Pelvic Organ Prolapse

It is often referred to “pelvic prolapse” or “vaginal prolapse”. Pelvic organs include the cervix, bladder, uterus, vagina, small bowel and rectum. These organs are held in place by a group of muscles that combine to create a hammock like structure or sling for support. This structure of muscles is called the pelvic floor. As the muscles become weak, damaged, torn or stretched due to factors such as childbirth, age, constipation, cancers, hysterectomy, pelvic surgery or excessive weight, the pelvic floor can fail or prolapse. Genetics may also play a role with some women having weaker connective tissue.

Often times there will not be any symptoms of POP. The most common symptoms include:

• Pelvic or vaginal pressure
• A feeling that “something is falling out” (this is usually a prolapsing cervix and uterus)
• Vaginal cramping, pain or low back pain
• Difficulty emptying the bladder or rectum and the need to splint, or push the prolapse back in
• Painful intercourse

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Things that may increase the probability of pelvic organ prolapse to occur include:

• Genetics
• Number of and types of delivery during childbirth
• Weight or obesity
• Smoking
• Chronic constipation

Pelvic organ prolapse is very common in women with the incidence increasing with age and after having children. Things that cause POP include:

• Childbirth and pregnancy can cause injury to the muscles of the pelvic floor.
• Genetics including family members that have had POP. Caucasian women are more likely to develop POP as well.
• Smoking increases chances of developing POP as well as many other conditions.
• Pelvic floor injury which can be caused by numerous things including childbirth and surgery.
• Obesity – obese woman has and a 40% – 75% increased chance of having prolapse.
• Menopause and aging are a contributor to pelvic organ prolapse.
• Intense or heavy lifting.

Although childbirth is a big contributor or cause of POP, it’s important to note that many women who have had multiple births will not experience POP.

• Pelvic Exam
• Urinary tract x-ray
• CT scan
• Ultrasound
• MRI

When pelvic prolapse is effecting quality of life and causing pain, surgery may be needed. Common symptoms that may require surgery include:

• Feeling as if something is “falling out”
• Bulge inside our even protruding outside of the vagina
• Pelvic pressure when lifting or straining
• Painful intimacy
• Difficulties with regularity and bowel movements
• Incontinence urge or frequent urination

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There are 3 main types of vaginal prolapse.

This occurs at the top of the vagina. If the muscles that support the bladder fail or detach the bladder can drop or fall down to the vagina. This condition can cause recurrent bladder infections, frequency and loss of bladder control. Stress urinary incontinence is another symptom of prolapse.

This type of prolapse refers to support tissue between the vagina and rectum. If this tissue is damaged, stretches or detaches it can lead to the rectum or intestines “falling”.

This is when the upper portion of the vagina can lose its shape and support and can drop down into the vaginal canal or outside of the vagina. In can occur at the same time as uterine prolapse.

As terrible as pelvic organ prolapse may sound, you do not have live with these symptoms. Which treatment will depend on the severity and symptoms? Treatment options include:

1. Pelvic strengthening or physical therapy such as Kegel exercises. As common as prolapse is, it doesn’t always lead to surgery.

2. Pessary – A small plastic device used to provide support to organs normally supported by the pelvic floor.

3. Surgery – There are several options depending on patient goals and particular prolapse. In general, we can repair the vagina prolapse through the vagina, or transvaginal reconstruction versus an abdominal approach. Typically, we offer a Robotic assisted abdominal approach rather than repairing through an incision. This reduces recovery time.