Pelvic Organ Prolapse

Topic Overview

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when a pelvic organ—such as your bladder—drops (prolapses) from its normal spot in your lower belly and pushes against the walls of your vagina. This can happen when the muscles that hold your pelvic organs in place get weak or stretched from childbirth or surgery.

Many women will have some kind of pelvic organ prolapse. It can be uncomfortable or painful. But it isn't usually a big health problem. It doesn't always get worse. And in some women, it can get better with time.

More than one pelvic organ can prolapse at the same time. Organs that can be involved when you have pelvic prolapse include the:

• Bladder. This is the most common kind of pelvic organ prolapse.
• Urethra.
• Uterus.
• Vagina.
• Small bowel.
• Rectum.

What causes pelvic organ prolapse?

Pelvic organ prolapse is most often linked to strain during childbirth. Normally, your pelvic organs are kept in place by the muscles and tissues in your lower belly. During childbirth, these muscles can get weak or stretched. If they don't recover, they can't support your pelvic organs.

You may also get pelvic organ prolapse if you have surgery to remove your uterus (hysterectomy). Removing the uterus can sometimes leave other organs in the pelvis with less support.

Pelvic organ prolapse can be made worse by anything that puts pressure on your belly, such as:

• Being very overweight (obesity).
• A long-lasting cough.
• Frequent constipation.
• Pelvic organ cancers.

Older women are more likely to have pelvic organ prolapse. It also tends to run in families.

What are the symptoms?

Symptoms of pelvic organ prolapse include:

• Feeling pressure from pelvic organs pressing against the vaginal wall. This is the most common symptom.
• Feeling very full in your lower belly.
• Feeling as if something is falling out of your vagina.
• Feeling a pull or stretch in your groin area or pain in your lower back.
• Releasing urine without meaning to (incontinence), or needing to urinate a lot.
• Having pain in your vagina during sex.
• Having problems with your bowels, such as constipation.

How is pelvic organ prolapse diagnosed?

Your doctor will ask questions about your symptoms and about any pregnancies or health problems. Your doctor will also do a physical exam, which will include a pelvic exam.

How is it treated?

Decisions about your treatment will be based on which pelvic organs have prolapsed and how bad your symptoms are.

If your symptoms are mild, you may be able to do things at home to help yourself feel better. You can relieve many of your symptoms by adopting new, healthy habits. Try special exercises (called Kegels) that make your pelvic muscles stronger. Reach and stay at a healthy weight. Cut back on caffeine, which acts as a diuretic and can cause you to urinate more often. Avoid lifting heavy things that put stress on your pelvic muscles.

If you still have symptoms, your doctor may have you fitted with a device called a pessary to help with the pain and pressure of pelvic organ prolapse. It is a removable device that you put in your vagina. It holds the pelvic organs in place. But if you have a severe prolapse, you may have trouble keeping a pessary in place.

Surgery is another treatment option for serious symptoms of pelvic organ prolapse. But you may want to delay having surgery if you plan to have children. The strain of childbirth could cause your prolapse to come back.

You may want to consider surgery if:

• You have a lot of pain because of the prolapsed organ.
• You have a problem with your bladder and bowels.
• The prolapse makes it hard for you to enjoy sex.

Types of surgery for pelvic organ prolapse include:

• Surgery to repair the tissue that supports a prolapsed organ.
• Surgery to repair the tissue around your vagina.
• Surgery to close the opening of your vagina.
• Surgery to remove the uterus (hysterectomy).

Pelvic organ prolapse can come back after surgery. Doing Kegel exercises to make your pelvic muscles stronger will help you recover faster from surgery. The two together can help you more than surgery alone.

Frequently Asked Questions

Learning about pelvic organ prolapse:	What is pelvic organ prolapse? What causes it? What are the symptoms? How common is it? What increases my risk of pelvic organ prolapse? How can I prevent it? When do I need to see my doctor?
Being diagnosed:	How will my doctor diagnose pelvic organ prolapse? What happens with it? Who should I see if I have symptoms?
Getting treatment:	How is pelvic organ prolapse treated? What is a vaginal pessary? Will I need to take medicine? Will I need surgery? Should I have surgery for pelvic organ prolapse? Is home treatment available? What other treatment is available for pelvic organ prolapse?
Ongoing concerns:	When should I call my doctor?

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Author:	Monica Rhodes	Last Updated: October 25, 2006
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine R. Hugh Gorwill, MD - Obstetrics and Gynecology
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