Pelvic Organ Prolapse

Overview

Close to 25% of women will experience a pelvic floor disorder in their lifetime. 

Pelvic Organ Prolapse is what happens when the vaginal and uterine supports fail and the vagina and uterus begin to sag or fall out of position. Since the bladder and rectum rely on the vaginal walls for support, prolapse can affect the function of these organs.

Prolapse is often associated with bladder and bowel problems, such as incomplete emptying or incontinence. It is typically described by our patients as an uncomfortable “bulge”. There are many different ways to re-support the vagina and get rid of the bulge and discomfort. Women are not usually aware of the prolapse until it is at the opening of the vagina. It is also very difficult for a patient to tell what is exactly prolapsing.

Causes

Many different factors can influence prolapse and the cause is felt to be multifactorial. Pregnancy and delivery can influence prolapse. Chronic constipation, heavy lifting, chronic coughing as well as some collagen disorders are all thought to increase the chance of developing a prolapse. Some studies also indicate that smoking and obesity can be risk factors.

Minimizing factors that increase abdominal pressure such as constipation and cough can minimize the risk of prolapse. Improving pelvic floor stength, either through a home regimen or through phsyical therapy can also stabalize or even reverse pelvic organ prolapse.

Sometimes symptoms of prolapse can be made worse by atrophic tissue- or tissue that is lacking estrogen. This happens in postmenopausal women. It can easily be corrected with estrogen therapy. The estrogen is usually directly applied to the symptomatic tissues so the overall dose of estrogen is minimized.

If you think you may suffer from pelvic organ prolapse, please calll our office for treatment and evaluation.

Treatments

There are many treatment options available for prolapse. 

Nonsurgical Options

  • Physical Therapy: This may be an option to help women minimize the earlier stages of prolapse.
  • No Treatment: Many women have prolapse and are not bothered by it. In this situation, the prolapse can be followed and no treatment is needed.
  • Pessary Ring: Some women opt for a pessary. A pessary is a device that is made out of silicon and placed in the vagina to hold the prolapsed organs up. This device is usually placed and removed by the patient. Pessaries come in all different shapes and sizes and must be fitted to the individual patient. 

Surgical Options

  • Obliterative: Some approaches are obliterative and involve closing the vagina. Obliterative procedures are only a reasonable option for women who are no longer interested in sexual activity.
  • Native Tissue Repairs: Some procedures are native tissue repairs and involve using a patient's own tissue to resupport the prolapsing tissues.  

Some procedures use mesh to reinforce the tissue. These procedures tend to be more durable than native tissue repairs. There is a lot of media attention centered on mesh and it is very important that a woman understands the risks and benefits of using mesh. We are diligent in ensuring that our patients are as informed as possible. Please read additional information on mesh for pelvic floor repairs.