Pelvic organ prolapse occurs when a pelvic organ-such as your bladder-drops (prolapses) from its normal place in your lower belly and pushes against the walls of your vagina. This can happen when the muscles that hold your pelvic organs camera.gif in place get weak or stretched from childbirth or surgery.
Many women will have some kind of pelvic organ prolapse. It can be uncomfortable or painful. But it isn’t usually a big health problem. It doesn’t always get worse. And in some women, it can get better with time.
More than one pelvic organ can prolapse at the same time. Organs that can be involved when you have pelvic prolapse include the:
- Bladder This is the most common kind of pelvic organ prolapse.
- Urethra
- Uterus
- Vagina
- Small bowel
- Rectum
Cause
Pelvic organ prolapse is usually caused by damage to the tissues (muscles, ligaments, and connective tissue) that support the pelvic organs. Damage or stretching of these tissues allows the organs to move out of their normal positions. This causes them to press against (and sometimes move) the inside walls of the vagina.
Having a baby makes it more likely that you will have pelvic organ prolapse later. Vaginal childbirth has been strongly linked to weakened and stretched support structures in the pelvic area. This loss of support is the biggest cause of pelvic organ prolapse. Having a cesarean section, on the other hand, seems to be less strongly linked to pelvic organ prolapse.
Another cause of reduced support in the pelvis is lower levels of the hormone estrogen. Estrogen levels are lower during and after menopause. The lower levels of estrogen in the body mean less collagen, a protein that helps the pelvic connective tissues stretch and return to their normal positions.
Pelvic organ prolapse can also occur after surgical removal of the uterus (hysterectomy) for another health problem, such as endometriosis. Removal of the uterus can sometimes leave the other organs in the pelvic area with less support.
Other conditions that may cause pelvic organ prolapse include:
- Obesity, which can lead to long-term pressure within the abdomen.
- Smoking and/or lung disorders, which are often causes of chronic coughing.
- Conditions affecting the spinal cord, such as muscular dystrophy, multiple sclerosis, and spinal cord injury, that cause paralysis of the muscles of the pelvic floor.
Symptoms
Although many women who have pelvic organ prolapse do not have symptoms, the most common and bothersome symptom is pressing of the uterus or other organs against the vaginal wall. The pressure on your vagina may cause minor discomfort or problems in how your pelvic organs work. Symptoms of pelvic organ prolapse include:
- A feeling of pelvic pressure.
- A feeling as if something is actually falling out of the vagina.
- A pulling or stretching in the groin area or a low backache.
- Painful intercourse.
- Spotting or bleeding from the vagina.
- Urinary problems, such as involuntary release of urine (incontinence) or a frequent or urgent need to urinate, especially at night.
- Problems with bowel movements, such as constipation or needing to support the back (posterior) of the vaginal wall to have a bowel movement.
Symptoms of pelvic organ prolapse are made worse by standing, jumping, and lifting and usually are relieved by lying down.
Exams and Tests
A prolapse of a pelvic organ is sometimes difficult to diagnose. Pelvic organ prolapse that does not cause symptoms is often discovered during a routine exam. You may be aware that there is a problem but be unsure of the exact location or cause. If prolapse is suspected, your doctor will take your medical history, including your symptoms and your history of pregnancies and other health problems, and do a physical exam, including a pelvic exam.
Tests may be done to find out the nature of a prolapse, particularly if it is causing problems with bladder or bowel function. These tests include:
Cystoscopy, a test that allows your doctor to look at the interior lining of the bladder and the urethra.
Intravenous pyelogram (IVP), an X-ray test that can show the size, shape, and position of the kidneys, bladder, ureters, and urethra.
Computed tomography scan (CT scan), which uses X-rays to produce detailed pictures of structures inside the pelvic area.
Urodynamic tests, to see how your body stores and releases urine.
Doctors use a classification system to determine the level of an organ’s prolapse. Identifying the exact level of prolapse helps guide decisions about which treatments are most likely to offer long-term success. One standard classification uses “stages” of prolapse and is based on how close the lowest part of the organ is to the opening of your vagina (the hymen).
Treatment
Many women who have pelvic organ prolapse do not have symptoms and do not require treatment. If your symptoms are bothersome, you may want to consider treatment. Treatment decisions should take into account which organs are affected, how bad symptoms are, and whether other medical conditions are present. Other important factors are your age and sexual activity.
Many women are able to reduce pain and pressure from a pelvic organ prolapse with nonsurgical treatment, which may include making lifestyle changes, doing exercises, and/or using a removable device called a pessary that is placed into the vagina to support areas of prolapse.
If your pelvic organ prolapse is causing pain or problems with bowel and bladder functions or is interfering with your sexual activity, you may want to consider surgery. Surgical procedures used to correct different types of pelvic organ prolapse include repair of the supporting tissue of the prolapsed organ or vagina wall. Another option is the removal of the uterus (hysterectomy) when it is the prolapsed organ or if it is causing the prolapse of other organs (such as the vagina).