Pelvic organ prolapse refers to the loss of support and subsequent drooping of tissues or organs usually through the natural openings in the pelvic floor. The pelvic floor consists of a bowl of muscles, ligaments and tendons as well as dense and loose connective tissue. These tissues hold the contents of the abdomen and pelvis inside the body. The uterus, bladder, and rectum are all involved with and directly affected by the support given by the pelvic floor. Because of this, any or all of these organs may become prolapsed. Typically, because they are intimately connected, if prolapse occurs in one area it is likely to be present in one or more of the others.
No one has actually been able to define what amount of prolapse is “normal”. It is very common to find some level of drooping during a routine vaginal exam, this may involve any combination of the bladder, uterus, or rectum. Most of the time, there are no symptoms involved with the milder degrees of prolapse. In fact, some women with even greater degrees of prolapse deny any bothersome symptoms. However, once prolapse becomes severe enough to produce a bulge at the opening of the vagina it usually results in some symptoms. The larger the bulge becomes, the more likely that bothersome symptoms will develop.
Symptoms of prolapse may range simply from a sensation of tissue protruding from the vagina to a significant sensation of pressure and discomfort (often described as “someone standing on my vagina” by women experiencing this). Prolapse itself is not typically painful. However, muscles may go into spasm from pelvic support defects and this may produce some level of pain. In addition, difficulties emptying the bladder or bowel may become bothersome, with some women needing to “splint” (apply pressure to the vagina to lift the tissues back up by hand) in order to empty the bladder or bowels.
Risk factors for prolapse include childbirth (particularly vaginal delivery), menopause, smoking, family history of prolapse, collagen-vascular disorders (eg: Marfan’s Syndrome), and hysterectomy. It is possible for someone to have all of these risk factors and not to have symptomatic prolapse, and it is possible for someone to have no known risk factors and have prolapse.
Treatments may consist of nonsurgical management with pelvic floor physical therapy or pessary devices or may be appropriate for surgical repair. There are many approaches to prolapse treatment, and it is important to take each woman’s particular situation and create an appropriate plan for her individually.
Linda Kiley, MD
Dr. Kiley is a Board Certified subspecialist in Female Pelvic Medicine and Reconstructive Surgery, and is also Board Certified in general Obstetrics and Gynecology.