Pelvic Prolapse

Pelvic organ prolapse is a common type of Pelvic Floor Dysfunction that occurs when there is a loss of the normal supporting structures. Because of this loss of support, women can feel a vaginal bulge or a sensation of dropping of the bladder, uterus, rectum, urethra, or vaginal wall.

Pelvic Prolapse Causes

Pelvic prolapse is commonly linked to trauma to the muscles, nerves, and supportive structures of the pelvic organs during vaginal childbirth. If the muscles are not able to recover, they can no longer support the pelvic organs. A vaginal bulge may develop soon after childbirth but often arises many years later. Pelvic prolapse can also occur after a hysterectomy, as the removal of the uterus may result in less support to the remaining organs.

Other factors that can increase the risk of developing pelvic prolapse due to increased pressure on the pelvic organs include:
  • Advanced age
  • Heredity
  • Pelvic organ tumors
  • Frequent constipation
  • Obesity
  • A prolonged cough

Symptoms of Pelvic Prolapse

Symptoms of pelvic prolapse vary depending on the person, but some of the most common symptoms include:
  • Pelvic pressure
  • Abdominal heaviness or fullness
  • Bulge from the vagina
  • Pain in the groin or lower back pain
  • Incontinence, urinary frequency, or bladder control problems
  • Pain during intercourse
  • Constipation
  • Loss of stools (fecal incontinence)
  • Slow urine stream or incomplete voiding

Pelvic Prolapse Types

Cystocele: This condition occurs when the upper vaginal wall loses support, which allows the bladder to drop into the vaginal area.

Rectocele: This condition occurs when the support of the lower vaginal wall is lost and the rectum bulges into/out of the vagina.

Enterocele: This condition occurs when the small intestine pushes on the back wall of the vagina creating a bulge and can most often occur with vaginal vault prolapse.

Uterine Prolapse/Vaginal Vault Prolapse: This condition occurs when the uterus drops down into the vagina.

Pelvic Prolapse Diagnosis

A diagnosis of pelvic organ prolapse is typically made during a physical examination. Your doctor will examine the organs to determine the type and severity of the prolapse. During this examination, we will also seek additional information about your symptoms including your family and medical history as well as any previous treatments for your pelvic floor dysfunction.

Various tests may be performed during the evaluation for pelvic organ prolapse, including:

Urodynamics: This test helps check for urine leakage, bladder emptying, and helps make a diagnosis of an overactive bladder. Even, if there is no leakage, the test may be done to test for potential urine control problems, especially those with prolapse. This testing is important to distinguish the form of incontinence a person has and helps measure the health of the urinary sphincter and capacity of your bladder.

Cotton Swab Test: Your physician will use a small cotton swab with anesthetic gel in your urethra. You will be asked to strain. The use of the applicator can detect whether there has been a loss in support to your urethra.

MRI Testing: By taking an MRI of your pelvis, your physician is able to create a detailed image in 3D. This can be useful in detecting and diagnosing pelvic prolapse. This technique is still considered experimental for the diagnosis of pelvic prolapse.

Cystoscopy: With this test, an instrument with a lens is placed into the urethra. This allows your doctor to check for urinary tract abnormalities.

Treatment for Pelvic Organ Prolapse

Treatment for pelvic prolapse will vary depending on the type of condition that you have. Many physicians recommend first trying to treat the condition without surgery. However, symptoms will affect each woman’s quality of life differently.

Expectant Management

Not all pelvic prolapses must be treated. After your doctor confirms that there are no potentially serious conditions, pelvic prolapse can be left alone.

Pessary

A pessary is a device used in the vagina to support the pelvic organs. There are often many inaccurate assumptions about pessaries. A pessary can be used very effectively for women young and old to treat pelvic prolapse and urinary incontinence.

Hormonal Treatments

The safe use of vaginal estrogen can be very effective in relieving the symptoms of pelvic prolapse. It is important to discuss the risks and benefits of vaginal estrogen therapy with your doctor.

Behavioral Treatments

Certain activities can lead to or aggravate pelvic prolapse. Patients should also maintain a healthy weight and avoid lifting heavy items that can put stress on your pelvic region. Heavy lifting and being overweight can place extra stress on the pelvic support, which increases the chance of developing pelvic prolapse.

Surgery

Most doctors will utilize laparoscopic or other minimally invasive surgeries to treat pelvic prolapse. These surgeries allow your physician to make small incisions and they can ultimately shorten the hospital stay.

Non-surgical and Surgical

There are non-surgical and surgical treatment options available for those with pelvic organ prolapse. Your doctor is there to provide you with the information about all your options and help you determine which is best for you.

Non-Surgical Treatments

  • Pessary
  • Pelvic floor exercises

Surgical Treatment

  • Pelvic Reconstruction – There are different types of prolapse and therefore different techniques to repair prolapse, but the main goal for all is to reposition and strengthen the function of the weakened tissues surrounding the prolapsed organ.