Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the pelvic floor muscles and connective tissue become weak or tear. Any portion of the vaginal walls may fall downwards, pulling with it the organ (bladder, rectum, or uterus) directly behind that wall. This is similar to what occurs with a hernia. When researchers examine healthy women after childbearing more than half will usually have some small degree of prolapse.

Causes

Prolapse is usually caused by a combination of factors such as aging, stressors (such as pregnancy, childbirth, chronic constipation, and repetitive heavy lifting) as well as genetics. Genetics can also be a factor for developing prolapse. The female organs can begin to push through the vaginal opening which is when women usually begin to have symptoms.

Common symptoms of Pelvic Organ Prolapse

  • Vaginal or pelvic pressure
  • Lower abdominal or lower back pain
  • An obvious or physical “bulge” protruding from the vaginal opening
  • Difficulty with urination due to a physical “kinking” of the urethra
  • Difficulty with defecation due to a possible stool-trapping rectocele
  • Having to “splint” or push the vaginal organs back into place in order to empty the bladder or have a bowel movementDifficulty with intercourse or painful intercourse
  • A worsening of symptoms with standing, lifting or coughing

Treatment

Pelvic organ prolapse is generally not dangerous and some patients choose watchful waiting. Large studies show that prolapse will not necessarily get worse and may even improve slightly with decreases in pressure such as resolving constipation, stopping heavy lifting or weight loss. However there are several treatment options available and women report high levels of satisfaction after finding the one that best suits them.

Home Exercises

Home exercises have not been well studied for treatment of prolapse, but may work in a similar manner to physical therapy and may be beneficial.

Pelvic Floor Physical Therapy

Studies have demonstrated that pelvic floor physical therapy improves prolapse in some women and may be used by women who want to avoid pessaries and surgery.

Pessaries

A pessary is a small silicone device that is worn inside the vagina. Similar to eyeglasses, a pessary will not “fix” prolapse in the long term, but offers an immediate solution. When a pessary fits correctly the women will not be able to feel it in the vagina. The most common type of pessary is a ring with support. Some women chose to remove the pessary before being intimate, while others report that they do not need to.

Surgical Management

There are many different surgical options for prolapse. Some repairs use the body’s own tissues while others use types of mesh to strengthen the repair. In 2011 the FDA released a  statement about transvaginal placement of surgical mesh for pelvic organ prolapse. This brought all meshes into the spotlight. Like many medical therapies mesh has both benefits as well as potential drawbacks. Vaginally placed mesh (transvaginal mesh) is known to have the highest risk of problems. 

Abdominally placed mesh as well as mesh for urinary incontinence surgery continues to be widely used because it is effective and has low risk of complications. Experts in this field have strong opinions both for and against the use of mesh, but a majority regard mesh an excellent option for most patients. The decision whether to use mesh is a personal one based on each woman’s goals and values