Pelvic organ prolapse

Pelvic organ prolapse happens when the muscles in your pelvis weaken, letting the bladder, urethra, uterus or rectum slip down into the vagina. It’s common, but usually isn’t dangerous. You can have it for years without problems.

Symptoms

Talk to your doctor if you experience symptoms of pelvic organ prolapse, such as: 

  • Incontinence (difficulty controlling your bladder or bowels) 
  • Lower back pain
  • Tissue you can see or feel coming out of your vagina 
  • Trouble wearing a tampon (or feeling like it’s always half in and half out) 
  • Vaginal irritation, pressure or pain, especially during sex

Types of Prolapse

Your doctor may give you a diagnosis of: 

  • Bladder prolapse (cystocele) or urethral prolapse (urethrocele) – The front of the vagina sags downward or outward, allowing the bladder or urethra to drop from its normal position. 
  • Enterocele – Support to the top of the vagina weakens, letting the small intestine bulge into the vagina.
  • Rectocele – The rectum bulges upward into the vagina because of a weakened lower vaginal wall and perineum (area of the pelvic floor between the vagina and the anus). 
  • Uterine prolapse – Support for the uterus and upper vagina weakens, allowing the uterus to slide down into the vagina. 
  • Vaginal vault prolapse – Upper support of the vagina weakens after a hysterectomy, allowing the vaginal walls to sag into the vagina. 

The stage, or severity, is on a scale of 0 (no prolapse) to 4 (total prolapse).

Lifestyle Tips

Learn how to manage symptoms of pelvic organ prolapse during everyday life.

Behavior

  • Don’t strain with bowel movements. If you’re constipated, loosen stools with a natural laxative, such as apple juice or prune juice. Hot water and coffee may also help stimulate bowel movements. Eat plenty of fiber, and exercise regularly. Ask your doctor about treatment options for moderate to severe constipation. 
  • You don’t need to avoid sex unless it hurts. Some forms of sexual activity can exercise the pelvic floor muscles and push prolapsed organs back in place. 
  • Maintain a healthy weight through diet and exercise. 
  • Don’t smoke. This bad habit doubles your risk for pelvic floor disorders.

Diet

  • Eat lots of fruits, vegetables and whole grains. If they don’t prevent constipation, consider taking a fiber supplement. 
  • Drink 60 to 80 ounces of water a day.

Exercise

  • Avoid extreme weight lifting and repeated heavy lifting. 
  • Do Kegel exercises, in which you squeeze and release pelvic floor muscles to relieve mild symptoms or prevent prolapse.

Treatment Options

Women who aren’t experiencing discomfort may choose to monitor their symptoms. If symptoms are bothersome, treatments can help.

Nonsurgical Treatments

  • Physical therapy to strengthen your pelvic floor muscles 
  • Pessary, a silicone device customized for you to comfortably wear in the vagina to keep a pelvic organ in place

Surgery

Ask your doctor if surgery is a good option to treat your symptoms. Surgery succeeds 80% to 95% of the time, depending on your medical history and health of your pelvic tissue before treatment.

Apical Suspension

You can restore support for the top of the vagina with an apical suspension procedure, such as: 

  • Sacral colpopexy—Makes an incision in your belly and then uses a strip of mesh to connect the vagina to a strong ligament on the sacrum (the back bone between the hips) 
  • Uterosacral or sacrospinous ligament suspension—Inserts surgical tools through the vagina (without making an incision) to stitch the top of the organ to ligaments in the pelvis 
  • Anterior vaginal prolapse repair—Makes an incision in the wall of the vagina and then uses sutures to help tissue hold up a slipped bladder

If you have a uterus, one of these procedures may take place at the same time as a hysterectomy. 

You can have sex after apical suspension.

Posterior Vaginal Prolapse Repair

This surgery uses an incision in the wall of the vagina to fix a bulging rectum. Your surgeon rebuilds the wall between the vagina and rectum using sutures in the supporting tissue and muscles.

Obliterative Procedures

Colpocleisis and colpectomy close and shorten the vagina by removing the skin and sewing the inside vaginal walls together. This type of surgery is less invasive and has a higher success rate than other procedures. Afterward, you will no longer be able to have vaginal sex.

Frequently Asked Questions

What are risk factors for pelvic organ prolapse?

Most women with a slipped pelvic organ have two of more of these:

  • Health problems that involve repeated straining of the pelvic muscles, including obesity, chronic cough and constipation
  • Hysterectomy
  • Loss of estrogen during menopause
  • Mother, grandmother, or aunt who has pelvic organ prolapse
  • Pregnancy and childbirth
  • Repeated heavy lifting

About one-third of women who have given birth vaginally have prolapse. The problem is particularly common among women who have had a large baby, needed forceps to deliver or have had many vaginal births.

How is pelvic organ prolapse diagnosed?

A urogynecologist will review your medical history and then perform a pelvic exam to look for lumps, wounds and prolapsed organs. You will likely also receive a rectal exam. Depending on the results of your physical exams, your doctor may recommend more tests, including:

  • Ultrasound
  • Urinary tract infection screening
  • Urodynamic (bladder strength) testing
What if I don’t get treatment?

Left untreated, prolapse almost always gets worse over time, but usually gradually—over years or decades, not months. The exception is prolapse right after the birth of a baby. This will often get better within the first year after delivery. 

Your choice to get treatment usually depends on your symptoms and quality of life. But you must receive care if prolapse makes urine back up into your kidneys, causing damage or infection. This is rare.

Contact us

Talk to a care navigator or schedule an appointment at the Women’s Health & Wellness Center.