What is pelvic organ prolapse?

Pelvic organ prolapse (POP) occurs when an organ in the pelvic region, such as the bladder, slips from its normal position into the lower pelvis, vagina, or outside the body. The prolapse of an organ may involve the entire organ, or part of an organ. These organs can include: the urethra, bladder, uterus, small bowel / intestines, sigmoid colon, rectum and vagina.

Types of pelvic organ prolapse

Urologists diagnose and treat patients who experience different types of prolapse. Pelvic organ prolapse is typically characterized as being a vaginal wall prolapse – anterior, posterior, or apical.

Anterior prolapses include:

• Cystocele – This prolapse occurs when the bladder falls into the vagina.
• Urethrocele – When the urethra drops into the vagina.
• Cystourethrocele – When the bladder and the urethra fall into the vagina.

Posterior prolapses include:

• Rectocele – This prolapse involves the rectum dropping into the vagina.
• Enterocele – The small intestine drops into the vagina with this prolapse.
• Sigmoidocele – When the sigmoid colon – located at the lowest end of the large intestine, just above the rectum – falls into the pelvic cavity.

Apical prolapses include:

• Vaginal vault – A prolapse in which the roof of the vagina falls.
• Uterine prolapse – A women’s uterus drops down into the vagina.

Depending on the type of prolapse, some of the organs may protrude outside the vagina.

What causes a POP?

The most common cause of pelvic organ prolapse is the weakening of the pelvic muscles that hold organs in place. Prolapse often occurs after childbirth (vaginal deliveries) when pelvic muscles have been weakened and/or stretched. Other contributors to pelvic organ prolapse can include:

• Aging
• Menopause
• Excess weight
• A long-standing cough / chronic lung disease
• Frequent or chronic constipation
• Family history
• Pelvic tumors

Symptoms of prolapse

There are many symptoms associated with pelvic organ prolapse, which are dependent on the organ and type of prolapse. The most obvious is actually seeing the organ protruding outside of the body, or having the sensation of a vaginal bulge. Others might include:

• Pressure in the pelvic region or lower abdomen.
• Heaviness in the vagina.
• Painful intercourse – dyspareunia.
• Urinary incontinence including urgent urination and frequency.
• Having a weak or prolonged urine stream.
• The feeling of not being empty after urinating.
• Having to maintain a specific position to urinate or defecate.
• Splinting – Having to place a finger into the vagina to assist in urinating or defecating.
• Chronic constipation.
• Fecal incontinence.

Treatments for prolapse

Treatment is determined based on the seriousness of the problem. If the problem is minor, Kegel exercises may be  recommended by your urologist to strengthen the pelvic muscles. Patients may also be fitted for a vaginal pessary to hold an organ. In more serious cases, surgery may be required. This can include placement of a mesh. In many cases, minimally invasive and/or robotic surgery may be employed; lessening recovery time and delivering desired outcomes.

If you’re experiencing any of the symptoms associated with pelvic organ prolapse, contact Urology Austin to schedule an appointment.