Pelvic Prolapse

What is pelvic prolapse?

Pelvic prolapse is when one or more of the pelvic organs has fallen out of place. It almost never occurs in males.

What causes Pelvic Organ Prolapse?

A network of muscles provides the main support for the pelvic viscera (the vagina and the surrounding tissues and organs within the pelvis). This network, which is located below most of the pelvic viscera and supports the viscera’s weight, is called the levator ani. Pelvic ligaments provide additional stabilizing support.

When parts of this support network are weakened (e.g. following pregnancy) or damaged, the vagina and surrounding structures may lose some or all of the support that holds them in place. Collectively, this condition is called pelvic floor relaxation. A pelvic organ prolapse occurs when the weight-bearing or stabilizing structures that keep the vagina in place weaken or deteriorate. This may cause the supports for the rectum, bladder, uterus, small bladder, urethra, or a combination of them to become less stable.

Common factors that may cause a vaginal prolapse include the following:

  • Childbirth (especially multiple births): Childbirth is stressful to the tissues, muscles, and ligaments in and around the vagina. Long, difficult labors and large babies are especially stressful to these structures. Childbirth is the risk factor most commonly associated with cystoceles. A cystocele is a condition in which the bladder prolapses into the vagina. A cystocele is usually accompanied by a urethrocele, in which the urethra becomes displaced and prolapses. A cystocele and urethrocele together are called a cystourethrocele.
  • Menopause: Estrogen is a hormone that helps to keep the muscles and tissues of the pelvic support structure strong. After menopause, the estrogen level decreases; this means that the support structures may weaken.
  • Hysterectomy: The uterus is an important part of the support structure at the top of the vagina. A hysterectomy involves removing the uterus. Without the uterus, the top of the vagina may gradually fall toward the vaginal opening. This condition is called a vaginal vault prolapse. As the top of the vagina droops, added stress is placed on other ligaments. Hysterectomy is also commonly associated with a condition called an enterocele, in which the small bladder herniates near the top of the vagina.

Other risk factors of pelvic organ prolapse include the following:

  • Advanced age
  • Obesity
  • Dysfunction of the nerves and tissues
  • Abnormalities of the connective tissue
  • Strenuous physical activity
  • Prior pelvic surgery

 What are the symptoms?

The symptoms associated with a pelvic organ prolapse depend on the type of prolapse present. The most common symptom of all types of prolapse is the sensation that tissues or structures in the vagina are out of place. Some women describe the feeling as “something coming down” or as a dragging sensation. This may involve a protrusion or pressure in the area of the sensation. Generally, the more advanced the prolapse, the more severe the symptoms.

The following are general symptoms of all types of pelvic organ prolapse:

  • Pressure in the vagina or pelvis
  • Painful intercourse (dyspareunia)
  • A lump at the opening of the vagina
  • A decrease in pain or pressure when the woman lies down
  • Recurrent urinary tract infections

The following are symptoms that are specific to certain types of prolapse:

  • Difficulty emptying bowel s— This  may be indicative of an enterocele, rectocele, vaginal vault prolapse, or prolapsed uterus. A woman with difficulty emptying her bowel may find that she needs to place her fingers on the back wall of the vagina to help evacuate her bowel completely. This is referred to as splinting.
  • Difficulty emptying bladder –This may be indicative of a cystocele, urethrocele, enterocele, vaginal vault prolapse, or a prolapsed uterus.
  • Constipation – This is the most common symptom of a rectocele.
  • Urinary stress incontinence — This is a common symptom of a cystocele.
  • Pain that increases during long periods of standing — This may be indicative of an enterocele, vaginal vault prolapse, or a prolapsed uterus.
  • Protrusion of tissue at the back wall of the vagina — This is a common symptom of a rectocele.
  • Protrusion of tissue at the front wall of the vagina — This is a common symptom of a cystocele or urethrocele.
  • Enlarged, wide, and gaping vaginal opening — This is a common symptom of a vaginal vault prolapse.

Some women who develop a pelvic organ prolapse do not experience symptoms.

How is it treated?

Most worsening pelvic organ prolapses can only be fully corrected with surgery. However, the type of treatment that is appropriate to treat prolapse depends on factors such as the cause and severity of the prolapse, whether the woman is sexually active, and the woman’s treatment preference.

  • Nonsurgical options may be most appropriate for women who are not sexually active, cannot undergo surgery because of medical reasons, or experience few or no symptoms associated with the condition.
  • Surgery is the treatment option that most sexually active women who develop prolapse choose because the procedure is usually effective.

Can Prolapse be prevented?

Women at risk for prolapse should avoid heavy lifting, if possible.

Obesity puts extra stress on the muscles and ligaments within the pelvis and vagina. Weight control may help prevent this condition from developing.