Pelvic Organ Prolapse

What Causes Pelvic Organ Prolapse?

The most common reason for pelvic organ prolapse is when the pelvic ligaments and muscles that support your pelvic organs, or the pelvic floor, become weakened or injured. This causes the organs to shift out of place or sag. Weakening of the pelvic floor is most often due to age-related physical changes, childbirth, especially multiple births, or post-surgical complications.

Types of Pelvic Organ Prolapse

Types of pelvic organ prolapse include:

• Uterine prolapse: The uterus drops into the vagina or bulges through the vaginal opening.
• Vaginal vault prolapse: Weakened pelvic floor muscles cause the top of the vagina, or vaginal vault, to bulge into the vaginal canal or past the vaginal opening.
• Cystocele (anterior vaginal wall prolapse): One of the most common types of pelvic organ prolapse, this causes the front wall of the vagina to sag, allowing the bladder to drop and bulge into the vagina.
• Rectocele (posterior vaginal wall prolapse): Weakened pelvic floor muscles cause the rectum to bulge onto the vagina’s posterior or back wall.
• Enterocele (small bowel prolapse): This type of prolapse causes the small intestine to bulge onto the back wall of the vagina.
• Urethrocele (urethral prolapse): With this type of prolapse, the urethra bulges through the vaginal opening. It is often accompanied by a dropped bladder.

Recognizing the Signs of Pelvic Organ Prolapse

Pelvic organ prolapse can range from mild to severe. With mild cases, the organs may only drop slightly, causing few or no symptoms. In severe cases, the organs may drop outside of the vagina and create a bulge.

The most common symptoms of pelvic organ prolapse are:

• Involuntary loss of urine
• Loss of bowel control
• Difficulty emptying your bladder or bowel
• Feeling a bulge or sensation of pressure in your vagina or pelvis
• Feeling or seeing something coming out of your vagina
• Painful intercourse
• Pelvic or vaginal discomfort

Diagnosing Pelvic Organ Prolapse

To diagnose pelvic organ prolapse, your healthcare provider will review your symptoms and perform a pelvic exam. They may be able to diagnose and assess the severity of the pelvic organ prolapse through the pelvic exam alone, or they may perform additional tests such as:

• Pelvic floor function tests: This test allows your provider to assess the strength of your pelvis muscles and ligaments
• Cystoscopy: a procedure that allows your provider to see inside the bladder and urethra.
• Urodynamics test: Assess the function of the bladder and urethra.
• Imaging tests: These will provide images of the inside of the pelvic cavity. They include pelvic floor ultrasound or magnetic resonance imaging (MRI) test.

Comprehensive Treatment Options for Pelvic Organ Prolapse

The expert female pelvic health team at University Hospitals offers women a full range of treatment options to help improve both function and quality of life. We take a personalized approach to the care of each woman and look at all available options for treatment.

Nonsurgical treatment options may include:

• Pessaries: A device that is inserted into the vagina to help support and strengthen the pelvic floor. A pessary can be managed by the patient herself or with the help of your doctor, it often requires minimal care and is very effective in alleviating bothersome pelvic organ prolapse symptoms.
• Physical therapy: A specially trained pelvic floor therapist will work with you to learn exercises that will help alleviate some of the bothersome symptoms that might be associated with pelvic organ prolapse.

Surgical Treatment Options for Pelvic Organ Prolapse

If conservative therapies are not successful or women develop significant pelvic organ prolapse, our fellowship-trained surgeons are highly experienced in transvaginal, open abdominal, laparoscopic and robotic-assisted surgeries for the treatment of pelvic organ prolapse and other complex pelvic floor disorders, including vesicovaginal fistulas.

Surgical procedures may include:

• Robotic-assisted hysterectomy (removal of the uterus)
• Robotic-assisted sacrocolpopexy (repair of vaginal prolapse)
• Revisional surgery (provide additional support for women who have had a previous pelvic floor surgery)

These procedures may provide relief and improve quality of life for women with pelvic organ prolapse and associated urinary incontinence. In addition, we use the most advanced minimally invasive techniques which often results in less pain, less bleeding and faster recovery.