What is Pelvic Organ Prolapse

Pelvic organ prolapse is the stretching, bulging, or dropping of pelvic organs into an abnormal position.

It happens when the muscles and tissues that surround and support pelvic structures become weak or stretched. Pelvic organ prolapse can involve the:

• Vagina (vaginal prolapse).
• Uterus (uterine prolapse).
• Bladder (cystocele).
• Rectum (rectocele).
• Intestines (enterocele).

When organs other than the vagina are involved, they often bulge into the vagina or protrude from the vagina, depending on how severe the prolapse is.

What are the causes?

This condition may be caused by:

• Pregnancy, labor, and childbirth.
• Past pelvic surgery.
• Decreased production of the hormone estrogen associated with menopause.
• Consistently lifting more than 50 lb (23 kg).
• Obesity.
• Long-term inability to pass stool (chronic constipation).
• A cough that lasts a long time (chronic).
• Buildup of fluid in the abdomen due to certain diseases and other conditions.

What are the signs or symptoms?

Symptoms of this condition include:

• Passing a little urine (loss of bladder control) when you cough, sneeze, strain, and exercise (stress incontinence). This may be worse immediately after childbirth. It may gradually improve over time.
• Feeling pressure in your pelvis or vagina. This pressure may increase when you cough or when you are passing stool.
• A bulge that protrudes from the opening of your vagina.
• Difficulty passing urine or stool.
• Pain in your lower back.
• Pain, discomfort, or disinterest in sex.
• Repeated bladder infections (urinary tract infections).
• Difficulty inserting a tampon.

In some people, this condition causes no symptoms.

How is this diagnosed?

This condition may be diagnosed based on a vaginal and rectal exam. During the exam, you may be asked to cough and strain while you are lying down, sitting, and standing up. Your health care provider will determine if other tests are required, such as bladder function tests.

How is this treated?

Treatment for this condition may depend on your symptoms. Treatment may include:

• Lifestyle changes, such as changes to your diet.
• Emptying your bladder at scheduled times (bladder training therapy). This can help reduce or avoid urinary incontinence.
• Estrogen. Estrogen may help mild prolapse by increasing the strength and tone of pelvic floor muscles.
• Kegel exercises. These may help mild cases of prolapse by strengthening and tightening the muscles of the pelvic floor.
• A soft, flexible device that helps support the vaginal walls and keep pelvic organs in place (pessary). This is inserted into your vagina by your health care provider.
• Surgery. This is often the only form of treatment for severe prolapse.

Follow these instructions at home:

• Avoid drinking beverages that contain caffeine or alcohol.
• Increase your intake of high-fiber foods. This can help decrease constipation and straining during bowel movements.
• Lose weight if recommended by your health care provider.
• Wear a sanitary pad or adult diapers if you have urinary incontinence.
• Avoid heavy lifting and straining with exercise and work. Do not hold your breath when you perform mild to moderate lifting and exercise activities. Limit your activities as directed by your health care provider.
• Do Kegel exercises as directed by your health care provider. To do this:
  • Squeeze your pelvic floor muscles tight. You should feel a tight lift in your rectal area and a tightness in your vaginal area. Keep your stomach, buttocks, and legs relaxed.
  • Hold the muscles tight for up to 10 seconds.
  • Relax your muscles.
  • Repeat this exercise 50 times a day, or as many times as told by your health care provider. Continue to do this exercise for at least 4–6 weeks, or for as long as told by your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you have a pessary, take care of it as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you:

• Have symptoms that interfere with your daily activities or sex life.
• Need medicine to help with the discomfort.
• Notice bleeding from your vagina that is not related to your period.
• Have a fever.
• Have pain or bleeding when you urinate.
• Have bleeding when you pass stool.
• Pass urine when you have sex.
• Have chronic constipation.
• Have a pessary that falls out.
• Have bad smelling vaginal discharge.
• Have an unusual, low pain in your abdomen.

Summary

• Pelvic organ prolapse is the stretching, bulging, or dropping of pelvic organs into an abnormal position. It happens when the muscles and tissues that surround and support pelvic structures become weak or stretched.
• When organs other than the vagina are involved, they often bulge into the vagina or protrude from the vagina, depending on how severe the prolapse is.
• In most cases, this condition needs to be treated only if it produces symptoms. Treatment may include lifestyle changes, estrogen, Kegel exercises, pessary insertion, or surgery.
• Avoid heavy lifting and straining with exercise and work. Do not hold your breath when you perform mild to moderate lifting and exercise activities. Limit your activities as directed by your health care provider.