What Is Pelvic Prolapse?
Your pelvic tissues and muscles cradle and support your pelvic organs. Pelvic organs consist of the uterus, bladder, rectum, cervix and vagina. When pelvic prolapse occurs, the muscles and tissues of the pelvic become weak or damaged and can no longer support the organs. As a result, one or more of the organs of the pelvis drop (prolapse). Prolapse of the pelvic organs can be extremely uncomfortable and requires medical diagnosis and treatment. Although rare, prolapse can occur after a hysterectomy procedure when any part of the vaginal wall may collapse and bulge into or beyond the vaginal opening.
Prolapse of the pelvic organ is just one type of pelvic floor disorder. The most common disorders are:
- Urinary incontinence - the leaking of urine
- Fecal incontinence - the leaking of stool
- Pelvic organ prolapse - the loss of support of the organs in the pelvis
What are the Different Types of Pelvic Prolapse?
Anterior Vaginal Wall Prolapse (Cystocele or Urethrocele) is the most common type of pelvic prolapse and occurs at the top of the vagina when the bladder’s supportive tissue stretch or detach and the bladder falls into the vagina. Posterior Wall Prolapse (Rectocele or Enterocele) occurs when the supportive tissues of the rectum stretch or detach from the pelvic bones and the rectum bulges into the vagina. Uterine prolapse occurs when the pelvic muscles and tissue weaken, allowing the uterus to drop into the vagina. Uterine prolapse can sometimes be associated with prolapse of the small bowel, called enterocele. When enterocele occurs, the small bowel or small intestine may bulge into the vagina.
What are the Symptoms of Pelvic Organ Prolapse?
The pressure experienced from prolapse can cause a bulge that can often be seen or felt and is accompanied by feelings of pressure, fullness and sometimes pain during moderate physical or sexual activity. Symptoms may include:
- Feeling or seeing something coming out of the vagina
- Intense pelvic pressure or fullness
- Discomfort in the pelvis that intensifies when standing or coughing
- Bladder or bowel problems such as incontinence or constipation
- Pain when attempting to insert a tampon
Who is at Risk for Pelvic Organ Prolapse?
Vaginal childbirth can put a great deal of strain on the pelvic floor. With each subsequent vaginal childbirth, the risk for pelvic prolapse increases. Additionally, giving birth to a large baby puts a great deal of strain on the pelvic floor and a prolapse can occur for women who give birth to a baby weighing more than 8 ½ pounds.
Frequent pressure on the abdomen, which can come from obesity, straining during bowel movements and prolonged coughing can increase the risk. Hormonal changes during menopause can also cause prolapse due to the significant loss of estrogen. Smoking is another factor that increases risk.
Pelvic Organ Prolapse Stages
There are four pelvic organ prolapse stages that may require different treatment methods.
- Stage 1: Mild prolapse. The pelvic organs are still intact and actively supported by the pelvic floor.
- Stage 2: Pelvic organs have begun to fall but are still contained within the vagina.
- Stage 3: Pelvic organs have fallen and are at the opening of the vagina.
- Stage 4: Pelvic organs have fallen through the vaginal opening.
How Is Pelvic Organ Prolapse Treated?
Treatment for Pelvic Organ Prolapse may include one or more of the following:
- Insertion of a pessary - Pelvic organ prolapse surgery when a pessary is inserted into the vagina to support and strengthen the pelvic organs. Pessaries are often the first treatment sought, depending on the stage of the prolapse when diagnosed. Pessaries can treat urinary incontinence as well as pelvic prolapse.
- Muscle therapy of the pelvic floor -The physician may encourage an exercise routine designed to strengthen the pelvic floor. Routinely this is overseen by a Physical Therapist.
- Dietary changes - If there is ongoing constipation, a diet rich in fiber may be suggested.
- Pelvic organ prolapse surgery to support the vagina or uterus - During surgery body tissue or a synthetic mesh may be used to help build pelvic floor support. This is a common treatment for women who are still sexually active.
- Surgically closing the vagina - For women who are no longer sexually active, colpocleisis may be the desired mode of treatment.
Dr. J. Anthony Heit, MD is one of the founding physicians at Kansas City ObGyn. Dr. Heit is well-known for his careful and thorough approach to medicine, and is proud of the low complication rates he has achieved. Originally from Topeka, Dr. Heit is a family man and is happily married and has four children.