Prolapse — The long & short

Feb 07, 2020

Q: What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse is a “falling down” or bulging of the vagina and pelvic organs, into or out through the vaginal opening. It is a kind of hernia of the vagina and pelvic organs.

Q: What are the symptoms of Pelvic Organ Prolapse?

Symptoms of POP include pelvic pressure, low back pain, seeing or feeling tissue bulging from the vaginal opening, usually worse at the end of the day. Other symptoms include urinary frequency, a feeling of incomplete bladder emptying, and urinary urge incontinence. Some women with prolapse also complain of difficulty emptying their bowels. Women with prolapse also report needing to put their fingers on the perineum or in the vagina to help with bowel movements and/or bladder emptying.

Q: How is Pelvic Organ Prolapse Diagnosed?

POP is diagnosed by examining the vagina, and looking for the bulging tissues. Sometimes, a woman may have to strain or bear down in order to demonstrate the prolapse. Advanced prolapse can usually be seen at rest, with the pelvic tissues bulging out of the vaginal opening.

Q: What causes Pelvic Organ Prolapse?

The biggest risk factor for POP is vaginal childbirth. Other risk factors include hysterectomy, chronic coughing, straining, and a lifetime of repeatedly lifting heavy objects. Repeated straining due to constipation is also a risk factor for developing prolapse.

Q: What is the role of the vagina in prolapse?

The vagina is normally like a long tube, pulled up on the inside, and anchored to the sides and top of the pelvis by ligaments. The front part of this flattened tube holds up the bladder, the back part keeps the rectum in place, and the top part helps to hold the small bowels in place. In women with a uterus, the ligaments that support the uterus also help to hold the vagina in place.

When the pelvic ligaments that hold up the vagina stretch or break, or when the vagina itself stretches and becomes loose, the vagina turns “inside out” on itself, and bulges downward towards the opening. The term “pelvic organ prolapse” refers to the bulging of the vaginal and pelvic tissues.

Q: What are some of the other names for Prolapse?

Other names used to describe prolapse are: Vaginal prolapse, bladder prolapse, prolapsed bladder, dropped bladder, cystocele, rectocele, dropped uterus. Prolapsed vagina. All of these terms are used to refer to prolapse.

Q: Does this mean that there are different types of prolapse?

There are 3 parts to the vagina: The front or anterior wall, the back or posterior wall, and the top, and the apex, or top. The anterior wall supports the bladder, and the posterior wall keeps the rectum in place. If the main part of the prolapse is in the anterior wall, that is sometimes called a “cystocele”. If the main part of the prolapse is in the posterior wall, that is sometimes called a “rectocele”. If the main part of the prolapse is at the top of the vagina, that is sometimes called an “enterocele” or “uterine prolapse”. No matter what the bulge is called, the way to fix the prolapse is to put the vaginal walls back into a normal position, where they can support the bladder, the rectum, and other pelvic organs.

Q: Are there nonsurgical treatments for Prolapse?

Nonsurgical treatments for prolapse include pessaries, and pelvic floor exercises.

Q: Are there medications that can be used to treat Prolapse?

There are no known medications that can successfully restore the vaginal support necessary to treat prolapse.

Q: What are the surgical options for treating Pelvic Organ Prolapse?

Surgical treatment for prolapse is geared to re-suspending the vagina, and pulling it back up into the pelvis. Some therapies also involving strengthening the stretched vaginal walls. Surgery to repair prolapse can be performed using minimally invasive abdominal approaches using laparoscopic and/or robotic surgery, but prolapse can also be corrected using minimally invasive vaginal approaches. For women who cannot tolerate major surgery, there is a low intensity surgical intervention that can correct prolapse by closing off the vagina using stitches. In his book “Prolapse Repair”, Dr. Hoyte discusses the various options for treating pelvic organ prolapse.

Q: Is Pelvic Organ Prolapse life threatening?

Generally, prolapse is not life threatening, but prolapse can adversely affect a woman’s quality of life. Sometimes prolapse can cause severe urinary retention, leading to recurrent life threatening kidney infections, in other cases, the exposed vaginal tissues can become infected and put a woman at risk for major infection. In these very rare cases, prolapse can be life threatening, and prompt treatment is required.

Q: What if I choose to do nothing about my Pelvic Organ Prolapse?

In most cases if a women chooses, prolapse can be safely ignored without problems. It is important to have the prolapse evaluated by a pelvic floor specialist to determine if it is safe to ignore.