Pelvic Organ Prolapse

What is pelvic organ prolapse?

Pelvic organ prolapse (POP) refers to any descent or falling down of the female pelvic organs.  This can include the bladder, uterus, rectum.  It may also include the top of the vagina or vaginal cuff if a woman has had a hysterectomy.

What are symptoms of pelvic organ prolapse?

Symptoms may include pelvic pain, pelvic pressure or a sense of pelvic heaviness.  Women may also report pain with intercourse or difficulty emptying the bladder or having a bowel movement.  Other patients may notice a mass or bulge which may extend outside the body. Some women are noted to have prolapse on examination but may not have any symptoms.

How common is pelvic organ prolapse?

This depends on which study is read.  The numbers can vary depending on whether or not the patient has symptoms or if prolapse is noted on examination by a provider.  In one large study, about 3 to 6% of woman had prolapse.

What are risk factors for pelvic organ prolapse?

Common risk factors for developing prolapse include a history of being pregnant and undergoing delivery, particularly vaginal delivery.  The risk may also increase with an operative vaginal delivery (such as with a forceps or vacuum).  Certain connective tissue disorders or weakened tissues may also increase the risk.  It is also seen more commonly in postmenopausal women and women of increasing age.  Obesity, chronic constipation and chronic cough may also increase the risk of prolapse.

However, it is also important to note that many patients with prolapse may not have any of these risk factors.  We also suspect there may be a genetic or hereditary component.  This means that if you have multiple family members such as mother or sisters who have had prolapse this may also increase your risk.

How is pelvic organ prolapse treated?

The symptoms of prolapse are what dictate patient treatment.  If a woman does not have any symptoms, then no special treatment is required.  For patients with mild symptoms and or mild prolapse, a trial of physical therapy and pelvic floor strengthening exercises may be recommended.  In addition, there are some lifestyle changes such as avoiding constipation and losing weight that may be helpful long-term.

A pessary is a medical device made of silicone that can be placed in the office to treat pelvic organ prolapse.  These devices act to hold up the tissues that are falling down.  If the patient successfully uses a pessary, she will either be taught to remove and reinsert the device or come in for a few office visits here to have this done.

If the pessary is not successful or not desired by the patient, then there are many surgical options to treat pelvic organ prolapse.  The type of surgery depends on the degree and anatomy affected by prolapse.  

What is the surgery for prolapse?

A type of surgery called "native tissue repair" helps support the tissues that have become weakened and led to the prolapse.  This is the common approach to fix a falling bladder or rectum.  If the uterus is falling, there are multiple approaches to correct this.  Removal of the uterus may or may not be part of the treatment option and support of either the cervix or vaginal cuff would be undertaken.  A procedure called a sacrospinous ligament fixation is done via a vaginal route.  A uterosacral ligament suspension may be done at the time of vaginal or laparoscopic hysterectomy.  Another procedure is called a sacrocolpopexy and this utilizes a mesh graft to support the cervix or vagina.  Your surgeon will work with you to discuss these in more detail and help you decide on what the best surgical route is for you.

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