What is Pelvic Organ Prolapse?
Prolapse is when part of an organ drops from its normal position, bulging (prolapsed) or protruding (herniated) into other areas of the pelvis. It can affect the vagina and rectum in addition to the bladder and urethra and is caused by weakened or damaged muscles and ligaments that no longer support the pelvic organs.
Between 45% to 74% of women may have some pelvic organ prolapse in their lifetime.
Symptoms of Pelvic Organ Prolapse
Many women suffer from the symptoms of pelvic organ prolapse, some often living for years with pain or embarrassment before they finally talk to their health care providers. Prolapse symptoms vary and may include:
- a protruding bulge or lump.
- a stretching or pulling sensation in the groin.
- vaginal pain, pressure, or bleeding.
- difficult or painful intercourse.
- fecal incontinence.
- difficulty having bowel movements or urinary issues.
Pregnancy and childbirth are two of the primary precursors to pelvic organ prolapse, but other triggers such as repeated heavy lifting, chronic constipation, pelvic surgery, and menopause can be involved. Family history and genetics play a role, as well as aging and obesity. Your healthcare provider can help you identify whether or not any of these factors place you at higher risk.
Types of Pelvic Organ Prolapse
The organs in the female pelvis that are at most risk for prolapse include the bladder, bowel, uterus, and rectum. There are different clinical terms and procedures associated with each type of prolapse:
- Cystocele is when the bladder bulges or protrudes into the vagina.
- Enterocele is when the small bowel bulges or protrudes into the vagina.
- Rectocele is when the rectum bulges or protrudes into the vagina.
- Uterine prolapse is when the uterus bulges or protrudes into the vagina.
- Vaginal vault prolapse is when the upper section of the vagina drops into the vaginal canal.
Treatment options vary and depend on the type and extent of the prolapse. There are non-surgical options that may work for you. Talk with your health care provider so that together, you can find the right treatment for your condition.
- Exercise – performing Kegels and other exercises can help strengthen supportive muscles. It may be all that’s needed for mild cases
- Pelvic physical therapy or rehabilitation
- Pessary intervention therapy – a plastic device is fitted and inserted to support the pelvic floor and prolapsed organ. It’s removable and must be cleaned often and taken out before intercourse
- Vaginal vault suspension – surgery to repair a bulge. The bladder and bowels are attached to the top of the vagina by stitching them to ligaments in the pelvis
- Abdomino-sacrocolpopexy – a reconstruction using supportive mesh or a graft to repair the prolapse. It’s most often performed using minimally invasive surgery
- Cystocele repair – surgery to return the bladder back to its normal position
- Rectocele repair – surgery to return the rectum back to its normal position