Pelvic Organ Prolapse

Pelvic organ prolapse can be a sensitive topic that some women are reluctant to discuss, though 12 percent of U.S. women have pelvic organ prolapse that’s bothersome enough to warrant surgery.

Pelvic organ prolapse occurs when a woman’s pelvic muscles and tissue weaken and can no longer support the pelvic organs, causing them to bulge or drop into the vagina.

There are four primary types of pelvic organ prolapse.

Anterior vaginal wall prolapse (cystocele)

Anterior vaginal wall prolapse occurs when the wall between the bladder and vagina is weakened, causing the front wall of the vagina to fall down.

Symptoms

  • A sense of pressure, heaviness or bulge in the vagina
  • Frequent urination
  • Trouble completely emptying the bladder
  • Recurring bladder infections
  • Loss of bladder control

Posterior vaginal wall prolapse (rectocele)

Posterior vaginal wall prolapse occurs when the back wall of the vagina (separating the vagina from the rectum) stretches or weakens.

Symptoms

  • A sense of pressure, heaviness or bulge in the vagina
  • Straining during bowel movements
  • Feeling of not completely emptying the bowels

Apical prolapse (vaginal vault prolapse)

Apical prolapse occurs when the top of the vagina is not supported. The uterus (if it hasn’t been removed) and cervix fall into – and sometimes through – the opening of the vagina. However, simply removing the uterus, without suspending the vagina, will not solve the problem. Even after a hysterectomy, the top of the vagina (called the vaginal cuff or vaginal vault) can still fall.

Symptoms

  • A sense of pressure, heaviness or bulge in the vagina
  • Trouble completely emptying the bladder
  • The need to push the prolapse back in before starting to pee
  • Ulcers and bleeding from the cervix or vaginal skin if it protrudes outside the vagina

Rectal prolapse:

Rectal prolapse occurs when muscles and tissues detach from the rectal wall, allowing the rectum to fall through the anus.

Symptoms

  • Blood from the protruding tissue, which may be mistaken for a hemorrhoid
  • Loss of control of bowel movements

Diagnosis

At Providence Little Company of Mary Torrance, your diagnosis begins with a thorough review of your medical history and a physical exam. Your doctor also may conduct additional tests, exams or procedures to help diagnose pelvic organ prolapse.

Pelvic exam: Your doctor measures your vagina while you’re standing up and lying down in order to determine which part of the vagina is prolapsed and to what extent.

Urodynamics: This test assesses urinary incontinence or trouble urinating. It is commonly used to gather more information about how the bladder may function after surgery.

Pelvic ultrasound: This procedure uses sound waves to examine the pelvic floor, reproductive organs and bladder. It is most commonly used for women who have postmenopausal bleeding, fibroids in the uterus or ovarian cysts.

Treatment

Not all prolapses are treated the same way. Our specialists help you determine which treatment is right for you.

Treatment depends on the severity of your symptoms, your general health and your personal preferences. Your compassionate care team works with you to develop a treatment plan that may include the following.

Non-surgical treatment

  • Quitting smoking: Smoking increases the risk of pelvic floor disorders in women.
  • Pelvic floor muscle training (PFMT): Pelvic floor muscle training, which is more than simply Kegel exercises, involves squeezing and relaxing the pelvic floor muscles to strengthen and better control them. Over time, Kegel exercises can help decrease urinary leakage and may prevent progression of prolapse.
  • Pessary: A pessary is a silicone device made that is inserted through the vagina to support pelvic organs and hold them in place. Similar to glasses or contact lenses, a pessary should be noticeable during insertion or removal, but otherwise it should be comfortable to wear. A pessary that feels uncomfortable is probably not the right size or shape. 

Surgical treatment

Surgery involves repairing the anatomy and restoring pelvic floor support. There are multiple ways to accomplish this, depending on the type of prolapse and other factors. If you choose to undergo surgery, you may or may not want to have your uterus removed through a procedure called a hysterectomy. Some women elect to have other procedures to treat or prevent urinary incontinence at the same time as prolapse surgery.

Our urogynecologists take the time to explain all of your options in detail and give you ample opportunities to ask questions. It’s important that you feel fully informed and confident in making any decisions about your health.

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