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Pelvic Organ Prolapse

About 35 percent of women will develop some form of pelvic organ prolapse.

When the muscles of the pelvic floor are damaged or become weak — often due to childbirth — they are sometimes unable to support the weight of some or all of the pelvic and abdominal organs. If this occurs, one or more of the organs may drop (or prolapse) below their normal positions, causing symptoms including discomfort, pain, pressure and urinary incontinence.

"This is one of those conversations that women don’t like to have, but it’s important for us to understand that pelvic organ prolapse is not a normal part of aging," said Susan Hendrix, D.O., a urogynecology and menopause specialist for DMC Women’s Health Services.About 35 percent of women will develop some form of pelvic organ prolapse during their lives. The condition can often be treated with non-surgical therapies, but it sometimes requires pelvic floor reconstructive surgery. When surgical treatment is necessary, it’s important to select a urogynecologist who is experienced with the many different surgical options available."The expertise and skill of the surgeon is extremely important in these complex procedures," said Dr. Hendrix. "You want to choose someone who specializes in urogynecology and has had extensive experience performing the complete range of surgical treatments, not just one or two types of procedures."Symptoms of Pelvic Organ Prolapse

In early stages, pelvic organ prolapse often has few noticeable symptoms. Women often describe the first signs as subtle — an inability to keep a tampon inside the vagina, dampness in underwear or discomfort due to dryness during intercourse. As the prolapse gets worse, some women complain of:

  • A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements

  • The feeling that they are "sitting on a ball" 

  • Needing to push stool out of the rectum by placing their fingers into the vagina during bowel movement 

  • Difficulty starting to urinate, a weak or spraying stream of urine 

  • Urinary frequency or the sensation that they are not emptying their bladder well 

  • The need to lift up the bulging vagina or uterus to start urination    

  • Urine leakage with intercourse

Types of Pelvic Organ Prolapse

Every woman is different and every instance of pelvic organ prolapse is different too, which is why Dr. Hendrix stresses the importance of finding a skilled urogynecologist who can choose the best treatment for your particular type of prolapse. The most common types of pelvic organ prolapse are:

  • Anterior Vaginal Prolapse (also known as cystocele).
  • This type of prolapse occurs when the wall between the vagina and the bladder stretches or detaches from the pelvic bones. This loss of support allows the bladder to prolapse or fall down into the vagina. Most women do not have symptoms when the anterior vaginal prolapse is mild. As it progresses outside the opening of the vagina, the prolapsed bladder may not empty well which can lead to urinary frequency, night time voiding, loss of bladder control and recurrent bladder infections. Strengthening pelvic muscles may improve the support to the bladder and neighboring organs and reduce symptoms. In addition, women can get temporary support by wearing a device called a vaginal pessary. It works much like a knee or ankle brace would support a weak joint. When these efforts are inadequate, surgery is available to elevate the bladder and other internal organs to their proper position.
  • Posterior Vaginal Prolapse (also known as rectocele). Weakening and stretching of the back wall of the vagina allows the rectum to bulge into and out of the vagina. Most often, the damage to the back wall of the vagina occurs during vaginal childbirth, although not everyone who has delivered a child vaginally will develop a rectocele. Mild rectoceles rarely cause symptoms. However, straining with constipation puts significant pressure on the weak vaginal wall and can further thin it. Avoiding constipation may prevent progression and also reduce symptoms from the rectocele. Some women may find benefit from pelvic floor muscle strengthening and vaginal pessaries. When these interventions are insufficient to relieve symptoms, surgery can be performed to reinforce the posterior vaginal wall.
  • Uterine Prolapse. When the supporting ligaments and muscles of the pelvic floor are damaged, the cervix and uterus descend into and eventually out of the vagina. Often, uterine prolapse is associated with loss of vaginal wall support (cystocele, rectocele). When the cervix protrudes outside the vagina, it can develop ulcers from rubbing on underwear or protective pads. There is a risk that these ulcers will bleed and become infected.  As with other forms of prolapse, it is not until the uterine descent is bothersome that treatment is necessary. Women who have uterine prolapse often report pelvic pressure, the need to sit or lay down to relieve the discomfort, a sensation that their insides are falling out, difficulty emptying their bladder and urine leakage. Strengthening the pelvic muscles with Kegel exercises, avoiding heavy lifting, constipation, and weight gain may slow or stop uterine descent. Additional treatment options include pessary devices and surgery. 
  • Vaginal Prolapse after Hysterectomy. If a woman has already had a hysterectomy, the very top of the vagina (where the uterus used to be) can become detached from its supporting ligaments. This can result in the tube of the vagina turning inside out. This condition is also known as vaginal "vault" prolapse. One or several pelvic organs (such as the bladder, small and large bowel) may prolapse into the protruding bulge.
    • With bladder prolapse, women may report difficulty in starting to urinate, and emptying their bladder well. 
    • With bowel prolapse, women may report the need to push up the vaginal bulge and strain to have a bowel movement. 
    • Skin sores may develop if the bulge is rubbing on pads or underwear. Treatment options include pessary devices and surgery.
  • Rectal Prolapse. The rectum is the name given to the last 6 inches of the colon. Like the vagina and uterus, the rectum is normally securely attached to the bony pelvis by ligaments and muscles. Infrequently, the supporting structures stretch or detach from the rectal wall, which results in the rectum prolapsing through the anus. This looks like red, often donut shaped soft tissue coming through the anus. In early stages, it can be confused with a large hemorrhoid. Risk factors include chronic constipation or diarrhea, nerve and muscle weakness (paralysis or multiple sclerosis) and advancing age. Women with rectal prolapse often report the following symptoms: pain during bowel movements, mucus or blood discharge from the protruding tissue, loss of control of bowel movements, and soft, red tissue protruding from the anus. 

Talking to your physician about any of these problems can be difficult, but the highly trained urogynecology specialists at DMC Women’s Health Services are compassionate, understanding and very experienced with pelvic floor prolapse and the most appropriate treatment options. Call 1-888-DMC-2500 to make an appointment today.
Source: American Urogynecologic Society
 

 



Facts about Pelvic Organ Prolapse

  • About 35 percent of women will develop some form of pelvic organ prolapse.

  • Women who are obese have a 40% to 75% increased risk of pelvic organ prolapse. 

  • Caucasian women are more likely than African American women to develop pelvic organ prolapse. 

  • Loss of pelvic support can occur when any part of the pelvic floor is injured during vaginal delivery, surgery, pelvic radiation or back and pelvic fractures during falls or motor vehicle accidents.

  • Hysterectomy and other procedures done to treat pelvic organ prolapse also are associated with future development of prolapse.

  • Aging, menopause, debilitating nerve and muscle diseases also contribute to the deterioration of pelvic floor strength and the development of prolapse.

  • Other conditions that promote prolapse include:

    • Chronic constipation and straining
    • Smoking
    • Chronic coughing
    • Heavy lifting
    • Obesity

    Source: American Urogynecologic Society

 



Susan Hendrix, DO

 

Susan Hendrix, DO
Clinical Professor of Obstetrics and Gynecology
Dr. Hendrix is board certified in obstetrics and gynecology. Her clinical interests include: menopause; gynecology procedures; urogynecology; and the Essure birth control procedure. Dr. Hendrix is a nationally known authority on menopause. She was a primary investigator on the national Women's Health Initiative, the study that found hormone therapy can actually increase women's risk of breast cancer, heart disease, blood clots and stroke. She is also the author of a Chicken Soup for the Soul book on Menopause published in Spring 2005. Dr. Hendrix currently serves as Clinical Professor of Obstetrics and Gynecology at Michigan State University College of Osteopathic Medicine.

Education: Philadelphia College of Osteopathic Medicine, Philadelphia, Penn., 1979-80
Michigan State University College of Osteopathic Medicine, East Lansing, Mich., M.D., 1980-83

Residency: Lansing OB/GYN Residency Program, Sparrow Hospital, Lansing, Mich., (Obstetrics and Gynecology) 1984-88

Fellowships: Wayne State University/Hutzel Women's Hospital, Detroit, Mich., (Maternal Fetal Medicine) 1998-2001


 

 

 

 

 

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DMC Hutzel Women’s Hospital Urogynecology and Incontinence 
 
  
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