Pelvic Organ Prolapse

Pelvic prolapse is the gradual moving or “dropping” of a pelvic organ to a lower position in the pelvis. The top of the vagina, the bladder, or the rectum may be the main prolapsed organ. If the uterus has not been removed, it too may prolapse. A careful pelvic exam should reveal which organs have dropped.

Symptoms of Pelvic Organ Prolapse

If you have a prolapsed organ or organs, you may experience lower back pain, pelvic pressure, loss of bladder or rectal control, or difficulty emptying the bladder or bowels. In severe cases, the vagina or uterine cervix is felt or seen as a bulge outside the body.

Weak supporting pelvic tissues and muscles may allow the pelvic organs to prolapse into the pelvis. Childbirth, chronic cough, and constipation may lead to this pelvic muscle weakness. Prolapse also may occur more commonly within specific families or certain ethnic groups.

When to See a Doctor

Pelvic organ prolapse may not occur quickly, but the condition typically worsens when left untreated. The choice of treatment should be based on the impact of symptoms on your health and activities. In rare cases, severe prolapse can cause urine to be retained in the bladder and the kidneys, leading to kidney damage or infection. In this situation, treatment is necessary. In most other cases, though, you can decide, based on your specific symptoms, when prolapse should be treated. 

Treatment Options

The goal of continence surgery or pelvic reconstructive surgery is to recreate normal anatomy. None of these procedures, however, has a 100 percent success rate.

In many cases, only a partial failure occurs, requiring pessary use, surgery that is less extensive than the original surgery, or no treatment at all. Patients who follow our recommended restrictions for 12 weeks after surgery give themselves the best chance for permanent success. 

Techniques

• Pessary: A pessary is a supportive device that is placed in the vagina to elevate it. Positioned similarly to a contraceptive diaphragm, the pessary uses the strength of the pelvic bones to support the vagina. Pessaries come in a variety of shapes and sizes and are most commonly made from either silicone or latex. Patients may continuously wear their pessary but should remove and clean it on a regular basis. Pessaries may be used as a temporary aid prior to surgery or as a permanent treatment for prolapse.
  
• Surgery: Techniques that use permanent sutures to attach the vagina to the pelvic bones rely on the strength of these bones to support the vagina. The surgery may involve a vaginal or abdominal incision, or both. Determining the precise urinary problem prior to surgery ensures selection of the best technique. 
  

After-Surgery Care

You will be in the hospital for one to four days, depending on the extent of your surgery. Most patients require at least some prescription-strength pain medicine for one or two weeks after surgery.

You should avoid strenuous physical activity, especially lifting heavy objects, for 12 weeks to allow proper healing. Increased physical straining adds to the force against these weak pelvic muscles, possibly resulting in worsening prolapse or damage to a surgical repair.