Pelvic Organ Prolapse
What is pelvic organ prolapse?
Pelvic organ prolapse means that a pelvic organ—such as your bladder—has dropped (prolapsed) from its normal place in your belly and is pushing against your vagina. This can happen when the muscles that hold your pelvic organs in place get weak or stretched. This is often due to childbirth.
Pelvic organ prolapse is common. It isn't usually a big health problem, but it can be uncomfortable or painful. It can be treated if it bothers you. And it may get better with time.
More than one pelvic organ can prolapse at the same time. Organs that can be involved include the:
- Bladder. This is the most common kind of pelvic organ prolapse.
- Small bowel.
Female pelvic organs
What causes it?
Pelvic organ prolapse is most often linked to pregnancy and vaginal childbirth. These can weaken and stretch the muscles that keep your pelvic organs in place. If the muscles don't recover, they can't support your pelvic organs. Other causes of prolapse include aging, menopause, obesity, a chronic cough, and frequent constipation.
What are the symptoms?
You may not have any symptoms. Or you may feel pressure from pelvic organs pressing against the vaginal wall. Your lower belly may feel very full, and you may feel as if something is falling out of your vagina. You may have urinary or bowel problems or pain during intercourse.
How is it diagnosed?
If prolapse is suspected, your doctor will ask you questions about your past and current health. This includes asking about your symptoms and past pregnancies. Your doctor will also do a physical exam, including a pelvic exam. Pelvic organ prolapse that doesn't cause symptoms is often found during a routine exam.
How is pelvic organ prolapse treated?
You may not need or want treatment. For mild symptoms, you can try doing Kegel exercises and staying at a healthy weight. You can also try a pessary. Surgery is an option for some people whose symptoms don't get better with other treatments.
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Pelvic organ prolapse is most often linked to pregnancy and vaginal childbirth. Normally your pelvic organs are kept in place by the muscles and tissues in your lower belly. During pregnancy and vaginal delivery, these muscles can get weak or stretched. If they don't recover, they can't support your pelvic organs.
Pelvic organ prolapse can occur when you're young. But it's more likely to happen as you get older. And it's more common after menopause. It also tends to run in families.
Anything that puts pressure on your belly can make prolapse worse. Examples include:
- Being very overweight (obesity).
- A long-lasting (chronic) cough.
- Frequent constipation.
- Frequent heavy lifting.
You may not have any symptoms. Or pressure on your vagina may cause discomfort or problems with your pelvic organs. Symptoms may include:
- Feeling pressure or fullness in your lower belly.
- Feeling as if something is actually falling out of your vagina.
- Feeling a pull or a stretch in the groin area or a low backache.
- Pain during intercourse.
- Urinary problems. For example, you may release urine without meaning to (incontinence). Or you may have a frequent or urgent need to urinate.
- Problems with bowel movements. You may be constipated or need to support the back (posterior) of the vaginal wall to have a bowel movement.
Symptoms are worse when you stand, jump, or lift. They usually are relieved if you lie down.
When to Call a Doctor
Call your doctor to schedule an appointment if:
- You notice a bulge of tissue inside your vagina or bulging out of your vagina.
- You feel pulling or increased pelvic pressure that gets worse when you strain or lift but feels better when you lie down.
- Pain in your low back or pelvic area is interfering with your daily activities.
- Sexual intercourse has become difficult or painful.
- You have irregular spotting or bleeding from the vagina.
- You have urinary symptoms, such as involuntary release of urine (incontinence), urinating often, having an urgent need to urinate, or urinating often at night, that interfere with your daily activities.
- You have trouble having a bowel movement.
Watchful waiting is a wait-and-see approach. If you have been diagnosed with pelvic organ prolapse and you don't have symptoms, or if you have mild symptoms that aren't interfering with your daily activities, you may wish to try watchful waiting. In many cases, pelvic organ prolapse doesn't cause symptoms and doesn't need treatment.
If you have symptoms, such as a feeling of pressure in your vagina, schedule an appointment with your doctor.
Exams and Tests
A prolapse of a pelvic organ can be hard to diagnose. Pelvic organ prolapse that doesn't cause symptoms is often found during a routine exam. You may be aware that there's a problem, but you might not be sure of the exact location or cause. If your doctor thinks you may have an organ prolapse, he or she will ask you questions about your past and current health. This includes questions about your symptoms and your history of pregnancies and other health problems. Your doctor will also do a physical exam, including a pelvic exam.
Tests may be done to find out more about the prolapse, particularly if it's causing problems with bladder or bowel function. These tests include:
Decisions about treating pelvic organ prolapse are based on which organs have prolapsed and how bad your symptoms are. You may not need or want treatment.
If your symptoms are mild, you may be able to relieve them at home.
- Try Kegel exercises. These can make your pelvic muscles stronger.
- Reach and stay at a healthy weight.
- Avoid lifting heavy things. This can put stress on your pelvic muscles.
If these changes don't help, you can ask your doctor to fit you with a pessary. It's a removable device that you can put in your vagina to support areas of prolapse. But if you have a severe prolapse, you may have trouble keeping a pessary in place.
Surgery is an option for some people whose symptoms don't get better with other treatments. But you may want to delay surgery if you plan to have children. The strain of childbirth could cause the prolapse to come back.
Home treatment can relieve the discomfort of pelvic organ prolapse. It can also help to keep prolapse from getting worse.
- Do Kegel exercises every day to strengthen the muscles and ligaments of the pelvis.
- Prevent or correct constipation.
The straining caused by constipation increases pressure from the bowel on the vaginal wall and weakens and damages the connective tissue and muscles in the pelvis.
- Reach and stay at a healthy weight.
- Avoid activities that stress your pelvic muscles, such as heavy lifting.
If you have pain and discomfort from pelvic organ prolapse that isn't helped by nonsurgical treatment and lifestyle changes, you may want to think about surgery. Which type of surgery depends upon which organs are involved, how bad your symptoms are, and what other medical conditions you have. Also, your surgeon may have experience with and prefer to do a certain procedure. The goals of surgery are to relieve your symptoms and restore the normal functioning of your pelvic organs.
Surgeries are designed to treat specific symptoms. Be aware that you may still have other symptoms after surgery. An exam while you have a pessary in your vagina may help the doctor see if urinary incontinence would be a problem after surgery. If the exam shows that urinary incontinence will be a problem, another surgery can be done at the same time to fix the problem.
There are several types of surgery to correct stress urinary incontinence. These can be done at the same time as surgery to repair prolapse. These surgeries lift the urethra, the bladder, or both into their normal position.
Surgical procedures used to correct different types of pelvic organ prolapse include:
- Repair of the prolapsed bladder (cystocele) or urethra (urethrocele).
- Removal of the uterus (hysterectomy).
- Repair of the rectum (rectocele) and small bowel (enterocele).
- Repair of the vaginal wall (vaginal vault suspension).
- Closure of the vagina (vaginal obliteration).
Surgery in one part of your pelvis can make a prolapse in another part worse. This could require separate treatment in the future.
Current as of: February 11, 2021
Author: Healthwise Staff
Sarah Marshall MD - Family Medicine
Kathleen Romito MD - Family Medicine
Martin J. Gabica MD - Family Medicine
Femi Olatunbosun MB, FRCSC - Obstetrics and Gynecology