Pelvic organ prolapse

Pelvic organ prolapse occurs when supportive tissues around the vaginal walls and uterus weaken, allowing pelvic organs to drop. This causes a bulge or protrusion in the vagina or through the vaginal opening.

Types of Pelvic Organ Prolapse

Cystocele

A cystocele occurs when the front wall of the vagina sags downward or outward, allowing the bladder to drop from its normal position. This may impact bladder function and result in urinary problems.

Rectocele

A rectocele occurs when the back wall of the vagina sags outward, allowing the rectum to bulge into the vagina. Rectoceles may impact bowel function by making it more difficult to empty the rectum during defecation.

Uterine prolapse

Uterine prolapse occurs when the support around the uterus or cervix weakens, allowing the uterus drop down. In some cases, the cervix can bulge into the lower vagina or protrude through the vaginal opening.

Causes of Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the muscles and/or connective tissues around the vaginal walls are damaged or weakened. This may be due to one or more of the following factors:

  • One or more vaginal births
  • Giving birth to a large baby
  • Difficult labor and delivery
  • Physical problems associated with aging
  • Conditions that increase abdominal pressure (obesity, chronic coughing or straining)
  • Family history of pelvic organ prolapse

Pelvic Organ Prolapse Symptoms

Prolapse usually isn’t painful, but it can be uncomfortable. Symptoms associated with pelvic organ prolapse include:

  • A feeling of heaviness, pressure, or pulling in the pelvis
  • Seeing or feeling a bulge at the vaginal opening
  • Lower back pain
  • Painful sex
  • Frequent or urgent urination
  • Bladder control problems
  • Difficulty emptying the bladder
  • Difficulty with bowel movements

Pelvic Organ Prolapse Treatment Options

There are a wide variety of treatment options available for pelvic organ prolapse, ranging from watchful waiting to surgery.

Local treatment

Topical estrogen therapy and skin protectants can be used to treat bothersome problems related to a prolapse bulge. For example, if the bulge is causing skin irritation at the opening of the vagina, prescribed medications or creams can help relieve symptoms. 

Kegel exercises

Kegel exercises, or squeezing your pelvic floor muscles, helps strengthen the pelvic floor and improves mild to moderate degrees of prolapse

Vaginal devices

Vaginal pessaries are silicone rubber devices placed in the vagina to lift up and hold the prolapsed organ in place. When properly fitted and cared for, pessaries can be worn comfortably and safely for many years. Most patients can manage their own pessary without frequent office visits. Pessary placement is a nonsurgical treatment.

Surgery

Surgery may also be recommended to correct a prolapse.

Prevention

While there are some causes of prolapse that you can’t prevent, there are ways to decrease your chances of developing pelvic organ prolapse. These include:

  • Avoid repetitive heavy lifting
  • Don’t smoke or quit smoking to prevent unnecessary coughing
  • Maintain a healthy body weight
  • Avoid constipation and chronic straining
Last reviewed: 
February 2018

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