Pelvic organ prolapse

Pelvic organ prolapse happens when the muscles and tissues supporting the pelvic organs (the uterus, bladder, or rectum) become weak or loose. This allows one or more of the pelvic organs to drop or press into or out of the vagina. Many women are embarrassed to talk to their doctor about their symptoms or think that their symptoms are normal. But pelvic organ prolapse is treatable.

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What is pelvic organ prolapse?

The pelvic muscles and tissues support the pelvic organs like a hammock. The pelvic organs include the bladder, uterus and cervix, vagina, and rectum, which is part of the bowel. A prolapse happens when the pelvis muscles and tissues can no longer support these organs because the muscles and tissues are weak or damaged. This causes one or more pelvic organs to drop or press into or out of the vagina.

Pelvic organ prolapse is a type of pelvic floor disorder. The most common pelvic floor disorders are:

  • Urinary incontinence (leaking of urine)
  • Fecal incontinence (leaking of stool)
  • Pelvic organ prolapse (weakening of the muscles and tissues supporting the organs in the pelvis)

What are the different types of pelvic organ prolapse?

The different types of pelvic organ prolapse depend on the pelvic organ affected. The most common types include:

  • Dropped bladder (called cystocele). This is the most common type of pelvic organ prolapse. This happens when the bladder drops into or out of the vagina.
  • Rectocele. This happens when the rectum bulges into or out of the vagina.
  • Dropped uterus (uterine prolapse). This happens when the uterus bulges into or out of the vagina. Uterine prolapse is sometimes associated with small bowel prolapse (called enterocele), where part of the small intestine, or small bowel, bulges into the vagina.

Although it is rare, pelvic organ prolapse can also happen after a hysterectomy. Any part of the vaginal wall may drop, causing a bulge into or out of the vagina.

Who gets pelvic organ prolapse?

Pelvic floor disorders (urinary incontinence, fecal incontinence, and pelvic organ prolapse) affect one in five women in the United States.1 Pelvic organ prolapse is less common than urinary or fecal incontinence but affects almost 3% of U.S. women.1 Pelvic organ prolapse happens more often in older women and in white and Hispanic women than in younger women or women of other racial and ethnic groups.2,3

Some women develop more than one pelvic floor disorder, such as pelvic organ prolapse with urinary incontinence.

What are the symptoms of pelvic organ prolapse?

The pressure from prolapse can cause a bulge in the vagina that can sometimes be felt or seen. Women with pelvic organ prolapse may feel uncomfortable pressure during physical activity or sex.

Other symptoms of pelvic organ prolapse include:

  • Seeing or feeling a bulge or "something coming out" of the vagina
  • A feeling of pressure, discomfort, aching, or fullness in the pelvis
  • Pelvic pressure that gets worse with standing or coughing or as the day goes on
  • Leaking urine (incontinence) or problems having a bowel movement
  • Problems inserting tampons

Some women say that their symptoms are worse at certain times of the day, during physical activity, or after standing for a long time. Talk to your doctor or nurse about your symptoms.

What causes pelvic organ prolapse?

Pelvic organ prolapse happens when the muscles or connective tissues of the pelvis do not work as they should. The most common risk factors are:

  • Vaginal childbirth, which can stretch and strain the pelvic floor. Multiple vaginal childbirths raise your risk for pelvic organ prolapse later in life.4 But you can get prolapse even if you have never had children or if you had a cesarean, or C-section, delivery.
  • Long-term pressure on your abdomen, including pressure from obesity, chronic coughing, or straining often during bowel movements
  • Giving birth to a baby weighing more than 8½ pounds5
  • Aging. Pelvic floor disorders are more common in older women. About 37% of women with pelvic floor disorders are 60 to 79 years of age, and about half are 80 or older.1
  • Hormonal changes during menopause. Loss of the female hormone estrogen during and after menopause can raise your risk for pelvic organ prolapse. Researchers are not sure exactly why this happens.6
  • Family history. Researchers are studying how genetics can play a role in pelvic organ prolapse.

How is pelvic organ prolapse diagnosed?

Your doctor will talk to you about your symptoms and do a pelvic exam. You may be asked to strain or cough during the exam so your doctor can see whether these actions cause prolapse or urine leakage. Your doctor may also do other tests to see whether you can completely empty your bladder when you go to the bathroom.

How is pelvic organ prolapse treated?

Treatment for pelvic organ prolapse depends on the type of prolapse you have, your symptoms, your age, other health problems, and whether you are sexually active.

Your treatment may include one or more of the following:

  • Pessary. A pessary is a removable device inserted into the vagina to support the pelvic organs. Pessaries come in many different shapes and sizes. Pessaries are often the first treatment your doctor will try.7 Certain types of pessaries can treat both pelvic organ prolapse and urinary incontinence.
  • Pelvic floor muscle therapy. Your doctor may show you how to do pelvic floor exercises or refer you to a physical therapist to do exercises to help strengthen the pelvic floor muscles. Pelvic floor muscle exercises can also help women who have pelvic organ prolapse as well as urinary incontinence.
  • Changing eating habits. If you have bowel problems, your doctor may recommend eating more foods with fiber. Fiber helps prevent constipation and straining during bowel movements. Learn more about ways to treat fecal incontinence.
  • Surgery to support the uterus or vagina. During surgery, your doctor may use your own body tissue or synthetic mesh to help repair the prolapse and build pelvic floor support. This type of surgery is recommended for sexually active women with serious prolapse of the vagina or uterus. Surgery for prolapse can be done with or without mesh and either through your vagina or abdomen. The Food and Drug Administration (FDA) strengthened the safety requirements for new mesh devices that repair pelvic organ prolapse through the vagina.8
  • Surgery to close the vagina. This surgery, called colpocleisis, treats prolapse by closing the vaginal opening. This can be a good option for women who do not plan to have or who no longer have vaginal intercourse.

How can I prevent pelvic organ prolapse?

Researchers are studying ways to prevent pelvic organ prolapse. The following steps may reduce your risk of getting a pelvic floor problem:

  • Maintain a healthy weight or lose weight (if you are overweight). Women who have overweight or obesity are more likely to have pelvic floor problems.
  • Choose foods with fiber. Fiber helps prevent constipation and straining during bowel movements. Preventing constipation may reduce the risk of some pelvic floor disorders.
  • Do not smoke. Smoking can lead to chronic cough, which puts stress on the pelvic floor muscles.

Did we answer your question about pelvic organ prolapse?

For more information about pelvic organ prolapse, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:

Sources

  1. Nygaard, I., et al. (2008). Prevalence of Symptomatic Pelvic Floor Disorders in U.S. Women. JAMA; 300(11): 1311–1316.
  2. Whitcomb, E.L., et al. (2009). Racial Differences in Pelvic Organ Prolapse. Obstetrics and Gynecology; 114(6): 1271–1277.
  3. Kudish, B.I., Iglesia, C.B., Gutman, R.E., Sokol, A.I., Rodgers, A.K., Gass, M. et al. (2011). Risk Factors for Prolapse Development in White, Black, and Hispanic Women. Female Pelvic Med Reconstr Surg; 17(2): 80-90.
  4. Patel, D.A., et al. (2006). Childbirth and Pelvic Floor Dysfunction: An Epidemiologic Approach to the Assessment of Prevention Opportunities at Delivery. American Journal of Obstetrics & Gynecology; 195: 23–28.
  5. Fonti, Y., et al. (2009). Post Partum Pelvic Floor Changes. Journal of Prenatal Medicine; 3(4): 57–59.
  6. Sengupta, N., et al. (2013). Urogynecological Risk Assessment in Postmenopausal. Expert Review of Obstetrics & Gynecology; 8(6): 625–637.
  7. Jones, K.A., et al. (2010). Pessary Use in Pelvic Organ Prolapse and Urinary Incontinence. Reviews in Obstetrics & Gynecology; 3(1). (PDF file, 293.16 KB)
  8. Food and Drug Administration. (2016). FDA Strengthens Requirements for Surgical Mesh for the Transvaginal Repair of Pelvic Organ Prolapse to Address Safety Risks.