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Pelvic Organ Prolapse

Pelvic organ prolapse is when one or more pelvic organs drop below their normal position and protrude into the vagina or push against the vaginal walls. This occurs when the supporting muscles and tissues of the pelvic floor no longer support the pelvic organs. There are many causes of prolapse that can include; pregnancy, labor and childbirth, obesity, chronic constipation, chronic cough, hysterectomy or other pelvic surgeries, smoking, menopause and occupations that require heavy lifting over a prolonged period of time.

There are four basic sites of prolapse:

  • Uterine/vaginal vault: Dropping of the uterus into vaginal canal or sagging of the upper vagina vault after hysterectomy. Uterine prolapse is the only prolapse where the organ actually falls into the vagina and can pass through the vagina to protrude outside the vaginal opening.
  • Cystocele: Bulging of the upper front vaginal wall where the bladder is pushing into the vaginal wall.
  • Rectocele: Bulging of the lower rear vaginal wall where the rectum bulges into the vaginal wall.
  • Enterocele: Bulging of the upper rear wall where the small bowl pushes into the vaginal wall.

Symptoms of prolapse often include:

  • Pressure or heaviness in the pelvis or vagina
  • Difficulty urinating or having a bowl movement
  • Painful or uncomfortable intercourse
  • Leaking of urine or sudden urge to empty the bladder
  • Low backache that is eased by lying down
  • Uterus and cervix that bulge into the vaginal opening

Symptoms may worsen when you stand or sit for a long time. Exercise or lifting may also exacerbate symptoms.

Non-surgical treatment for prolapse:

  • Pelvic floor exercises (Kegel exercises) can help to strengthen muscles supporting pelvic organs
  • Physical therapy to compensate for prolapse or strengthen muscles
  • Pessaries to help to support pelvic organs (removable device inserted into the vagina)
  • Constipation relief medicines to help reduce the need to strain when moving bowels
  • Weight loss when obesity is a causal factor in organ prolapse

Minimally-invasive surgical treatments for prolapse:

  • Surgery, without mesh, to restore the normal position of the vagina using sutures
  • Repair of tears in tissues around the vagina
  • Surgery to reattach vagina to ligaments and tissue
  • Use of interlocking sutures to repair bladder prolapse (cystocele) eliminating the need for mesh that has been the cause of many complications
  • Use of sutures to repair rectum prolapse (rectocele), without mesh
  • Mesh is used as a sling in surgeries for some cases of incontinence, however this procedure uses a very small piece of mesh and has a world-wide complication rate of less than 2%

Women who have had at least one vaginal birth are very likely to have some degree of pelvic organ prolapse in their lifetime. Many women with prolapse do not have significant symptoms and do not ever require surgical intervention. Women with any sign of prolapse should be evaluated by their gynecologist to avoid progression of this condition and in many cases to determine whether the cause of the symptoms is prolapse or stress urinary incontinence (SUI).

Drs. Elizabeth Barbee and Tammy Hilbert both specialize in treatment of pelvic organ prolapse and use the most advanced non-surgical and mesh-free surgical techniques for their patients. They have exceptional success using minimally invasive laparoscopic surgical techniques resulting in shorter recovery times.