Pelvic organ prolapse occurs when one or more of the pelvic organs (bladder, uterus, vagina and rectum) fall downward and bulge out through the opening of the vagina. This happens when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs.
While prolapse is not considered a life-threatening condition, it may be painful and distressing.
Types of Pelvic Prolapse
The different types of prolapse are divided into categories according to the part of the vagina they affect: front wall, back wall or top of the vagina. You may have more than one type of prolapse.
- Cystocele (fallen bladder) — This occurs when the bladder falls down into the vagina and creates a large bulge in the front vaginal wall. This may cause discomfort and difficulty emptying the bladder.
- Uterine prolapse (fallen uterus) — This happens when the uterus drops down into the vagina and causes discomfort and difficulty having bowel movements. It's the second most common type of prolapse and is classified into three grades depending on how far the uterus has fallen.
- Vaginal vault prolapse (fallen/bulging vagina) — In women who have had a hysterectomy, it's still possible for the vagina to fall down even though the uterus is no longer present. This is referred to as post-hysterectomy vaginal prolapse.
- Enterocele (bulging of small bowels) — This occurs when a space between the vagina and rectum opens and the small bowel bulges through.
- Rectocele (bulging rectum) — This occurs when the rectum falls. It may cause discomfort and difficulty having bowel movements.
If nonsurgical treatments don't work, we offer many different surgical options to correct pelvic organ prolapse. Often, more than one of these surgeries will be performed at the same time.
In general, vaginal approach surgeries have a faster recovery time and cause less pain than abdominal surgeries.
- Vaginal hysterectomy
- Cystocele repair (anterior colporrhaphy)
- Rectocele repair (posterior colporrhaphy)
- Sacrospinous ligament suspension — This operation attaches the vagina to the sacrospinous ligament through the vagina.
- Uterosacral ligament suspension — This procedure re-attaches the top of the vagina when it has come down.
- Colpocleisis (vaginal shortening)
- Total vaginal reconstruction
In general, abdominal approach surgeries have a longer recovery time and cause more discomfort than vaginal surgeries.
- Hysteropexy (uterine sparing): Your doctor makes incision on your abdomen and supports the uterus by stitching mesh to the front of the tailbone (sacrum).
- Supracervical hysterectomy with sacrocolpopexy: Your doctor makes an incision on your abdomen and removes the uterus. This is different from a total hysterectomy in that your doctor doesn't remove your cervix.
- Abdominal sacrocolpopexy
Laparoscopic Reconstructive Surgery
Your doctor may perform an abdominal surgery laparoscopically, through several very small (1 cm) incision, with the use of a video camera. Abdominal sacrocolpopexy, paravaginal repair, and uterosacral ligament suspension can be done with the laparoscope. The recovery time is faster and postoperative pain is usually less than abdominal approach surgeries.
Robotic-Assisted Laparoscopic Surgery
A newer technology in laparoscopic surgery is robotically assisted laparoscopic surgery with the DaVinci robot. Your doctor may use this technique with an abdominal sacrocolpopexy. Similar to standard laparoscopy, this procedure requires a several very small (1 cm) incision and the use of a video camera. The advantage of this approach is faster healing time and shorter hospital stays than with a more traditional abdominal approach through a larger abdominal incision.
Causes of Prolapse
The causes of prolapse include:
- Chronic cough
- Prior pelvic floor surgery
- Neurologic diseases, such as Parkinson’s disease, multiple sclerosis or a spinal cord injury
- Ethnicity (prolapse is found more often in Caucasian and Hispanic women)
Symptoms of Pelvic Prolapse
Physical symptoms can include:
- A bulge or lump on the outside of the vagina
- Feeling as though something is bulging out of the vagina, like a tampon is about to fall out
- Lower back pain or increased pelvic pressure that interferes with daily activities
- Irregular vaginal spotting or bleeding
- Frequent urinary incontinence, urinary tract infections, difficulty urinating, frequent urination or any of the above that interfere with a daily routine
- Difficult or painful sexual intercourse
- Difficult bowel movements, constipation or liquid stools
How We Diagnose Prolapse
An evaluation begins in your doctor’s office with questions about your health and health history.
- Pelvic exam: usually done while you lie on an exam table, or sometimes while standing; your doctor may ask you to push down or cough to see the full extent of the prolapse.
- Rectal exam : checks the strength of these muscles which can weaken with age or childbirth
- Post-void residual (PVR): determines how much urine is left behind after you urinate
- Urinalysis: determines if you have an infection or other substances found in the urine
Stages of Pelvic Organ Prolapse
- Stage 0 : no prolapse, and the pelvic organs are perfectly supported by the ligaments in the pelvis
- Stage 1: virtually no prolapse, and the pelvic organs are very well-supported by the ligaments in the pelvis
- Stage 2: the pelvic organs are not as well supported by the ligaments and have begun to fall down but are still inside the vagina
- Stage 3: the pelvic organs are beginning to bulge to or beyond the opening of the vagina
- Stage 4: the pelvic organs are completely outside of the vagina