Prolapse

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What are pelvic support problems?

The pelvic organs include the vagina, cervix, uterus, bladder, urethra, small intestines, and rectum. The pelvic organs are held in place my muscles of the pelvic floor. Layers of connective tissue called fascia also provide support. These supporting muscles and fascia may become torn or stretched, or they may weaken because of aging. Problems with pelvic support often are associated with pelvic organ prolapse. In this condition, the fascia and muscles can no longer support the pelvic organs.  As a result, the organs that they support can drop downward.

What are the symptoms of pelvic organ prolapse?

  • Feeling of pelvic heaviness or fullness
  • Bulge in the vagina
  • Organs bulging out of the vagina
  • Pulling or aching feeling or a feeling of pressure in the lower abdomen or pelvis
  • Lower back pain
  • Leakage of urine (urinary incontinence) or problems having a bowel movement
  • Needing to push organs back up into the vagina to empty the bladder or have a bowel movement
  • Needing to lean forward, backward, or change positions to empty the bladder or have a bowel movement
  • Leaking urine upon standing after urinating or needing to sit down again to empty more urine
  • Sexual difficulties
  • Problems with inserting tampons or applicators
  • Pelvic pressure that gets worse with standing, lifting, or coughing or as the day goes on

What causes pelvic organ prolapse?

The main cause of pelvic organ prolapse is having had children. Women who have had a vaginal delivery have a slightly increased risk of pelvic support problems than those who have had a cesarean delivery.

Other causes of pelvic support problems include the following:

  • Forceps or vacuum delivery of a child
  • Vaginal delivery of a large child
  • Menopause
  • Aging
  • Intense physical activity
  • Prior pelvic surgery
  • Factors that increase pressure in the abdomen, such as being overweight, constipation and straining to have a bowel movement, and chronic coughing
  • Genetic factors

What are the types of pelvic organ prolapse?

  • Uterine prolapse-The uterus drops into the vagina.
  • Vaginal vault prolapse-The top of the vagina-the “vaginal vault”-drops. This problem occurs most often in women who have had a hysterectomy.
  • Cystocele-The bladder drops from its normal place into or out of the vagina.
  • Rectocele-The rectum bulges into or out of the vagina.
  • Urethrocele-A urethrocele happens when the urethra bulges into the vagina. If often occurs with a cystocele.
  • Enterocele-The small intestine pushes against the back wall of the vagina, creating a bulge. Enteroceles often occur with vaginal vault prolapse.

View ACOG patient education videos to better understand pelvic organ prolapse.

Cystocele:

Uterine Prolapse:

Rectocele:

How is pelvic organ prolapse diagnosed?

  • Your doctor will do a thorough exam, including a vaginal and rectal exam. You may be asked to strain or cough during the exam to see the severity of the prolapse when pressure is applied. It also may reveal any leaking of urine.

What are some nonsurgical ways to obtain relief?

  • Lifestyle changes-Women with bowel problems may find that increasing the amount of fiber in their diets prevents constipation and straining during bowel movements.
  • Weight loss-If you are overweight or obese, weight loss can help reduce some of the pressure pushing out your pelvic organs.
  • Kegel exercises-These exercises strengthens the muscles that surround the openings of the urethra, vagina, and rectum. Doing these exercises regularly my improve incontinence and reduce some of the pressure pushing on the pelvic organs.
  • Pessaries-A pessary is a device that is inserted into the vagina to support the pelvic organs. It may need to be removed periodically to clean or to have sex.

What surgical options are available?

Surgery can help return the pelvic organs back to their original position and relieve many of the symptoms such as back pain, pelvic pressure, feeling a bulge, improved bladder emptying, and painful sex. Some of the options include:

  • Da Vinci robotic sacrocolpopexyThe “Gold Standard” of treating significant prolapse.
  • Native Tissue Repair-In women who otherwise have adequate tissue quality, the prolapse may be able to be repaired through the vaginal opening. Often the women’s own supportive tissue can be repaired using sutures.  Sometimes her tissue may require additional reinforcement by adding specific surgical materials.
  • Le Fort Colpocleisis– In older woman who are no longer sexually active a simple procedure for reducing prolapse is a colpocleisis. The procedure was described by ‘Le Fort’ and involves essentially suturing the front and back walls of the vagina together to essentially close the vagina.