Pelvic organ prolapse symptoms & treatment

Over 40 percent of women experience pelvic organ prolapse, a condition where one or more pelvic organs drop or sag out of place. Pelvic organs include your uterus, bladder, bowel, vagina, urethra and rectum. These organs may sag into the vaginal canal or out of the vaginal opening as the prolapse worsens.

Although it’s common, you don’t have to accept it as a normal part of life. If you are experiencing any symptoms of pelvic organ prolapse, our experts can help.

What causes pelvic organ prolapse?

Your pelvic floor is a collection of muscles, ligaments and connective tissues. When the muscles in your pelvic floor are weakened or damaged, they can no longer support your pelvic organs, causing the organs to drop from their normal position in your body.

Your pelvic muscles may weaken due to:

• Aging: Pelvic floor disorders are more common as you age and increase due to hormonal changes (loss of estrogen) during and after menopause.
  
• Pregnancy and childbirth: The strain and stretching from childbirth is a risk factor that can lead to prolapse later in life.
  
• Hysterectomy: The surgical removal of the uterus can be a risk factor, leading to a vaginal prolapse.
  
• Obesity: Puts pressure on your lower abdomen and pelvis, impacting your pelvic floor muscles and organs.
  
• Chronic constipation, chronic coughing and heavy lifting: Strains the pelvic floor muscles, causing them to weaken.
  
• Genetics: If someone in your family had pelvic organ prolapse, you may be more at risk of developing the condition.

Symptoms of pelvic organ prolapse

Prolapse is not a life-threatening condition, but the symptoms are uncomfortable and can affect your quality of life. Symptoms may be mild in the morning but worsen throughout the day.

Common symptoms of pelvic organ prolapse include:

• Pressure or a heavy feeling in your pelvic organs
• Feeling like something is falling out of your vaginal opening
• Seeing a “ball” of tissue or protrusion out of your vagina opening
• Repeat bladder infections or urinary tract infections (UTIs)
• Feeling like you haven’t fully emptied your bladder
• Discomfort in the vaginal opening if uterine tissue is bulging out
• Leaking urine or stool
• Lower backache
• Constipation
• Pain during sex

Types & stages of pelvic organ prolapse

Prolapse is categorized by its type and stage. This is based on your affected organ or organs and the symptoms you’re experiencing.

Common types of pelvic organ prolapse:

• Bladder prolapse (cystocele): Bladder drops into the vagina.
  
• Enterocele: Intestines drop into the vagina.
  
• Rectocele: Rectum is pressed upward into the vagina.
  
• Uterine prolapse: Uterus drops into the vagina.
  
• Vaginal vault prolapse: Ligaments that support the vagina weaken and fall into the vaginal canal. This is more common if you’ve had a hysterectomy.

Stages of pelvic organ prolapse:

• Stage I: Mild prolapse, where organs are still somewhat supported by the pelvic floor muscles and may have dropped into the upper part of the vagina.
  
• Stage II: The pelvic organs have started to drop into the lower part of the vagina but are still contained inside the vagina.
  
• Stage III: Pelvic organs have fallen to or beyond the opening of the vagina and are protruding.
  
• Stage IV: Pelvic organs have completely fallen through the vaginal opening.

The most common type of pelvic organ prolapse is a stage I or II cystocele (bladder prolapse).

Diagnosing pelvic organ prolapse

You’ll first meet with a urogynecologist for a pelvic exam and to discuss your symptoms and medical history. Usually, a pelvic exam is sufficient for a prolapse diagnosis. In more complex cases, an imaging test, such as a CT scan or MRI, may be needed so your provider can get a closer look at the prolapse and determine the type and stage.

Many of the symptoms of prolapse are also symptoms of other pelvic floor or urinary tract conditions that cause pelvic pain or discomfort. Your provider may order additional tests to rule out any other complications.

Pelvic organ prolapse treatments

Treatment for prolapse depends on your type and stage. Sometimes prolapses go unnoticed and will clear up on their own. But sometimes the prolapse and symptoms can get worse.

If left untreated, pelvic organ prolapse can cause sores on the cervix (opening to the uterus) and increase the chances of injury or infection to other pelvic organs.

Our full range of treatment options, both nonsurgical and surgical, means we'll find one that's right for you and your specific case so you can regain your comfort and confidence.

Pelvic organ prolapse physical therapy

Physical and occupational pelvic floor therapy can successfully treat most mild cases of prolapse. This includes methods that strengthen the pelvic floor muscles and improve bone alignment, including:

• Biofeedback: Uses a small sensor and a computer monitor to help you visualize your muscle control and activity.
  
• Kegel exercise: A common pelvic floor exercise.
  
• Hands on therapy: Targets any tissues, scars or tight muscles.

Vaginal pessary

A pessary is a soft, removable ring that can be inserted into the vagina to support the area of prolapse and provide stability and relief.

Pelvic organ prolapse surgery

If you have a severe case of prolapse, surgery may be recommended for you. The most common type of surgery for prolapse uses a surgical mesh to hold the impacted organs back in place. This minimally invasive surgery is usually done through a very small incision in your abdomen and results in less scarring and pain, and faster recovery time, than other surgeries.

Prevent pelvic organ prolapse

Behavioral and lifestyle changes can help you avoid prolapse or return of prolapse. This includes maintaining a healthy weight, and protecting your lower back if you lift heavy objects frequently. Physical therapy and certain exercises you can do at home will improve the strength of your pelvic floor so it doesn’t weaken.