Pelvic Organ Prolapse

Pelvic organ prolapse, a type of pelvic floor disorder, affects almost 3% of U.S. women. Some women have more than one pelvic floor disorder.

What Is a Pelvic Floor Disorder?

The "pelvic floor" is a group of muscles that form a kind of hammock across your pelvic opening. Normally, these muscles and the tissues surrounding them keep the pelvic organs in place. These organs include your bladder, uterus, vagina, small bowel, and rectum.

Sometimes, these muscles and tissues develop problems. Some women develop pelvic floor disorders following childbirth. And as women age, pelvic organ prolapse and other pelvic floor disorders become more common.

When pelvic floor disorders develop, one or more of the pelvic organs may stop working properly. Conditions associated with pelvic floor disorders include:

• Pelvic organ prolapse
• Urinary incontinence
• Anal incontinence

What Is Pelvic Organ Prolapse?

"Prolapse" refers to a descending or drooping of organs. Pelvic organ prolapse refers to the prolapse or drooping of any of the pelvic floor organs, including the:

• Bladder
• Uterus
• Vagina
• Small bowel
• Rectum

These organs are said to prolapse if they descend into or outside of the vaginal canal or anus. You may hear them referred to in these ways:

• Cystocele: A prolapse of the bladder into the vagina, the most common condition
• Urethrocele: A prolapse of the urethra (the tube that carries urine)
• Uterine prolapse
• Vaginal vault prolapse: prolapse of the vagina
• Enterocele: Small bowel prolapse
• Rectocele: Rectum prolapse

What Causes Pelvic Organ Prolapse?

Anything that puts increased pressure in the abdomen can lead to pelvic organ prolapse. Common causes include:

• Pregnancy, labor, and childbirth (the most common causes)
• Obesity
• Respiratory problems with a chronic, long-term cough
• Constipation
• Pelvic organ cancers
• Surgical removal of the uterus (hysterectomy)

Genetics may also play a role in pelvic organ prolapse. Connective tissues may be weaker in some women, perhaps placing them more at risk.

What Are the Symptoms of Pelvic Organ Prolapse?

Some women notice nothing at all, but others report these symptoms with pelvic organ prolapse:

• A feeling of pressure or fullness in the pelvic area
• A backache low in the back
• Painful intercourse
• A feeling that something is falling out of the vagina
• Urinary problems such as leaking of urine or a chronic urge to urinate
• Constipation or loss of bowel control
• Spotting or bleeding from the vagina

Symptoms depend somewhat on which organ is drooping. If the bladder prolapses, you may leak urine. If it's the rectum, you may have constipation and uncomfortable intercourse. A backache as well as uncomfortable intercourse often accompanies small intestine prolapse. Uterine prolapse is also accompanied by backache and uncomfortable intercourse.

In most cases, symptoms are mild in the morning but get worse as the day goes on.

How Is Pelvic Organ Prolapse Diagnosed?

If you think you may have pelvic organ prolapse, talk to your doctor. They’ll ask about your medical history and examine your pelvic organs to get an idea of how strong your pelvic floor muscles are. It may be all they need to do to make a diagnosis.

Your doctor may also discover pelvic organ prolapse during a routine pelvic exam, such as the one you get when you go for your Pap smear.

Your doctor may order a variety of tests if they suspect pelvic organ prolapse. They may also want to find out if more than one organ has moved out of place, how severe the prolapse is, and whether you have other related conditions. The tests might include:

• Bladder function tests, which measure how well your bladder and the structures around it work.
• A urinary tract X-ray (intravenous pyelography), which lets your doctor view your kidneys, bladder, and ureters and see how well they’re working.
• A voiding cystourethrogram, which involves X-rays of your bladder before and after you pee and shows if there’s something wrong with your bladder or urethra.
• A CT scan of the pelvis, which can help your doctor rule out other conditions.
• An ultrasound of the pelvis, which creates an image of your pelvic organs so your doctor can see if more than one organ has slipped out of place.
• An MRI scan of the pelvis, which creates a 3D image of pelvic organs and muscles and can help your doctor confirm pelvic organ prolapse.

How Is Pelvic Organ Prolapse Treated?

Treatment of pelvic organ prolapse depends on how severe the symptoms are. Treatment can include a variety of therapies, including:

• Behavioral treatments, such as physical therapy to strengthen the muscles of your core and Kegel exercises for the pelvic floor muscles
• Mechanical treatments, such as inserting a small plastic device called a pessary into the vagina to provide support for the drooping organs
• Surgical treatment, either to repair the affected tissue or organ or to remove the organ (such as removal of the uterus by hysterectomy)

Can Pelvic Organ Prolapse Be Prevented?

Many risk factors for pelvic organ prolapse are out of your control. These include:

• Family history
• Advancing age
• A difficult vaginal delivery
• Having had a hysterectomy

But you can reduce the likelihood you will have problems. Try these steps:

• Do Kegel exercises daily to maintain good muscle strength in your pelvic area
• Maintain a healthy weight
• Avoid constipation
• Do not smoke, as smoking can affect tissues, and a chronic cough often seen in smokers boosts the risk of problems
• Be careful with heavy lifting; use your legs, not your back or abs

Be careful with heavy lifting; use your legs, not your back or abs

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