By Rui Wang, MD
Though it can be a sensitive issue to talk about, pelvic organ prolapse is a common condition that affects millions of women throughout the United States, especially as they get older.
Fortunately, once it is diagnosed, there are a variety of treatment options for pelvic organ prolapse that relieve symptoms and can help women feel better.
Penn Medicine Princeton Medicine Physicians Princeton Urogynecology and the Center for Pelvic Wellness at Penn Medicine Princeton Medical Center offer highly specialized, progressive treatment for a wide range of pelvic disorders, including pelvic organ prolapse.
What is Pelvic Organ Prolapse?
The pelvic floor is a network of muscles, nerves, and tissues that support the pelvic organs like a hammock and hold them in their correct position. The pelvic organs include:
• Small and large intestines.
When the pelvic floor becomes weak or damaged, it loses its ability to support the organs, allowing them to drop down from their usual position and bulge into the vagina or rectum. This condition is called pelvic organ prolapse.
There are different types of prolapse depending on which pelvic organ has moved out of place.
• Cystocele. Also called anterior vaginal wall prolapse, cystocele is the most common type of pelvic organ prolapse. The front vaginal wall sags, allowing the bladder to drop into the vagina.
• Enterocele. Part of the small intestine presses into the vagina. This condition is also called small bowel prolapse.
• Rectocele. The back vaginal wall sags, allowing the rectum to bulge into the vagina.
• Uterine prolapse. The uterus drops into the vagina.
• Vaginal vault prolapse. The top part of the vagina sags lower into the vagina.
Pelvic organ prolapse affects 1 in 4 women in their 40s and 1 in 3 in their 60s, according to the American College of Obstetricians and Gynecologists (ACOG). By the time women reach their 80s, pelvic organ prolapse affects half of all women.
What Causes Pelvic Organ Prolapse?
Risk factors for pelvic organ prolapse can be anything that weakens the pelvic floor, such as:
• Vaginal childbirth, especially more than one.
• Long-term pressure on your pelvic areas such as from obesity, chronic coughing, constipation, or heavy lifting.
• Menopause or increasing age.
• Neuromuscular disorders, which affect the nerves that control muscle movement, such as multiple sclerosis.
• Pelvic injury or surgery.
What are the Symptoms?
Symptoms of pelvic organ prolapse may come on gradually and may not be noticed at first. Sometimes, women will report that something just does not feel right in that area of the body.
Signs and symptoms may include:
• Feeling of pelvic pressure or fullness, which can worsen during physical activity or sexual intercourse.
• Pain or a feeling of stretching in your groin or lower back.
• Bulge in the vagina.
• Organs bulging out of the vagina.
• Urinary incontinence or overactive bladder.
• Difficulty completely emptying the bladder.
• Problems having a bowel movement.
• Problems with inserting tampons or applicators.
If you have symptoms of pelvic organ prolapse, consult a urogynecologist for diagnosis and treatment.
How is Pelvic Organ Prolapse Diagnosed and Treated?
Diagnosing pelvic organ prolapse typically begins with a physical exam and internal pelvic exam to check your pelvic organs. In addition, tests to measure the strength of your pelvic floor can help determine how severe the prolapse is and help plan treatment options.
Treatment depends on how much the symptoms are affecting you and include non-surgical options as well as minimally invasive surgical procedures.
Non-surgical options include:
• Physical therapy to strengthen the pelvic floor. Exercises to strengthening your pelvic floor can help relieve symptoms.
• Healthy eating. Pressure from excess weight and straining during bowel movements can contribute to pelvic organ prolapse. Eating more fiber and other simple dietary changes can relieve constipation and help you maintain a healthy weight.
• Vaginal pessary. A vaginal pessary is a small, reusable device that is inserted into your vagina to support pelvic floor muscles and organs. Pessaries come in various shapes and sizes, and your doctor will work with you to find the appropriate device for your body.
For more severe cases of pelvic organ prolapse, surgery may be recommended. In general, there are two main options for surgery — reconstructive and vaginal closure surgery.
• Reconstructive surgery is the most common type of surgery for pelvic organ prolapse. The goal is to restore the pelvic organs to their original position and maintain sexual function. The procedure is typically performed using a minimally invasive approach through the vagina or laparoscopically through small incisions in the abdomen — often with highly precise robotic equipment.
There are several types of reconstructive surgery depending on the type of prolapse. Some involve using your own tissue to create support for the pelvic organs, while others may use surgical material.
• Vaginal closure surgery narrows or closes off the vagina to provide support for prolapsed organs. Sexual intercourse is not possible after this procedure. According to ACOG, vaginal closure surgery has a high success rate and may be a good choice if you do not plan to be sexually active in the future and prefer an easily performed procedure.
Recovery time varies depending on the type of surgery. It is generally advised that patients avoid vigorous exercise, lifting, and straining for the first few weeks after surgery.
While pelvic organ prolapse may be difficult to talk about, keep in mind that you are not alone, and that treatment can help relieve symptoms and restore your quality of life.
To find a physician affiliated with Princeton Urogynecology or for more information about the Center for Pelvic Wellness at Princeton Medical Center call 888-742-7496 or visit www.princetonhcs.org
Rui Wang, MD, is board certified in obstetrics and gynecology and specializes in urogynecology. She is a member of the Medical Staff at Penn Medicine Princeton Health.