Pelvic organ prolapse occurs when the uterus slips out of place and into the vaginal canal (uterine prolapse) or when the bladder bulges downward (cystocele) or when the rectum bulges forward (rectocele). Sometimes called pelvic organ relaxation, these conditions are typically the result of injury to the organs’ support system during childbirth or other strenuous activities.
Many women do not notice these conditions until they reach middle age when their hormones begin to change and their muscle strength decreases. Often pelvic prolapse occurs with urinary incontinence.
The most common types of pelvic organ prolapse are cystocele (dropped bladder), rectocele, and uterine prolapse.
Risk factors for pelvic organ prolapse
- Increased age; post-menopause
- Multiple vaginal deliveries
- Straining caused by chronic cough, constipation, or heavy lifting
- Family history
Symptoms of vaginal and uterine prolapse
- Pelvic pressure
- A feeling of vaginal fullness or heaviness
- A feeling of pulling in the pelvis
- Vaginal discharge
- Urinary urgency and frequency
- Protrusion of pink tissue from the vagina that may be irritated or itchy
- Feeling like you can't empty your bladder when you urinate
Treatment for uterovaginal prolapse
At Rose, your doctor will diagnose your prolapse with a physical exam and possibly an advanced imaging study called an MRI defogram. This study is only offered at a few centers in the region and can help your doctor clearly visualize the compartments of the vaginal tract that might be prolapsing.
The level of prolapse is measured by degrees. First degree prolapse is the least severe and fourth degree prolapse is the most severe. With a clear diagnosis, your doctor will then create an individualized plan to meet your needs. This may include:
- Kegel Exercises: Tensing the muscles around the vagina and anus, holding for several seconds, then releasing. When repeated, this exercise tones the pelvic muscles.
- Medication: Estrogen therapy may help prevent further weakness of the pelvic floor.
- Pessary Insertion: A pessary is shaped like a contraceptive diaphragm and is made of soft silicone. Your doctor may place this in the upper part of your vagina to give added support.
- Surgery: Surgery may be needed for severe uterine prolapse. Options include a hysterectomy, repair with sutures or the insertion of a mesh support device, and vaginal closure (only done in women who are elderly and who are no longer sexually active).