Pelvic organ prolapse is a condition in which one or more of the organs in the pelvis fall down from their normal position and bulge into the vagina. The condition affects nearly 3% of women in the U.S.
The pelvic floor is a group of muscles that create a hammock across the pelvic opening, helping to hold the bladder, vagina, uterus, small bowel, and rectum in place. Problems with these muscles can lead to pelvic floor disorders that include urinary incontinence, anal incontinence, and pelvic organ prolapse.
Symptoms of Pelvic Organ Prolapse
Individuals with pelvic organ prolapse may experience:
- Discomfort or numbness during sexual intercourse
- Dragging discomfort inside their vagina
- A feeling of heaviness around the lower abdomen and genitals
- A feeling of something falling into the vagina, as if sitting on a small ball
- Difficulty urinating, frequent urination, inability to fully empty the bladder, and incontinence caused by coughing, sneezing, or exercise
- Feeling or seeing a bulge coming out of the vagina
Causes of Pelvic Organ Prolapse
The condition occurs when the muscles and tissue that support the pelvic organs are weakened and unable to hold the organs in place.
Factors that increase the risk of pelvic organ prolapse include:
- Being overweight or obese
- Pregnancy, labor, and childbirth
- Aging and menopause
- Long-term constipation that causes coughing and forces straining
- Hysterectomy
- Pelvic organ cancers
- Occupation that requires heavy lifting
- Marfan syndrome
- Joint hypermobility syndrome
- Ehlers-Danlos syndrome
- Genetics
Types of Pelvic Organ Prolapse
Patients have one or more of these types of prolapse at the same time:
- Anterior prolapse, or cystocele, in which the bladder bulges into the front wall of the vagina.
- Uterine prolapse, in which the womb bulges or hangs down into the vagina.
- Vagina vault prolapse, in which the vagina sags down after surgery to remove the womb.
- Posterior wall prolapse, in which the bowel bulges forward into the back wall of the vagina.
A small bowel prolapse may be called an enterocele, whereas a prolapse of the urethra may be called urethrocele. A rectum prolapse is called a rectocele.
Diagnosing Pelvic Organ Prolapse
The first step is to do an internal pelvic examination. The patient will need to undress from the waist down and lie on an examination bed. The physician will then feel for any lumps in the pelvic area and inside the vagina. An instrument called a speculum may be inserted into the vaginal to hold the walls open and identify a prolapse.
Some patients may be asked to lie on their left side so that the physician can obtain a better view of the prolapse.
Additional testing that may be done to diagnose pelvic organ prolapse include a urine test that will identify an infection and a cystoscopy to look inside the bladder.
Treatment For Pelvic Organ Prolapse
Women experiencing bothersome symptoms may experience relief by losing weight if they’re overweight, avoiding heavy lifting, and preventing or treating constipation.
Severe instances of pelvic organ prolapse may be treated with vaginal pessaries, surgery, pelvic floor exercises, and hormone treatment.