Pelvic Organ Prolapse

Pelvic organ prolapse refers to the abnormal descent or dropping of a pelvic organ such as the uterus (uterine prolapse), the vaginal wall attached to the bladder (cystocele), the vagina itself (vault prolapse) or the back wall of the vagina that is bordering the rectum (rectocele).

Treatment for pelvic prolapse by specialists at The University of Kansas Health System is tailored to each person’s situation and desires. Our physicians are highly experienced and well-trained to help you manage your prolapse symptoms and develop a care plan just for you.

Pelvic organ prolapse occurs when the muscles and supporting connective tissues of the pelvic floor become too weak to support the pelvic organs. This causes the organs to fall from their normal position, affecting their ability to function properly.

The supportive muscles and tissues of the pelvic floor can become stretched or torn due to childbirth and labor, or they may weaken with age. The presence of other pelvic floor disorders can also contribute.

The symptoms of pelvic organ prolapse vary in severity and type of discomfort from person to person, depending on the extent of prolapse. Symptoms of pelvic organ prolapse may include:

• A protrusion or bulge through the vaginal opening
• A sensation of pressure in the pelvis
• Constipation
• Incomplete emptying of the bladder
• Pain or discomfort with intercourse
• Pressure and pain with bowel movements
• The need to press on the vagina or nearby to evacuate the stools adequately
• The need to strain to urinate
• Urinary incontinence

Prolapse is very common among all age groups but especially among postmenopausal women who have experienced vaginal childbirth. Additional risk factors for pelvic organ prolapse include connective tissue disorders, obesity and heredity.

Pelvic organ prolapse can be diagnosed by your doctor during a standard pelvic exam. During the exam, your doctor can assess the strength of your pelvic muscles. Your doctor can also check whether your uterus has fallen into the vagina and how far.

A complete medical history that includes a full overview of your symptoms helps your doctor determine the specifics of your prolapse and the effects your symptoms have on your quality of life. This helps your doctor recommend the most effective approach to treatment.

The symptoms and protrusion associated with prolapse can be successfully corrected in many cases with conservative therapy, such as pessaries (insertable support devices), although surgical procedures may be necessary. This depends on your personal preferences as well as lifestyle and medical/surgical history. For some women, prolapse can be watchfully monitored over time. However, this rarely helps resolve the prolapse.

Nonsurgical treatment options for pelvic organ prolapse include:

• A pessary may be used for cases where therapy may not help. A pessary is a plastic device that looks like a diaphragm and can support the prolapse.
• Pelvic floor physical therapy is useful and nonsurgical, but the improvement may depend on how bad the prolapse is. Pelvic floor physical therapy involves exercises for the vagina guided by a trained therapist over the course of a few weeks.

Nonsurgical treatment for pelvic organ prolapse may not work in all instances, in which case surgery may be recommended. Surgical prolapse repair procedures can include:

• Cuff suspension (tuck of the top side of the vagina)
• Cystocele repair (commonly called bladder tuck)
• Hysterectomy, if the uterus is prolapsing and causing discomfort
• Rectocele repair (tuck on the posterior vaginal wall)

The surgery depends on which area is weak and how large the prolapse is. To repair the prolapse, it is important that your physician perform a support procedure to hold the vagina in place. Otherwise, recurrence of the prolapse might be rapid.

Our specialists are specially trained on this type of repair and procedure. These techniques do not involve the use of mesh, but instead involve the use of your own tissues and stitches that dissolve over time, allowing your body to develop its own support system to help prevent recurrence of the prolapse.

Commonly performed procedures for prolapse of the top of the vagina include:

• High uterosacral ligament suspension
• Mayo-Mccall colpo-suspension
• Sacrospinous ligament fixation

Some women may be candidates for a type of robotic surgery called sacrocolpopexy. This procedure involves attaching mesh around the vaginal walls and then to a strong ligament near the tailbone. This procedure is often considered a gold standard treatment for prolapse.