with bowel movements

· Painful intercourse or altered sensation

Everyone has heard about Kegel exercises, right? Well, most people do them wrong, they don’t work that well, and you can stop wasting your time.

For women who are bothered by pelvic organ prolapse but don’t want to have surgery, options include pelvic floor physical therapy, which is much more than Kegel exercises. Pelvic floor physical therapy can include biofeedback training and other exercises to retrain the pelvic floor. Another option is to use a vaginal pessary to help support the uterus. Both of these options are well-tolerated and can help a lot.

But the most definitive treatment is surgery. Surgery for pelvic organ prolapse has to be tailored specifically to you to address the type and extent of prolapse. Some women will benefit from having a hysterectomy, but uterine preserving options are available as well.

Surgery can be performed robotically, laparoscopically, or vaginally, depending on the type of surgery that is needed to fix the problem and your preferences.

Examples of surgical options include:

· Anterior vaginal repair

· Posterior vaginal repair

· McCall Culdoplasty

· Uterosacral ligament suspension

· Colpocleisis

· Sacrocolpopexy