Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the organs in your pelvis—like your vagina, bladder, uterus, urethra, and rectum—shift out of their normal positions. This creates a bulge in the vagina.

Normally, strong muscles and supportive tissues in the pelvic floor hold these organs in place. Think of the pelvic floor as a hammock supporting the organs. But sometimes, these muscles and tissues weaken. This weakening can happen for a number of reasons, including pregnancies, childbirth, or the hormonal changes of menopause. The weakening allows the organs to slip down.

Fortunately, pelvic organ prolapse can often be treated. Many times, a doctor can help without surgery. This might involve exercises to strengthen the pelvic floor muscles, or devices to support the organs. In some cases, surgery is needed to reposition the organs and restore support. This surgery can be done in different ways, and your doctor will discuss the best option for you.

Pelvic organ prolapse can sometimes happen without any noticeable symptoms. However, when symptoms do appear, they can include:

• A noticeable bulge: You might see or feel a bulge of tissue near or inside your vagina.

• Lower back pain: Pain in your lower back is a common symptom.

• Tampon issues: You may have trouble keeping a tampon in place.

• Changes in urination: This can involve needing to urinate more often, feeling a sudden urge to urinate, not being able to fully empty your bladder, or experiencing a weak urine stream.

• Changes in bowel movements: You might have difficulty completely emptying your bowels or need to use your fingers inside your vagina (a process called "splinting") to help push out stool.

• Sexual problems: Pain during sex can be a symptom.

It's important to understand that pelvic floor weakness often affects multiple areas of the pelvis. If one of your pelvic organs is prolapsing, it's more likely that other organs might also be affected. In other words, if you have one problem, you might have related problems in other areas of the pelvic region.

Pelvic organ prolapse happens when the tissues and muscles holding your pelvic organs (like your bladder, uterus, and rectum) weaken. A common reason for this weakening is childbirth, especially vaginal delivery. During pregnancy and childbirth, the muscles and ligaments that support these organs can stretch and lose some of their strength. Other factors that can contribute to this weakening include aging, chronic coughing, heavy lifting, and obesity. In short, anything that puts extra stress on the pelvic floor muscles can increase the risk of prolapse.

Pelvic organ prolapse happens when the organs in your pelvis, like your bladder, uterus, or rectum, slip out of place. Several things can increase your chances of this happening.

One major risk factor is having multiple pregnancies, delivering babies vaginally, especially if the babies are large. Using tools during delivery can also increase the risk. Having a family history of prolapse or conditions affecting connective tissues (like ligaments) in the body also makes you more susceptible.

Age also plays a role. The risk goes up as you get older. Being overweight or obese is another factor.

Past pelvic surgery can weaken the supporting tissues and increase the likelihood of prolapse.

Chronic conditions like chronic obstructive pulmonary disease (COPD) can cause a persistent cough, which puts strain on the pelvic floor. Similarly, ongoing issues with constipation or heavy lifting can create pressure on these tissues, increasing your risk.

Understanding Pelvic Organ Prolapse: Diagnosis and Testing

Finding out if you have pelvic organ prolapse starts with a conversation about your health history and a physical exam of your pelvic organs. This helps your doctor figure out what kind of prolapse you might have. Sometimes, additional tests are needed.

Tests for Pelvic Organ Prolapse:

• Pelvic Floor Strength Tests: During a pelvic exam, your doctor will check the strength of your pelvic floor and sphincter muscles. These muscles and ligaments support important organs like your vagina, uterus, rectum, urethra, and bladder. The exam helps determine how strong these supporting structures are.

• Bladder Function Tests: Doctors also check if your bladder leaks when pressure is applied during the pelvic exam. Other tests might look at how well your bladder empties completely. These tests help assess bladder control and function.

• Imaging Tests (MRI or Ultrasound): If your prolapse is more complicated or extensive, imaging tests like MRI (magnetic resonance imaging) or ultrasound might be used to get a clearer picture of the affected organs and structures. This can help your doctor understand the extent of the problem and plan the best treatment.

Getting Care at Mayo Clinic:

A team of experts at Mayo Clinic can provide comprehensive care for pelvic organ prolapse. They'll work with you to understand your specific situation and develop a personalized treatment plan. You can start by [link to Mayo Clinic resources].

Pelvic Organ Prolapse: Understanding Treatment Options

Pelvic organ prolapse (POP) happens when the organs inside your pelvis, like your bladder, uterus, or rectum, drop from their usual positions. This can cause discomfort or other problems. How you treat it depends on how much it affects your daily life.

If it doesn't bother you much: Your doctor might recommend no treatment at all, or non-surgical options.

If it does bother you: Surgery might be necessary to restore the organs to their proper place and improve your quality of life.

Symptoms and Other Issues: Pelvic organ prolapse can sometimes be linked to urinary or bowel problems, but it's not always the cause. If your bladder or bowel issues aren't related to the prolapse, treating the prolapse won't necessarily fix those problems.

Menopause and Estrogen: Many women with prolapse are also going through menopause. Menopause lowers estrogen levels, which can weaken the vaginal tissues and cause dryness. Talk to your doctor about whether estrogen treatment, possibly vaginal estrogen, might be helpful.

Strengthening Pelvic Floor Muscles: Pelvic floor exercises, often with biofeedback, can be very beneficial. Biofeedback uses special sensors in the vagina and rectum or on the skin to show you how to properly contract your pelvic floor muscles. A computer screen displays the strength and timing of your contractions, helping you learn the correct technique. Strengthening these muscles can improve symptoms over time.

Pessaries: A pessary is a supportive device that fits inside the vagina to hold the prolapsed organs in place. They come in different shapes and sizes. Some people can manage inserting and removing the pessary themselves, while others might need to see their doctor for regular replacements.

Surgery for Pelvic Organ Prolapse:

If pelvic organ prolapse significantly impacts your life, surgery may be an option. The goal of surgery is to correct the bulge and improve symptoms, not necessarily to strengthen the weakened tissues. There are different types of surgery, depending on the location and severity of the prolapse:

• Anterior (Front) Prolapse (Cystocele): This is the most common type, affecting the bladder. Surgery involves making a small cut in the vagina, repositioning the bladder, and securing the supporting tissues to keep the bladder in place (colporrhaphy). If you have urinary incontinence, additional procedures like bladder neck suspension or slings might be considered.

• Posterior (Back) Prolapse (Rectocele): This involves the rectum. Surgery focuses on repositioning and tightening the tissues between the vagina and rectum.

• Uterine Prolapse: If you don't plan to have more children, your doctor may recommend removing the uterus (hysterectomy).

• Vaginal Vault Prolapse (after hysterectomy): This involves the upper part of the vagina, often affecting the bladder, rectum, or small intestine (enterocele). Surgery might be done through the vagina or abdomen (laparoscopically, robotically, or as an open procedure). The surgeon might attach the vagina to the tailbone or use mesh to provide support. Discussing the potential benefits and risks of mesh with your surgeon is crucial.

Important Note: Prolapse surgery only fixes the bulging tissues. Weakened tissues might still be present, meaning the prolapse could return.