Women’s Health & Urogynecology

Pelvic Organ Prolapse

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Pelvic Organ Prolapse is loss of support of the vagina that holds the organs up and often the uterus. It is easily diagnosed with a pelvic examination.

Prolapse can occur when there is weakening of or damage to pelvic floor muscles, support tissue and ligaments and/or nerve damage. Commonly referred as “dropped bladder” or “dropped bowel,” prolapse is actually loss of support of the vagina that holds the organs up and often the uterus.

Risk factors for prolapse include:

  • Pregnancy
  • Vaginal delivery
  • Heavy lifting
  • Chronic constipation
  • Obesity
  • Smoking
  • Family history of prolapse or hernias

Symptoms include feeling a bulge (often described as a bubble) coming out of the vagina.

Common terms include cystocele, rectocele, enterocele, uterine prolapse and vaginal vault prolapse. All of these indicate different support problems of the vagina and possibly uterus.

Prolapse is easily diagnosed with a pelvic examination. During your exam, you will be asked to bear down or cough while measurements are taken of the different compartments of the vagina to determine what is prolapsing and its severity.
In rare cases, special pelvic floor imaging studies may be performed.

Decision Whether Or Not to Treat Prolapse

Not all women who have prolapse require treatment. In most cases, patients have the option to do nothing, with the greatest risk being that the prolapse may get worse with time. Decisions about treatment are made considering several factors. These include:

  • Severity of the prolapse
  • Whether and how much prolapse is affecting bowel and bladder function
  • Patient goals for treatment
  • Quality of life

Pessary

For patients who are bothered by prolapse but do not want surgery, vaginal pessaries are often an option. A pessary is a device, usually made of silicone, that fits inside the vagina and holds up the pelvic organs. Most patients manage their pessaries by regularly taking them out and cleaning them, but we also provide that service to our patients who are unable to do so.

Surgery For Prolapse

There are many surgical procedures for prolapse that are safe, minimally invasive and highly effective. Most surgeries for prolapse are performed through the vagina or through small laparoscopic/robotic abdominal incisions. With most surgeries, you can anticipate going home the same day. You and your physician will work together to identify the surgery that is right for you.

Some of the choices commonly discussed are:

  • Obliterative (“close up vagina”) or Reconstructive (pull up vagina)
  • Keeping the uterus/uterine suspension or removing the uterus/hysterectomy
  • Native tissue (sutures) or mesh augmented surgeries

There is no one right surgery. The decision of what surgery is best for you will be based upon your prolapse, goals for surgery, lifestyle and preferences.