This condition is caused by weakness of the pelvic floor. The pelvic floor consists of the muscles, nerves and connective tissue that surround the uterus, vagina, bladder and rectum, providing support and helping these organs function properly. When these support structures become weakened, the pelvic organs can begin to fall out of their normal position. The movement of these organs, or prolapse, may make it more difficult for these organs to function normally.
Other names for pelvic organ prolapse include cystocele or "fallen bladder" (bladder prolapse), rectocele (rectal prolapse) and "dropped uterus" (uterine prolapse).
Risks & Causes
Pelvic organ prolapse is very common, with over 40% of all women experiencing some degree of prolapse in their lifetime. Despite the high prevalence of this disorder, the exact cause remains unknown.
We do, however, know of various risk factors that increase the chances of developing pelvic organ prolapse. Some of these risk factors include:
- Pregnancy
- Vaginal delivery (in particular, difficult deliveries)
- Some types of Hysterectomy
- Constipation
- Chronic coughing, straining or heavy lifting
- Genetic connective tissue weakness
Symptoms & Evaluation
The most obvious symptom of vaginal polapse is a noticeable bulge protruding from the opening of the vagina. Additional symptoms include:
- Feelings of pelvic pressure or discomfort
- Perception of something falling out
- Difficulty emptying the bladder
- leakage of urine
- Difficulty emptying the rectum
- Fecal incontinence
- Experiencing a sense of looseness or discomfort during sexual intercourse
Pelvic organ prolapse is diagnosed by physical exam. During the pelvic exam, the physician evaluates the anterior vaginal wall, posterior vaginal wall, top of the vagina and uterus, inspecting for signs of organ prolapse. The prolapse is then carefully measured - usually in both the lying down and standing up positions. It is important for the physician to carefully measure all aspects of pelvic floor support before suggesting a treatment plan.
Treatment Options
Pelvic organ prolapse may be treated with a variety of non-surgical and surgical options, depending on the severity of the condition and the patient's wishes.
Non-surgical treatments:
Kegel exercises:
These exercises are best used for mild cases of prolapse; with severe prolapse, the benefit is limited. Kegel exercises are used to strengthen the muscles of the pelvic floor. As these muscles grow stronger, they are better equipped to support the pelvic organs and slow the progression of prolapse.
In addition, these exercises can help control stress urinary incontinence, urge urinary incontinence, overactive bladder and fecal incontinence. As with any exercise program, Kegel exercises must be done correctly and regularly in order to work.
Pelvic floor therapy:
Pelvic floor therapy consists of visits to a physical therapist with specialized training in pelvic floor disorders. These specialized physical therapists utilize various techniques, depending on the condition they are treating.
With pelvic organ prolapse, the goal of pelvic floor therapy is to strengthen the pelvic floor in order to support the vagina and pelvic organs.
Four treatment options commonly used in pelvic floor therapy are listed below.
- Biofeedback: Biofeedback uses an intravaginal device to train pelvic floor muscles to contract and relax properly
- Functional electrical stimulation: Functional electrical stimulation utilizes a device that can be used intravaginally or externally, delivering a gentle electrical current to activate or relax the nerves and muscles in the pelvis
- Manual therapy: Manual therapy uses pressure applied to and released from muscles in spasm, in order to relax them and increase blood flow to the area for healing. Often, women with prolapse subconsciously contract their pelvic floor muscles to the point of creating muscles spasms. These spasms may cause a painful condition called pelvic floor dysfunction, which can cause pelvic pain, painful sex and difficulties with urination and defecation
- Joint and tissue mobilization: This therapy involves gentle manipulation to help calm the muscles and nerves of the pelvis
Vaginal pessary:
A vaginal pessary is a removable, diaphragm-like device worn within the vagina to support the bladder or other organs that are prolapsing through the vagina. A vaginal pessary may also be used to decrease stress urinary incontinence. Pessaries come in a variety of types and sizes. Pessary fitting may require two or more office visits in order to select the proper type and size of pessary that will work for you.
Surgical treatments:
Traditional "Native-Tissue" Prolapse Repair:
Anterior Colporrhaphy: A vaginal surgery using the patients' existing connective tissue to shore up support of the bladder / vagina.
Posterior Colporrhaphy: A vaginal surgery using the the patient's existing connective tissue to shore up support of the rectum / vagina.
Perineorrhaphy: Thesurgical repair of a weakened perineum (the area between the vaginal opening and the anus).
Vaginal Vault Suspension/Uterine Resuspension: The suspension of the top (or "apex" ) of the vagina to a ligament in the pelvic, usually either the sacrospinous ligament or the uterosacral ligaments.
Hysterectomy (removal of the uterus): Some type of hysterectomy (either vaginal, laparoscopic or sometimes abdominal) is often performed as the first step of a POP repair, because doing so often allows for a better suspension of the vagina to the surrounding support structures.
Graft-Augmented Prolapse Repairs:
When the patient's existing connective tissue is thought to be too weak to allow for a successful prolapse repair, the surgeon will offer "graft augmentation" with either synthetic mesh or some biologic graft material. Any of the above mentioned "native tissue" surgeries can be enhanced by the use of a graft material. Additionally, there are several surgical approaches where the placement of the graft is the main goal of the surgery.
Laparoscopic Sacrocolpopexy
First described in 1962 as an open abdominal surgery, the sacrocolpopexy has been the "gold-standard" prolapse repair ever since. Since about 2000, sacrocolpopexies have usually been performed laparoscopically, because doing so results much less discomfort during the healing process. This operation involves fashioning a 'custom-made' Y-shaped mesh that will reconstruct the entire support system of the pelvic organs through attachment to a ligament near the back bone in the pelvis.
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If you'd like to learn more about our providers that specialize in Pelvic Organ Prolapse, please view the "Our Care Team" page.