Definition

Pelvic organ prolapse is a condition that occurs when the normal support of the vagina is lost, resulting in “sagging” or dropping of the bladder, urethra, cervix and rectum. The ability of the pelvic diaphragm to support the organs in the pelvis is affected by conditions that damage the other muscles and nerves in the pelvis. When other muscles are damaged or stretched, the pelvic diaphragm loses its dome shape and becomes more like a funnel. It then bulges down into or out of the vaginal canal. The UF Health Pelvic Floor Program takes a multidisciplinary approach to diagnose and treat pelvic floor disorders with personalized plans geared toward improving each patient’s pelvic floor function and quality of life.

Symptoms

As the prolapse of the vagina and uterus progresses, women can feel bulging tissue protruding through the opening of the vagina. Frequently, prolapse is described as a “hernia” of the pelvic floor. This pressure can lead to a bulge in the vagina that can sometimes be felt or seen. Other symptoms of pelvic organ prolapse include:

• A feeling of pressure, discomfort, aching, or fullness in the pelvis
• Pelvic pressure that worsens while standing or coughing, or as the day goes on
• Pelvic pressure during physical activity or sex
• Leaking urine (incontinence) or problems having a bowel movement
• Problems inserting tampons

Causes and Risk Factors

Loss of pelvic support can occur when any part of the pelvic floor is injured during vaginal delivery or during gynecologic surgery, such as hysterectomy. Some other conditions that promote prolapse include: constipation and chronic straining, smoking, chronic coughing and heavy lifting. Obesity, like smoking, is one of the few modifiable risk factors. Overall, one in five women in the United States are affected by pelvic floor disorders, according to the Journal of the American Medical Association. Women who are obese have a 40%-75% increased risk of pelvic organ prolapse. Aging, menopause, debilitating nerve and muscle diseases contribute to the deterioration of pelvic floor strength and the development of prolapse. Additionally, inheritance of weak connective tissue is a major contributing factor.

Types of Pelvic Organ Prolapse

The type of pelvic organ prolapse a woman experiences is related to where in her pelvis injury or muscular damage has occurred. It is not unusual to have several areas of injury, resulting in several areas of prolapse. Cystocele Anterior wall prolapse (“cystocele”) is the most common type of pelvic organ prolapse. It occurs when the anterior wall of the vagina loses its support. As a result, the bladder drops and rotates into, and often out of, the vaginal opening. Some cystoceles can cause urine leakage while large cystoceles can cause difficulty voiding. Rectocele A posterior wall prolapse (“rectocele”) occurs when the posterior wall of the vagina loses its support. As a result, the rectum can bulge into, and often out of, the vaginal opening. A large rectocele can make it difficult to empty the bowels. Some patients must push on the wall between the vagina and the rectum to assist with evacuation. This is called “splinting.” Uterine Prolapse In uterine prolapse, the pelvic support is lost at the top of the vagina, and the uterus drops down, frequently bringing the bladder or rectum with it. Sometimes the uterus becomes completely exteriorized, as it hangs between a woman’s legs. This can lead to additional problems of urinary retention or infections. Vaginal Vault Prolapse With Enterocele Women who have undergone a hysterectomy (for whatever reason) are at increased risk for developing relaxation of the top of the vagina, or vaginal vault. Sometimes the small intestines can slip into this “hernia”, resulting in an “enterocele.”

Diagnosis

Your doctor will conduct a pelvic exam and discuss your symptoms with you. You may be asked to strain or cough during the exam to identify whether these actions trigger prolapse or urine leakage. Other tests may be performed to see whether you can empty your bladder completely when you use the restroom.

Treatment

The UF Health Pelvic Floor Program’s expert team of physicians will develop a personalized treatment plan for your pelvic organ prolapse depending on several factors: the type of prolapse you have, your symptoms, your age, other health issues, and whether you are sexually active. Your treatment may include one or more of the following:

• Pessary – A removable device inserted into the vagina to support the pelvic organs (will provide a link to this once the health topic is written)
• Pelvic floor muscle therapy
• Changing eating and/or drinking habits
• Surgery to support the uterus or vagina
• Surgery to close the vaginal canal