Pelvic organ prolapse symptoms & treatment

Pelvic organ prolapse is a common condition in women that is not talked about much. It happens when one of your pelvic organs drops or sags out of place. Pelvic organs include your uterus, bladder, bowel, vagina, urethra and rectum.

When a pelvic organ drops, it may sag into the vaginal canal or out of the vaginal opening as the prolapse worsens. This is due to weak connective tissues in the pelvic floor.

Pelvic organ prolapse can be an isolating condition that women don’t seek help for, but over 40 percent of women experience a type of prolapse. If you believe you’re experiencing symptoms of a prolapse, our specialists can help.

Causes of pelvic organ prolapse

When an organ in your body descends from its normal place in your body, it’s called prolapse. The pelvic floor is a collection of muscles, ligaments and tissues, and when they weaken, they can’t support your pelvic organs.

These 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.
• 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.
• Hysterectomy: The surgical removal of the uterus can be a risk factor, leading to a vaginal prolapse.
• Pregnancy and childbirth: The strain and stretching from childbirth is a risk factor that can lead to prolapse later in life.
• Genetics: If someone in your family had pelvic organ prolapse, you may be more at risk of developing the condition.

Pelvic organ prolapse symptoms

Symptoms of prolapse depend on what organ is dropping and where. You may find that symptoms are mild in the morning but worsen throughout the day, impacting your quality of life.

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” or protrusion from the vaginal opening
• Repeat bladder infections or urinary tract infections (UTIs)
• Feeling like you haven’t fully emptied your bladder
• Discomfort if uterine tissue is bulging out of the vaginal opening
• Pain during sex
• Leaking urine or stool
• Constipation
• Lower backache

Stages & types of pelvic organ prolapse

Common types of pelvic organ prolapse:

Your type of prolapse depends on the symptoms you are experiencing and the organs that are dropping.

• Bladder prolapse (cystocele): Bladder drops into the vaginal canal (most common type).
• Rectocele: Rectum is pressed into the vaginal canal.
• Enterocele: Small intestines drop into the vaginal canal.
• Uterine prolapse: Uterus drops into the vaginal canal.
• Vaginal vault: Ligaments that support the vagina weaken, causing the top of the vagina to descend into the vaginal canal. This is more common if you’ve had a hysterectomy.

Stages of pelvic organ prolapse:

The most common cases are mild, and the prolapse may correct itself or not drop down further after some time, with or without treatment. But sometimes it can get worse.

• Stage I: Mild prolapse, where organs are still somewhat supported by the pelvic floor 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.

It’s important to seek treatment if you suspect you have a type of prolapse, even in mild cases. If left untreated, pelvic organ prolapse can cause sores on the cervix (opening to the uterus) and increase chances of injury or infection to other pelvic organs.

Diagnosing pelvic organ prolapse

You’ll first meet with a urogynecologist for a pelvic exam and to discuss your symptoms. In most cases, a pelvic exam is sufficient for prolapse diagnosis. In more complex cases, a CT scan or MRI may be needed so your provider can get a closer look at the prolapse inside your body. These imaging tests will help determine the type and stage of prolapse.

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

Prolapse is not a life-threatening condition, but it does need treatment so it doesn’t worsen. Treatment depends on your type and stage.

Our treatment options include both nonsurgical and surgical methods. We’ll find a treatment 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:

• Kegel exercise: A common pelvic floor exercise.
• Biofeedback: Uses a small sensor and a computer monitor to help you visualize your muscle control and activity.
• 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 nonsurgical options are not successful, or 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. It can also help you prevent the return of prolapse. Changes include 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.