Understanding Pelvic Organ Prolapse
Understanding Pelvic Organ Prolapse
This article provided by Ethicon Women’s Health & Urology
Division of Ethicon, Inc.
Aging may cause a woman’s pelvic organs to shift. Obesity, pregnancy and
childbirth can cause stretching and may weaken muscles that support your pelvic
organs. Because of this shifting, it can become difficult to have a bowel
movement or hold urine.
Have you experienced some loss of bladder control lately? Have you felt a
pressure in your pelvic area that won't go away? Do you have pain or discomfort
during sexual intercourse? Does it constantly feel like you are wearing a
tampon, and it's falling out?
If so, you may be suffering from pelvic organ prolapse (POP), a common but
rarely discussed condition in which organs in the pelvic region shift out of
their normal position, or prolapse.
Pelvic organ prolapse, sometimes known as "dropped bladder," can be
uncomfortable both physically and emotionally. Women with this condition tend to
limit their daily activities and avoid sex because of pelvic pain and the need
to urinate frequently.
If you suffer from this condition, you are not alone and you can find help.
here to assess your symptoms and learn about treatment options that may be
right for you.
Causes of Pelvic Organ Prolapse
The organs in your pelvic area — uterus, vagina, bladder and rectum — are
held in place by a web of muscles and connective tissues that act like a
hammock. When this web becomes weakened or damaged, one or more pelvic organs
shift out of normal position and literally "fall," or prolapse, into the vagina.
As a result, organs may press against the vaginal wall and produce a
hernia-like bulge, causing discomfort and limiting physical and sexual activity.
The major risk factor for pelvic organ prolapse is having delivered a baby
vaginally. Other risk factors include:
- Loss of muscle tone with aging
Types of Pelvic Organ Prolapse
There are several different types of pelvic organ prolapse, defined by which
organs are involved. It’s also possible to have more than one type of prolapse.
Please use this diagram as a reference to compare the position
of the organs for the different types of prolapse
Organs that are commonly involved in pelvic organ prolapse include the:
(Cystocele): The most common type of pelvic organ prolapse is cystocele
(pronounced sis-tuh-seel) and is often called “dropped bladder.” As the front
wall (or roof) of the vagina stretches or loses its attachment to the pelvis, it
drops into the vaginal opening. The bladder, which rests on this area of the
vagina, similarly “drops” out of position.
(Rectocele): As the back wall (or floor) of the vagina loses its support, the
rectum can protrude into the vaginal opening, creating a “pocket” called a
rectocele (pronounced rek-tuh-seel).
(Uterine Prolapse): Prolapse of the uterus (and cervix) into the vagina is
called uterine prolapse.
Other organs that may also be involved in pelvic organ prolapse include the:
- Intestine/small bowel (Enterocele): Prolapse of the small bowel pushes the
vagina towards the opening. This is called an enterocele (pronounced en-tro-seel).
- Vagina (Vaginal Vault Prolapse): For women who have had a hysterectomy and
no longer have a uterus, the top of the vagina pushes into the lower vagina.
This is called vaginal vault prolapse.
Maybe you’ve been too embarrassed or confused by how you feel to seek medical
help. You may even have wondered if your symptoms would just go away.
But pelvic organ prolapse is a real, common and treatable problem. Consider
- About 4 out of 10 women over age 50 in the US have some form of
- One in 10 women undergo surgery for pelvic organ prolapse by age 80.2
You don’t have to accept the limits that pelvic organ prolapse can put on
your lifestyle. Click
here for questions to ask your doctor about pelvic organ prolapse.
Treatments for Pelvic Organ Prolapse
Pelvic organ prolapse (POP) can be treated with a variety of methods,
including nonsurgical and surgical procedures, depending on the severity of the
prolapse and the associated symptoms.
- Behavioral/Muscle Therapy: If symptoms are mild, therapy often starts with
Kegel exercises to help strengthen the pelvic floor muscles.
- Pessary: This device can be inserted into the vagina to support the pelvic
area and help relieve mild symptoms of pelvic organ prolapse, including
incontinence. Your doctor may recommend using vaginal estrogen along with the
pessary. In some instances, a pessary may make urinary incontinence worse; if
this happens, see your doctor to discuss other treatment options.
- Biofeedback: In this method, the patient exercises the pelvic floor
muscles while connected to an electrical sensing device. The device provides
“feedback” to help you learn how to better control these muscles. Over time,
biofeedback can help you use your pelvic muscles to decrease sudden urges to
urinate and lessen certain types of pelvic pain.
For women whose symptoms don’t respond to nonsurgical methods, your doctor
may recommend pelvic reconstructive surgery. Your doctor may choose to perform
one of several types of procedures. It is important for you to be familiar with
each type of repair and to understand your choices.
Graft Augmented Repair: During this procedure, the surgeon
repositions the prolapsed organs and secures them to surrounding tissues and
ligaments using a soft synthetic mesh or biologic tissue graft. This surgery
may be performed in one of three ways:
Through tiny incisions in the vagina. Click here to learn more
about this procedure
Through an incision below the bikini line
Through several small incisions in the abdomen together with a
small camera called a laparoscope (pronounced lap’-a-rō-skōp) inserted through
the belly button. This type of surgery is called laparoscopy (pronounced
Native Tissue Repair: This procedure, also referred to as
Posterior and Anterior Colporrhaphy (pronounced kol-por’e-fee) is performed
through incisions in the vagina. It involves folding and then suturing, or
stitching, the back (posterior) or front (anterior) wall of the vagina to
support prolapsed organs.
Hysterectomy: A hysterectomy may be done in combination with
other pelvic floor repair procedures, depending on the type of pelvic organ
prolapse. Click here to explore your hysterectomy options.
All surgeries present risks. For more information about treatment options,
please consult your doctor
If you’ve been told that pelvic organ prolapse is an inevitable part of
getting older, you should know that you don’t have to cope with it – treatment
may help. Click
here to find a doctor to discuss treatment options that may be right for
- Hendrix S, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic
organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J
Obstet Gynecol. 2002: 1160-1166.
- Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of
surgically managed pelvic organ prolapse and urinary incontinence. Obstet
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