Pelvic Organ Prolapse: A Female Disorder that Can Be Treated and Resolved

A woman’s pelvis is home to several organs, including the bladder, the uterus and the rectum. All three normally stay put, but sometimes one or more of these organs can actually fall through the vagina. That’s called prolapse, and it’s far more common that you might suspect.

Pelvic organ prolapse is caused by weakness in the muscles of the pelvic floor to a point where they can no longer keep the pelvic organs where they belong, says Dr. Unwanaobong Nseyo, a specialist in urogynecology and an Assistant Professor in the Department of Urology at Weill Cornell Medicine. “What happens with prolapse is similar to what happens with a hernia,” she says. “Fortunately, there’s a lot we can do to prevent, improve or even resolve these issues. Our main challenge is to let women know they don’t need to accept prolapse, or any other pelvic floor disorder, as shameful or inevitable.”

What is urogynecology?

As a specialty, uroogy tends to be male-oriented, both in terms of providers and the patients they treat, just as gynecology is female-oriented. Urogynecology is a blend of the two fields, and its practitioners specialize in the treatment of pelvic floor disorders, from urinary incontinence to accidental bowel leakage, constipation and prolapse.

What types of pelvic organ prolapse might a woman experience?

“We classify prolapse base on location and which organ is associated with that location,” Dr. Nseyo says. There are three categories:

• Anterior prolapse, involving the bladder
• Apical prolapse, which involves the uterus
• Posterior prolapse, involving the rectum

“The bowel can end up contributing to prolapse in any of these three areas, especially if you no longer have a uterus or have had prior surgery in the pelvis,” she adds.

What are the main symptoms of prolapse?

• Heaviness in the lower abdomen
• Cramping
• Bloat (a feeling of fullness)
• The feeling that something is coming out of the vagina
• The sensation that she is sitting on something

Is there a relationship between prolapse and urinary incontinence?

The mechanism is the same for stress incontinence—losing urine every time you laugh, cough or sneeze—and prolapse, Dr. Nseyo says. In both cases, the pelvic floor muscles don’t provide adequate support for the urethra or the pelvic organs respectively.

Women with prolapse may also have urge incontinence, difficulty emptying their bladder completely or a range of other bladder issues.

What factors or conditions put a woman at risk for prolapse?

The main risk factor for prolapse is pregnancy itself—especially vaginal delivery, which puts a great deal of stress on the pelvic floor muscles and the vagina. Dr. Nseyo recommends a course of post-partum rehabilitation to help the pelvic floor recover and decrease the likelihood of future prolapse and other pelvic floor disorders. “When an athlete runs a race, they may need rehab afterwards to treat overuse and injury. We need a similar approach after pregnancy,” she says.

What treatments are available for pelvic organ prolapse?

Dr. Nseyo offers the following overview of treatment approaches for prolapse, from the least to the most invasive:

• Least invasive of all are Kegel exercises, which women can do at home to strengthen their pelvic floor muscles (see instructions below).
• Physical therapy is often prescribed for prolapse and bladder complaints, especially if these are not in the “severe” range. PT can help to pull the organs up and back in place, as it works by strengthening the pelvic floor muscle.
• Surgery for more advanced or recurrent prolapse may involve a hysterectomy—the permanent removal of the uterus—and the return of a woman’s other pelvic organs to their rightful place.

What is the correct way to do Kegel exercises?

The National Institute of Diabetes and Digestive and Kidney Diseases offers a step-by-step guide to Kegel exercises, starting with two suggestions for finding your pelvic floor muscles.

• While urinating, try to stop your urine midstream. Do this gently. The muscles you squeeze to stop the urine flow are your pelvic floor muscles. Although this is an easy way to find the muscles at first, don’t normally do Kegel exercises when you’re urinating. Stopping your bladder from emptying completely could increase your risk for a bladder infection.

OR…

• Insert your finger into your vagina. Squeeze as if you were trying to hold in your urine. If you feel tightness around your finger, you are squeezing the right muscles.

Now that you’ve found your pelvic floor muscles, practice the following 3-step technique:

• Squeeze your pelvic floor muscles.
• Try to hold the squeeze for 3 to 5 seconds.
• Release the muscles and fully relax your pelvic floor.

Aim to do your Kegels three times a day. Try to do the exercises in three positions: lying down, sitting, and standing. Using all three positions is the most effective way to perform them.

Like any exercise routine, it can take a little time to build up muscle strength and conditioning. You may not feel your prolapse or bladder control improve until 3 to 6 weeks after you start your Kegel exercise regimen.

What about mesh? When is it used? When is its use discouraged?

Surgical mesh gives weak or damaged tissue extra support. It is used in some surgeries for pelvic organ prolapse and other conditions.

The U.S. Food and Drug Administration (FDA) has banned its placement directly in the vagina due to concerns around complications. However, says Dr. Nseyo, mesh is still used to address prolapse as long as it is placed via the abdomen, and is still used for stress urinary incontinence. When used for prolapse, it suspends the top of the vagina to a structure on the sacrum, which forms the back of the pelvis. The FDA, the Society for Urodynamics and Female Reconstructive Surgery (SUFU) and the American Urogynecologic Society (AUGS) consider mesh very safe and effective when used appropriately.

What is special about the practice of urogynecology?

Dr. Nseyo feels fortunate to be able to solve problems that affect women’s ability to do what they want and need to do in their lives. “My specialty offers a mix of patient advocacy, problem-solving and the opportunity to improve women’s quality of life,” she says. “It’s also about creating a safe space for patients who may feel misunderstood or even dismissed. Many of them find their issues with incontinence or prolapse embarrassing. They may also assume that these things just happen, and that they have to simply deal with them, when the truth is that rehabilitation or a simple procedure can solve many of these problems.”

Urogynecologic care at Weill Cornell Medicine

Learn more about Weill Cornell Medicine’s recently established Center for Female Pelvic Health, under the direction of Dr. Larissa Rodríguez, where you will be offered comprehensive analysis of your pelvic health along and a personalized treatment plan.

If you are experiencing a pelvic floor disorder, such as urinary continence or prolapse, make an appointment with a member of Weill Cornell Medicine’s urogynecological team.